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Oz F, Yucekeya B, Huzmeli I, Yilmaz A. Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies? NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:60-66. [PMID: 36754757 DOI: 10.1016/j.neucie.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/08/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance. MATERIALS AND METHODS Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05±7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60Hz and off-stimulation. Static balance tests were 'stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)'. These tests reported the centre of pressure data 'ellipse area, perimeter, front/back and mediolateral standard deviations'. RESULTS There were no statically differences between the static balance test results at any frequency (p>0.05), but results were found better at 90Hz. Stabilometric compared bipedal opened eye forward-backward standard deviation result was significant between off-stimulation and 130Hz (p=0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all p>0.05). CONCLUSION This study showed that STN-DBS did not affect the static balance negatively. Low-frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges.
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Affiliation(s)
- Fatma Oz
- Department of Anatomy, Faculty of Medical Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Bircan Yucekeya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Irem Huzmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hatay Mustafa Kemal University, Hatay, Turkey.
| | - Atilla Yilmaz
- Department of Neurosurgery, Okan University, Faculty of Medicine, Istanbul, Turkey
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Razmkon A, Abdollahifard S, Taherifard E, Roshanshad A, Shahrivar K. Effect of deep brain stimulation on freezing of gait in patients with Parkinson's disease: a systematic review. Br J Neurosurg 2023; 37:3-11. [PMID: 35603983 DOI: 10.1080/02688697.2022.2077308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Freezing of gait (FOG) is a disabling gait disorder in patients with Parkinson's disease (PD), characterized by recurrent episodes of halting steps. Dopaminergic drugs are common treatments for PD and FOG; however, these drugs may worsen FOG. Deep brain stimulation (DBS) is another option used to treat selected patients. The device needs to be programmed at a specific frequency, amplitude, and pulse width to achieve optimum effects for each patient. This systematic review aimed to evaluate the efficacy of DBS for FOG and its correlation with programmed parameters and the location of the electrodes in the brain. MATERIALS AND METHODS Data for this systematic review were gathered from five online databases: Medline (via PubMed), Scopus, Embase, Web of Science, and Cochrane Library (including both Cochrane Reviews and Cochrane Trials) with a broad search strategy. We included those articles that reported clinical trials and a specific measurement for FOG. RESULTS This review included 13 studies of DBS that targeted the subthalamic nucleus (STN), substantia nigra (SNr), or pedunculopontine nucleus (PPN). Our analysis showed that low-frequency stimulation (LFS) was superior to high-frequency stimulation (HFS) for improving FOG. In the long term, the efficacy of both LFS and HFS decreased. The effect of amplitude was variable, and this parameter needed to be adjusted for each patient. Bilateral stimulation was better than unilateral stimulation. CONCLUSION DBS is a promising choice for the treatment of severe FOG in patients with PD. Bilateral, low-frequency stimulation combined with medical therapy is associated with better responses, especially in the first 2 years of treatment. However, individualizing the DBS parameters should be considered to optimize treatment response.
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Affiliation(s)
- Ali Razmkon
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Saeed Abdollahifard
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Erfan Taherifard
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Department of Master Public Health (MPH), School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Roshanshad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Master Public Health (MPH), School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyab Shahrivar
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Baumgartner AJ, Thompson JA, Kern DS, Ojemann SG. Novel targets in deep brain stimulation for movement disorders. Neurosurg Rev 2022; 45:2593-2613. [PMID: 35511309 DOI: 10.1007/s10143-022-01770-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 03/08/2022] [Indexed: 12/26/2022]
Abstract
The neurosurgical treatment of movement disorders, primarily via deep brain stimulation (DBS), is a rapidly expanding and evolving field. Although conventional targets including the subthalamic nucleus (STN) and internal segment of the globus pallidus (GPi) for Parkinson's disease and ventral intermediate nucleus of the thalams (VIM) for tremor provide substantial benefit in terms of both motor symptoms and quality of life, other targets for DBS have been explored in an effort to maximize clinical benefit and also avoid undesired adverse effects associated with stimulation. These novel targets primarily include the rostral zona incerta (rZI), caudal zona incerta (cZI)/posterior subthalamic area (PSA), prelemniscal radiation (Raprl), pedunculopontine nucleus (PPN), substantia nigra pars reticulata (SNr), centromedian/parafascicular (CM/PF) nucleus of the thalamus, nucleus basalis of Meynert (NBM), dentato-rubro-thalamic tract (DRTT), dentate nucleus of the cerebellum, external segment of the globus pallidus (GPe), and ventral oralis (VO) complex of the thalamus. However, reports of outcomes utilizing these targets are scattered and disparate. In order to provide a comprehensive resource for researchers and clinicians alike, we have summarized the existing literature surrounding these novel targets, including rationale for their use, neurosurgical techniques where relevant, outcomes and adverse effects of stimulation, and future directions for research.
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Affiliation(s)
| | - John A Thompson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA
| | - Drew S Kern
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA
| | - Steven G Ojemann
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA.
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4
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Oz F, Yucekeya B, Huzmeli I, Yilmaz A. Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies? Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Bourilhon J, Olivier C, You H, Collomb-Clerc A, Grabli D, Belaid H, Mullie Y, François C, Czernecki V, Lau B, Pérez-García F, Bardinet E, Fernandez-Vidal S, Karachi C, Welter ML. Pedunculopontine and Cuneiform Nuclei Deep Brain Stimulation for Severe Gait and Balance Disorders in Parkinson's Disease: Interim Results from a Randomised Double-Blind Clinical Trial. JOURNAL OF PARKINSONS DISEASE 2021; 12:639-653. [PMID: 34744048 DOI: 10.3233/jpd-212793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dopa-resistant freezing of gait (FOG) and falls represent the dominant motor disabilities in advanced Parkinson's disease (PD). OBJECTIVE We investigate the effects of deep brain stimulation (DBS) of the mesencephalic locomotor region (MLR), comprised of the pedunculopontine (PPN) and cuneiform (CuN) nuclei, for treating gait and balance disorders, in a randomized double-blind cross-over trial. METHODS Six PD patients with dopa-resistant FOG and/or falls were operated for MLR-DBS. Patients received three DBS conditions, PPN, CuN, or sham, in a randomized order for 2-months each, followed by an open-label phase. The primary outcome was the change in anteroposterior anticipatory-postural-adjustments (APAs) during gait initiation on a force platformResults:The anteroposterior APAs were not significantly different between the DBS conditions (median displacement [1st-3rd quartile] of 3.07 [3.12-4.62] cm with sham-DBS, 1.95 [2.29-3.85] cm with PPN-DBS and 2.78 [1.66-4.04] cm with CuN-DBS; p = 0.25). Step length and velocity were significantly higher with CuN-DBS vs. both sham-DBS and PPN-DBS. Conversely, step length and velocity were lower with PPN-DBS vs. sham-DBS, with greater double stance and gait initiation durations. One year after surgery, step length was significantly lower with PPN-DBS vs. inclusion. We did not find any significant change in clinical scales between DBS conditions or one year after surgery. CONCLUSION Two months of PPN-DBS or CuN-DBS does not effectively improve clinically dopa-resistant gait and balance disorders in PD patients.
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Affiliation(s)
- Julie Bourilhon
- Department of Neurophysiology, Rouen UniversityHospital and University of Rouen, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Claire Olivier
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,PANAM platform, Institut du Cerveau et de la Moelle É14 pinière (ICM), Paris, France
| | - Hana You
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,Clinical Investigation Center, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Antoine Collomb-Clerc
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - David Grabli
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,Fédération des Maladies du Système Nerveux, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris Paris, Paris, France
| | - Hayat Belaid
- Department of Neurosurgery, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux Paris, Paris, France
| | - Yannick Mullie
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Chantal François
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Virginie Czernecki
- Fédération des Maladies du Système Nerveux, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris Paris, Paris, France
| | - Brian Lau
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Fernando Pérez-García
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,CENIR Platform, Institut du Cerveau et de la Moelle É22 pinière (ICM), Paris, France
| | - Eric Bardinet
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,CENIR Platform, Institut du Cerveau et de la Moelle É22 pinière (ICM), Paris, France
| | - Sara Fernandez-Vidal
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,STIM Platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
| | - Carine Karachi
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière, Charles Foix University Hospital, Assistance Publique-Hôpitaux Paris, Paris, France
| | - Marie-Laure Welter
- Department of Neurophysiology, Rouen UniversityHospital and University of Rouen, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France PANAM platform, Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France
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6
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Lin F, Wu D, Lin C, Cai H, Chen L, Cai G, Ye Q, Cai G. Pedunculopontine Nucleus Deep Brain Stimulation Improves Gait Disorder in Parkinson's Disease: A Systematic Review and Meta-analysis. Neurochem Res 2020; 45:709-719. [PMID: 31950450 DOI: 10.1007/s11064-020-02962-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been proposed as a treatment strategy for gait disorder in patients with Parkinson's disease (PD). We thus performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials to assess the effect of this treatment on gait disorder in patients with PD. We systematically searched PubMed, Cochrane, Web of Knowledge, Wan Fang and WIP for randomized and nonrandomized controlled trials (published before July 29, 2014; no language restrictions) comparing PPN-DBS with other treatments. We assessed pooled data using a random effects model and a fixed effects model. Of 130 identified studies, 14 were eligible and were included in our analysis (N = 82 participants). Compared to those presurgery, the Unified Parkinson Disease Rating Scale (UPDRS) 27-30 scores for patients were lowered by PPN-DBS [3.94 (95% confidence interval, CI = 1.23 to 6.65)]. The UPDRS 13 and 14 scores did not improve with levodopa treatment [0.43 (- 0.35 to 1.20); 0.35 (- 0.50 to 1.19)], whereas the UPDRS 27-30 scores could be improved by the therapy [1.42 (95% CI 0.34 to 2.51)]. The Gait and Falls Questionnaire and UPDRS 13 and 14 scores showed significant improvements after PPN-DBS under the medication-off (MED-OFF) status [15.44 (95% CI = 8.44 to 22.45); 1.57 (95% CI = 0.84 to 2.30); 1.34 (95% CI = 0.84 to 1.84)]. PPN-DBS is a potential therapeutic target that could improve gait and fall disorders in patients with PD. Our findings will help improve the clinical application of DBS in PD patients with gait disorder.
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Affiliation(s)
- Fabin Lin
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.,Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Dihang Wu
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.,Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Chenxin Lin
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.,Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Huihui Cai
- Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Lina Chen
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Guofa Cai
- College of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, Guangdong, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
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Abstract
Parkinson's disease (PD) and other synucleinopathies, namely dementia with Lewy bodies (DLB) and multiple system atrophy (MSA), are common degenerative neurological disorders that share synuclein pathology. Although certain cardinal features of parkinsonism, including bradykinesia and rigidity, respond well to levodopa, axial features, such as gait and balance impairment, are less reliably responsive to dopaminergic therapy and surgical interventions. Consequently, falls are common in PD and other synucleinopathies and are a major contributor toward injury and loss of independence. This underscores the need for appropriate fall risk assessment and implementation of preventative measures in all patients with parkinsonism. The aim of this review is therefore to explore modifiable and non-modifiable risk factors for falls in synucleinopathies. We next review and evaluate the evidence for pharmacological, nonpharmacological, and surgical approaches for fall prevention, and emphasize individualized and multifaceted approaches.
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Barrett MJ, Cloud LJ, Shah H, Holloway KL. Therapeutic approaches to cholinergic deficiency in Lewy body diseases. Expert Rev Neurother 2019; 20:41-53. [DOI: 10.1080/14737175.2020.1676152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Matthew J. Barrett
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Leslie J. Cloud
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Harsh Shah
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kathryn L. Holloway
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- The Southeast Parkinson’s Disease Research, Education, and Care Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, USA
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9
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Schuhmann MK, Stoll G, Bohr A, Volkmann J, Fluri F. Electrical Stimulation of the Mesencephalic Locomotor Region Attenuates Neuronal Loss and Cytokine Expression in the Perifocal Region of Photothrombotic Stroke in Rats. Int J Mol Sci 2019; 20:ijms20092341. [PMID: 31083528 PMCID: PMC6540310 DOI: 10.3390/ijms20092341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 01/04/2023] Open
Abstract
Deep brain stimulation of the mesencephalic locomotor region (MLR) improves the motor symptoms in Parkinson’s disease and experimental stroke by intervening in the motor cerebral network. Whether high-frequency stimulation (HFS) of the MLR is involved in non-motor processes, such as neuroprotection and inflammation in the area surrounding the photothrombotic lesion, has not been elucidated. This study evaluates whether MLR-HFS exerts an anti-apoptotic and anti-inflammatory effect on the border zone of cerebral photothrombotic stroke. Rats underwent photothrombotic stroke of the right sensorimotor cortex and the implantation of a microelectrode into the ipsilesional MLR. After intervention, either HFS or sham stimulation of the MLR was applied for 24 h. The infarct volumes were calculated from consecutive brain sections. Neuronal apoptosis was analyzed by TUNEL staining. Flow cytometry and immunohistochemistry determined the perilesional inflammatory response. Neuronal apoptosis was significantly reduced in the ischemic penumbra after MLR-HFS, whereas the infarct volumes did not differ between the groups. MLR-HFS significantly reduced the release of cytokines and chemokines within the ischemic penumbra. MLR-HFS is neuroprotective and it reduces pro-inflammatory mediators in the area that surrounds the photothrombotic stroke without changing the number of immune cells, which indicates that MLR-HFS enables the function of inflammatory cells to be altered on a molecular level.
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Affiliation(s)
- Michael K Schuhmann
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany.
| | - Guido Stoll
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany.
| | - Arne Bohr
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany.
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany.
| | - Felix Fluri
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany.
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10
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Ricciardi L, Sarchioto M, Morgante F. Role of pedunculopontine nucleus in sleep-wake cycle and cognition in humans: A systematic review of DBS studies. Neurobiol Dis 2019; 128:53-58. [PMID: 30710676 DOI: 10.1016/j.nbd.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Animal studies have demonstrated that the pedunculopontine nucleus (PPN) is involved in the control of posture and gait, and that it is also a key structure in controlling basic non-motor functions such as sleep, attention and arousal. In this systematic review we aimed to evaluate all available studies assessing the role of PPN on cognition, nocturnal sleep and alertness in humans. Finally, we attempted to define a model in which PPN acts as an interface structure between motor control and behavior. METHODS A systematic search of the computerized databases MEDLINE and PubMed was conducted to identify papers on PPN and cognitive functions, sleep and alertness. Key search terms included: 'PPN', 'arousal', 'sleep', 'cognition', 'memory', 'language', 'attention', 'alertness', 'PPN-DBS', 'Parkinson's and PPN', 'Parkinson's and PPN-DBS'. RESULTS Twelve studies met our inclusion criteria and were included. All of them involved PD patients implanted with unilateral or bilateral PPN-DBS, most patients had concomitant DBS of another anatomical structure (subthalamic nucleus or Zona incerta). There is a lack of consistent evidences confirming the effect of PPN-DBS on specific cognitive functions, alertness or sleep in PD. There is heterogeneity between and within surgical centres of study protocols especially regarding DBS targeting, parameters of stimulation and experimental methods. Moreover, the available studies are limited by the small sample size and the short follow-up time. It has been suggested that low frequency stimulation (25 Hz) has a better effect compared to the high frequency one (60-80 Hz) on alertness, however this needs to be confirmed in further studies. CONCLUSIONS PPN-DBS is a promising but yet an experimental procedure. PD represents an encouraging pathological model for future studies aiming to shade light on the role of PPN in cognition, attention and alertness in humans.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Marianna Sarchioto
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina, Italy.
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Eisinger RS, Cernera S, Gittis A, Gunduz A, Okun MS. A review of basal ganglia circuits and physiology: Application to deep brain stimulation. Parkinsonism Relat Disord 2019; 59:9-20. [PMID: 30658883 DOI: 10.1016/j.parkreldis.2019.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Drawing on the seminal work of DeLong, Albin, and Young, we have now entered an era of basal ganglia neuromodulation. Understanding, re-evaluating, and leveraging the lessons learned from neuromodulation will be crucial to facilitate an increased and improved application of neuromodulation in human disease. METHODS We will focus on deep brain stimulation (DBS) - the most common form of basal ganglia neuromodulation - however, similar principles can apply to other neuromodulation modalities. We start with a brief review of DBS for Parkinson's disease, essential tremor, dystonia, and Tourette syndrome. We then review hallmark studies on basal ganglia circuits and electrophysiology resulting from decades of experience in neuromodulation. The organization and content of this paper follow Dr. Okun's Lecture from the 2018 Parkinsonism and Related Disorders World Congress. RESULTS Information gained from neuromodulation has led to an expansion of the basal ganglia rate model, an enhanced understanding of nuclei dynamics, an emerging focus on pathological oscillations, a revision of the tripartite division of the basal ganglia, and a redirected focus toward individualized symptom-specific stimulation. Though there have been many limitations of the basal ganglia "box model," the construct provided the necessary foundation to advance the field. We now understand that information in the basal ganglia is encoded through complex neural responses that can be reliably measured and used to infer disease states for clinical translation. CONCLUSIONS Our deepened understanding of basal ganglia physiology will drive new neuromodulation strategies such as adaptive DBS or cell-specific neuromodulation through the use of optogenetics.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Stephanie Cernera
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
| | - Aryn Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA; Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Frequency-dependent effects of subthalamic deep brain stimulation on motor symptoms in Parkinson's disease: a meta-analysis of controlled trials. Sci Rep 2018; 8:14456. [PMID: 30262859 PMCID: PMC6160461 DOI: 10.1038/s41598-018-32161-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 09/03/2018] [Indexed: 11/08/2022] Open
Abstract
This study aims to investigate how the frequency settings of deep brain stimulation (DBS) targeting the subthalamic nucleus (STN) influence the motor symptoms of Parkinson's disease (PD). Stimulation with frequencies less than 100 Hz (mostly 60 or 80 Hz) is considered low-frequency stimulation (LFS) and with frequencies greater than 100 Hz (mostly 130 or 150 Hz) is considered high-frequency stimulation (HFS). We conducted a comprehensive literature review and meta-analysis with a random-effect model. Ten studies with 132 patients were included in our analysis. The pooled results showed no significant difference in the total Unified Parkinson Disease Rating Scale part III (UPDRS-III) scores (mean effect, -1.50; p = 0.19) or the rigidity subscore between HFS and LFS. Compared to LFS, HFS induced greater reduction in the tremor subscore within the medication-off condition (mean effect, 1.01; p = 0.002), while no significance was shown within the medication-on condition (mean effect, 0.01; p = 0.92). LFS induced greater reduction in akinesia subscore (mean effect, -1.68, p = 0.003), the time to complete the stand-walk-sit (SWS) test (mean effect, -4.84; p < 0.00001), and the number of freezing of gait (FOG) (mean effect, -1.71; p = 0.03). These results suggest that two types of frequency settings may have different effects, that is, HFS induces better responses for tremor and LFS induces greater response for akinesia, gait, and FOG, respectively, which are worthwhile to be confirmed in future study, and will ultimately inform the clinical practice in the management of PD using STN-DBS.
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13
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Thevathasan W, Moro E. What is the therapeutic mechanism of pedunculopontine nucleus stimulation in Parkinson's disease? Neurobiol Dis 2018; 128:67-74. [PMID: 29933055 DOI: 10.1016/j.nbd.2018.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022] Open
Abstract
Pedunculopontine nucleus (PPN) deep brain stimulation (DBS) is an experimental treatment for Parkinson's disease (PD) which offers a fairly circumscribed benefit for gait freezing and perhaps balance impairment. The benefit on gait freezing is variable and typically incomplete, which may reflect that the clinical application is yet to be optimised or reflect a fundamental limitation of the therapeutic mechanism. Thus, a better understanding of the therapeutic mechanism of PPN DBS may guide the further development of this therapy. The available evidence supports that the PPN is underactive in PD due to a combination of both degeneration and excessive inhibition. Low frequency PPN DBS could enhance PPN network activity, perhaps via disinhibition. A clinical implication is that in some PD patients, the PPN may be too degenerate for PPN DBS to work. Reaction time studies report that PPN DBS mediates a very specific benefit on pre-programmed movement. This seems relevant to the pathophysiology of gait freezing, which can be argued to reflect impaired release of pre-programmed adjustments to locomotion. Thus, the benefit of PPN DBS on gait freezing could be akin to that mediated by external cues. Alpha band activity is a prominent finding in local field potential recordings from PPN electrodes in PD patients. Alpha band activity is implicated in the suppression of task irrelevant processes and thus the effective allocation of attention (processing resources). Attentional deficits are prominent in patients with PD and gait freezing and PPN alpha activity has been observed to drop out prior to gait freezing episodes and to increase with levodopa. This raises the hypothesis that PPN DBS could support or emulate PPN alpha activity and consequently enhance the allocation of attention. Although PPN DBS has not been convincingly shown to increase general alertness or attention, it remains possible that PPN DBS may enhance the allocation of processing resources within the motor system, or "motor attention". For example, this could facilitate the 'switching' of motor state between continuation of pattern generated locomotion towards the intervention of pre-programmed adjustments. However, if the downstream consequence of PPN DBS on movement is limited to a circumscribed unblocking of pre-programmed movement, then this may have a similarly circumscribed degree of benefit for gait. If this is the case, then it may be possible to identify patients who may benefit most from PPN DBS. For example, those in whom pre-programmed deficits are the major contributors to gait freezing.
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Affiliation(s)
- Wesley Thevathasan
- Departments of Neurology, Royal Melbourne Hospital and Austin Hospitals, University of Melbourne, Australia and the Bionics Institute of Australia, Melbourne, Australia
| | - Elena Moro
- Movement Disorders Center, Division of Neurology, CHU Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France.
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Garcia-Rill E, Mahaffey S, Hyde JR, Urbano FJ. Bottom-up gamma maintenance in various disorders. Neurobiol Dis 2018; 128:31-39. [PMID: 29353013 DOI: 10.1016/j.nbd.2018.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 11/30/2022] Open
Abstract
Maintained gamma band activity is a key element of higher brain function, participating in perception, executive function, and memory. The pedunculopontine nucleus (PPN), as part of the reticular activating system (RAS), is a major source of the "bottom-up" flow of gamma activity to higher regions. However, interruption of gamma band activity is associated with a number of neurological and psychiatric disorders. This review will focus on the role of the PPN in activating higher regions to induce arousal and descending pathways to modulate posture and locomotion. As such, PPN deep brain stimulation (DBS) can not only help regulate arousal and stepping, but continuous application may help maintain necessary levels of gamma band activity for a host of other brain processes. We will explore the potential future applications of PPN DBS for a number of disorders that are characterized by disturbances in gamma band maintenance.
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Affiliation(s)
- E Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - S Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - F J Urbano
- IFIBYNE (CONICET-UBA), DFBMC, Universidad de Buenos Aires, Buenos Aires, Argentina
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15
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Fluri F, Malzahn U, Homola GA, Schuhmann MK, Kleinschnitz C, Volkmann J. Stimulation of the mesencephalic locomotor region for gait recovery after stroke. Ann Neurol 2017; 82:828-840. [PMID: 29059697 DOI: 10.1002/ana.25086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE One-third of all stroke survivors are unable to walk, even after intensive physiotherapy. Thus, other concepts to restore walking are needed. Because electrical stimulation of the mesencephalic locomotor region (MLR) is known to elicit gait movements, this area might be a promising target for restorative neurostimulation in stroke patients with gait disability. The present study aims to delineate the effect of high-frequency stimulation of the MLR (MLR-HFS) on gait impairment in a rodent stroke model. METHODS Male Wistar rats underwent photothrombotic stroke of the right sensorimotor cortex and chronic implantation of a stimulating electrode into the right MLR. Gait was assessed using clinical scoring of the beam-walking test and video-kinematic analysis (CatWalk) at baseline and on days 3 and 4 after experimental stroke with and without MLR-HFS. RESULTS Kinematic analysis revealed significant changes in several dynamic and static gait parameters resulting in overall reduced gait velocity. All rats exhibited major coordination deficits during the beam-walking challenge and were unable to cross the beam. Simultaneous to the onset of MLR-HFS, a significantly higher walking speed and improvements in several dynamic gait parameters were detected by the CatWalk system. Rats regained the ability to cross the beam unassisted, showing a reduced number of paw slips and misses. INTERPRETATION MLR-HFS can improve disordered locomotor function in a rodent stroke model. It may act by shielding brainstem and spinal locomotor centers from abnormal cortical input after stroke, thus allowing for compensatory and independent action of these circuits. Ann Neurol 2017;82:828-840.
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Affiliation(s)
- Felix Fluri
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Uwe Malzahn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - György A Homola
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
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16
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Thevathasan W, Debu B, Aziz T, Bloem BR, Blahak C, Butson C, Czernecki V, Foltynie T, Fraix V, Grabli D, Joint C, Lozano AM, Okun MS, Ostrem J, Pavese N, Schrader C, Tai CH, Krauss JK, Moro E. Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review. Mov Disord 2017; 33:10-20. [DOI: 10.1002/mds.27098] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 06/08/2017] [Accepted: 06/14/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Wesley Thevathasan
- Department of Medicine; Royal Melbourne Hospital, University of Melbourne, Australia and the Bionics Institute of Australia; Melbourne Australia
| | - Bettina Debu
- Movement Disorders Center; Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University; Grenoble France
| | - Tipu Aziz
- Department of Neurosurgery; John Radcliffe Hospital, University of Oxford; Oxford UK
| | - Bastiaan R. Bloem
- Department of Neurology; Donders Institute for Brain, Cognition and Behaviour, Radboud University; Nijmegen the Netherlands
| | - Christian Blahak
- Department of Neurology; Universitätsmedizin Mannheim, University of Heidelberg; Heidelberg Germany
| | - Christopher Butson
- Department of Bioengineering; Scientific Computing and Imaging Institute, University of Utah; Salt Lake City USA
| | - Virginie Czernecki
- Department of Neurology; Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université; Paris France
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience; University College London (UCL) Institute of Neurology; United Kingdom
| | - Valerie Fraix
- Movement Disorders Center; Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University; Grenoble France
| | - David Grabli
- Department of Neurology; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtière University Hospital; Paris France
| | - Carole Joint
- Department of Neurosurgery; John Radcliffe Hospital, University of Oxford; Oxford UK
| | - Andres M. Lozano
- Department of Neurosurgery; Toronto Western Hospital, University of Toronto; Toronto Canada
| | - Michael S. Okun
- Departments of Neurology and Neurosurgery; University of Florida Center for Movement Disorders; Gainesville Florida USA
| | - Jill Ostrem
- Department of Neurology; UCSF Movement Disorder and Neuromodulation Center, University of California; San Francisco USA
| | - Nicola Pavese
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne UK
- Department of Clinical Medicine; Centre for Functionally Integrative Neuroscience, University of Aarhus; Aarhus Denmark
- Department of Neurology; Hannover Medical School; Hannover Germany
| | | | - Chun-Hwei Tai
- Department of Neurology; National Taiwan University Hospital, College of Medicine, National Taiwan University; Taipei Taiwan
| | - Joachim K. Krauss
- Department of Neurosurgery; Hannover Medical School; Hannover Germany
| | - Elena Moro
- Movement Disorders Center; Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University; Grenoble France
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17
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Ryczko D, Dubuc R. Dopamine and the Brainstem Locomotor Networks: From Lamprey to Human. Front Neurosci 2017; 11:295. [PMID: 28603482 PMCID: PMC5445171 DOI: 10.3389/fnins.2017.00295] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
In vertebrates, dopamine neurons are classically known to modulate locomotion via their ascending projections to the basal ganglia that project to brainstem locomotor networks. An increased dopaminergic tone is associated with increase in locomotor activity. In pathological conditions where dopamine cells are lost, such as in Parkinson's disease, locomotor deficits are traditionally associated with the reduced ascending dopaminergic input to the basal ganglia. However, a descending dopaminergic pathway originating from the substantia nigra pars compacta was recently discovered. It innervates the mesencephalic locomotor region (MLR) from basal vertebrates to mammals. This pathway was shown to increase locomotor output in lampreys, and could very well play an important role in mammals. Here, we provide a detailed account on the newly found dopaminergic pathway in lamprey, salamander, rat, monkey, and human. In lampreys and salamanders, dopamine release in the MLR is associated with the activation of reticulospinal neurons that carry the locomotor command to the spinal cord. Dopamine release in the MLR potentiates locomotor movements through a D1-receptor mechanism in lampreys. In rats, stimulation of the substantia nigra pars compacta elicited dopamine release in the pedunculopontine nucleus, a known part of the MLR. In a monkey model of Parkinson's disease, a reduced dopaminergic innervation of the brainstem locomotor networks was reported. Dopaminergic fibers are also present in human pedunculopontine nucleus. We discuss the conserved locomotor role of this pathway from lamprey to mammals, and the hypothesis that this pathway could play a role in the locomotor deficits reported in Parkinson's disease.
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Affiliation(s)
- Dimitri Ryczko
- Groupe de Recherche sur le Système Nerveux Central, Département de Neurosciences, Université de MontréalMontréal, QC, Canada
| | - Réjean Dubuc
- Groupe de Recherche sur le Système Nerveux Central, Département de Neurosciences, Université de MontréalMontréal, QC, Canada.,Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l'Activité Physique, Université du Québec à MontréalMontréal, QC, Canada
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18
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Noga BR, Sanchez FJ, Villamil LM, O'Toole C, Kasicki S, Olszewski M, Cabaj AM, Majczyński H, Sławińska U, Jordan LM. LFP Oscillations in the Mesencephalic Locomotor Region during Voluntary Locomotion. Front Neural Circuits 2017; 11:34. [PMID: 28579945 PMCID: PMC5437718 DOI: 10.3389/fncir.2017.00034] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/28/2017] [Indexed: 11/28/2022] Open
Abstract
Oscillatory rhythms in local field potentials (LFPs) are thought to coherently bind cooperating neuronal ensembles to produce behaviors, including locomotion. LFPs recorded from sites that trigger locomotion have been used as a basis for identification of appropriate targets for deep brain stimulation (DBS) to enhance locomotor recovery in patients with gait disorders. Theta band activity (6–12 Hz) is associated with locomotor activity in locomotion-inducing sites in the hypothalamus and in the hippocampus, but the LFPs that occur in the functionally defined mesencephalic locomotor region (MLR) during locomotion have not been determined. Here we record the oscillatory activity during treadmill locomotion in MLR sites effective for inducing locomotion with electrical stimulation in rats. The results show the presence of oscillatory theta rhythms in the LFPs recorded from the most effective MLR stimulus sites (at threshold ≤60 μA). Theta activity increased at the onset of locomotion, and its power was correlated with the speed of locomotion. In animals with higher thresholds (>60 μA), the correlation between locomotor speed and theta LFP oscillations was less robust. Changes in the gamma band (previously recorded in vitro in the pedunculopontine nucleus (PPN), thought to be a part of the MLR) were relatively small. Controlled locomotion was best achieved at 10–20 Hz frequencies of MLR stimulation. Our results indicate that theta and not delta or gamma band oscillation is a suitable biomarker for identifying the functional MLR sites.
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Affiliation(s)
- Brian R Noga
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, United States
| | - Francisco J Sanchez
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, United States
| | - Luz M Villamil
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, United States
| | - Christopher O'Toole
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, United States
| | - Stefan Kasicki
- Department of Neurophysiology, Nencki Institute of Experimental BiologyWarsaw, Poland
| | - Maciej Olszewski
- Department of Neurophysiology, Nencki Institute of Experimental BiologyWarsaw, Poland
| | - Anna M Cabaj
- Department of Neurophysiology, Nencki Institute of Experimental BiologyWarsaw, Poland
| | - Henryk Majczyński
- Department of Neurophysiology, Nencki Institute of Experimental BiologyWarsaw, Poland
| | - Urszula Sławińska
- Department of Neurophysiology, Nencki Institute of Experimental BiologyWarsaw, Poland
| | - Larry M Jordan
- Department of Physiology, Spinal Cord Research Centre, University of ManitobaWinnipeg, MB, Canada
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19
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Gallea C, Ewenczyk C, Degos B, Welter ML, Grabli D, Leu-Semenescu S, Valabregue R, Berroir P, Yahia-Cherif L, Bertasi E, Fernandez-Vidal S, Bardinet E, Roze E, Benali H, Poupon C, François C, Arnulf I, Lehéricy S, Vidailhet M. Pedunculopontine network dysfunction in Parkinson's disease with postural control and sleep disorders. Mov Disord 2017; 32:693-704. [DOI: 10.1002/mds.26923] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Cecile Gallea
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Claire Ewenczyk
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- Assistance Publique Hôpitaux de Paris (APHP), INSERM, ICM, Centre d’Investigation Clinique Pitié Neurosciences, CIC-1422, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière; Paris France
| | - Bertrand Degos
- AP-HP, Centre Inter-Régional de Coordination de la Maladie de Parkinson, Hôpital de la Pitié Salpêtrière, Département des Maladies du Système Nerveux; Paris France
| | - Marie-Laure Welter
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- AP-HP, Centre Inter-Régional de Coordination de la Maladie de Parkinson, Hôpital de la Pitié Salpêtrière, Département des Maladies du Système Nerveux; Paris France
| | - David Grabli
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- AP-HP, Centre Inter-Régional de Coordination de la Maladie de Parkinson, Hôpital de la Pitié Salpêtrière, Département des Maladies du Système Nerveux; Paris France
| | - Smaranda Leu-Semenescu
- Inserm, U 1127; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- Sleep Disorders Unit, Pitié-Salpêtrière Hospital, AP-HP; Paris France
| | - Romain Valabregue
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Pierre Berroir
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Lydia Yahia-Cherif
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Eric Bertasi
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Sara Fernandez-Vidal
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Eric Bardinet
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Emmanuel Roze
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- Assistance Publique Hôpitaux de Paris (APHP), INSERM, ICM, Centre d’Investigation Clinique Pitié Neurosciences, CIC-1422, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière; Paris France. AP-HP, Centre Inter-Régional de Coordination de la Maladie de Parkinson, Hôpital de la Pitié Salpêtrière, Département des Maladies du Système Nerveux; Paris France
| | - Habib Benali
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
| | - Cyril Poupon
- CEA Saclay, Neurospin/LNAO; Gif sur Yvette France
| | - Chantal François
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Isabelle Arnulf
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- Sleep Disorders Unit, Pitié-Salpêtrière Hospital, AP-HP; Paris France
| | - Stéphane Lehéricy
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle, ICM; Paris France
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
| | - Marie Vidailhet
- Inserm, U 1127; Paris France
- CNRS, UMR 7225; Paris France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127; Paris France
- Institut du Cerveau et de la Moelle épinière, ICM; Paris France
- Assistance Publique Hôpitaux de Paris (APHP), INSERM, ICM, Centre d’Investigation Clinique Pitié Neurosciences, CIC-1422, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière; Paris France. AP-HP, Centre Inter-Régional de Coordination de la Maladie de Parkinson, Hôpital de la Pitié Salpêtrière, Département des Maladies du Système Nerveux; Paris France
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20
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Perez-Lloret S, Peralta MC, Barrantes FJ. Pharmacotherapies for Parkinson's disease symptoms related to cholinergic degeneration. Expert Opin Pharmacother 2016; 17:2405-2415. [PMID: 27785919 DOI: 10.1080/14656566.2016.1254189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Dopamine depletion is one of the most important features of Parkinson's Disease (PD). However, insufficient response to dopaminergic replacement therapy suggests the involvement of other neurotransmitter systems in the pathophysiology of PD. Cholinergic degeneration contributes to gait impairments, cognitive impairment, psychosis, and REM-sleep disturbances, among other symptoms. Areas covered: In this review, we explore the idea that enhancing cholinergic tone by pharmacological or neurosurgical procedures could be a first-line therapeutic strategy for the treatment of symptoms derived from cholinergic degeneration in PD. Expert opinion: Rivastigmine, a drug that increases cholinergic tone by inhibiting the enzyme cholinesterase, is effective for dementia, whereas the use of Donepezil is still in the realm of investigation. Interesting results suggest the efficacy of these drugs in the treatment of gait dysfunction. Evidence on the clinical effects of these drugs for psychosis and REM-sleep disturbances is still weak. Stimulation of the pedunculo-pontine tegmental nuclei (which provide cholinergic innervation to the brain stem and subcortical nuclei) has also been used with some success for the treatment of gait dysfunction. Anticholinergic drugs should be used with caution in PD, as they may aggravate cholinergic symptoms. Notwithstanding, in some patients they might help control parkinsonian motor symptoms.
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Affiliation(s)
- Santiago Perez-Lloret
- a Institute of Cardiology Research , University of Buenos Aires, National Research Council (CONICET-ININCA) , Buenos Aires , Argentina
| | - María Cecilia Peralta
- b Parkinson's Disease and Movement Disorders Clinic, Neurology Department , CEMIC University Hospital , Buenos Aires , Argentina
| | - Francisco J Barrantes
- c Laboratory of Molecular Neurobiology , Institute for Biomedical Research, UCA-CONICET, Faculty of Medical Sciences , Buenos Aires , Argentina
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Snijders AH, Takakusaki K, Debu B, Lozano AM, Krishna V, Fasano A, Aziz TZ, Papa SM, Factor SA, Hallett M. Physiology of freezing of gait. Ann Neurol 2016; 80:644-659. [DOI: 10.1002/ana.24778] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Anke H. Snijders
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Medical Center; Nijmegen the Netherlands
- Maasziekenhuis Pantein; Boxmeer the Netherlands
| | - Kaoru Takakusaki
- Research Center for Brain Function and Medical Engineering; Asahikawa Medical University; Asahikawa Japan
| | - Bettina Debu
- Joseph Fourier University, Grenoble Universities; Grenoble France
| | - Andres M. Lozano
- Division of Neurosurgery; University of Toronto; Toronto Ontario Canada
| | - Vibhor Krishna
- Division of Neurosurgery; University of Toronto; Toronto Ontario Canada
- Department of Neurosurgery; Ohio State University; Columbus OH
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; University Health Network; Toronto Ontario Canada
| | - Tipu Z. Aziz
- John Radcliffe Hospital; Headington Oxford United Kingdom
| | - Stella M. Papa
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Center; Emory University School of Medicine; Atlanta GA
| | - Stewart A. Factor
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Center; Emory University School of Medicine; Atlanta GA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health; Bethesda MD
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22
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Mestre TA, Sidiropoulos C, Hamani C, Poon YY, Lozano AM, Lang AE, Moro E. Long-term double-blinded unilateral pedunculopontine area stimulation in Parkinson's disease. Mov Disord 2016; 31:1570-1574. [DOI: 10.1002/mds.26710] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tiago A. Mestre
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
- Parkinson's disease and Movement Disorders Center, Division of Neurology, Department of Medicine, University of Ottawa Brain and Mind Institute, The Ottawa Hospital Research Institute; Ottawa Ontario Canada (current affiliation)
| | - Christos Sidiropoulos
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
- Parkinson's Disease and Movement Disorders Program, Henry Ford Health System; West Bloomfield Michigan USA (current affiliation)
| | - Clement Hamani
- Department of Neurosurgery; Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
| | - Yu-Yan Poon
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
| | - Andres M. Lozano
- Department of Neurosurgery; Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
| | - Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
| | - Elena Moro
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network; Toronto Ontario Canada
- Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, Université Joseph Fourier; Grenoble France (current affiliation)
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23
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Huh YE, Hwang S, Kim K, Chung WH, Youn J, Cho JW. Reply to letter: The association of postural sensory deficit with freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2016; 31:141-142. [PMID: 27318705 DOI: 10.1016/j.parkreldis.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Young Eun Huh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seonhong Hwang
- Center for Robotics Research, Korea Institute of Science and Technology, Seoul, South Korea
| | - Keehoon Kim
- Center for Robotics Research, Korea Institute of Science and Technology, Seoul, South Korea
| | - Won-Ho Chung
- Department of Otolaryngology, Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jinyoung Youn
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jin Whan Cho
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
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24
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Wichmann T, DeLong MR. Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality? Neurotherapeutics 2016; 13:264-83. [PMID: 26956115 PMCID: PMC4824026 DOI: 10.1007/s13311-016-0426-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Deep brain stimulation (DBS) is highly effective for both hypo- and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal ganglia-thalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.
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Affiliation(s)
- Thomas Wichmann
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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25
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Jin X, Schwabe K, Krauss JK, Alam M. The anterior and posterior pedunculopontine tegmental nucleus are involved in behavior and neuronal activity of the cuneiform and entopeduncular nuclei. Neuroscience 2016; 322:39-53. [PMID: 26880033 DOI: 10.1016/j.neuroscience.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/13/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
Loss of cholinergic neurons in the mesencephalic locomotor region, comprising the pedunculopontine nucleus (PPN) and the cuneiform nucleus (CnF), is related to gait disturbances in late stage Parkinson's disease (PD). We investigate the effect of anterior or posterior cholinergic lesions of the PPN on gait-related motor behavior, and on neuronal network activity of the PPN area and basal ganglia (BG) motor loop in rats. Anterior PPN lesions, posterior PPN lesions or sham lesions were induced by stereotaxic microinjection of the cholinergic toxin AF64-A or vehicle in male Sprague-Dawley rats. First, locomotor activity (open field), postural disturbances (Rotarod) and gait asymmetry (treadmill test) were assessed. Thereafter, single-unit and oscillatory activities were measured in the non-lesioned area of the PPN, the CnF and the entopeduncular nucleus (EPN), the BG output region, with microelectrodes under urethane anesthesia. Additionally, ECoG was recorded in the motor cortex. Injection of AF64-A into the anterior and posterior PPN decreased cholinergic cell counts as compared to naive controls (P<0.001) but also destroyed non-cholinergic cells. Only anterior PPN lesions decreased the front limb swing time of gait in the treadmill test, while not affecting other gait-related parameters tested. Main electrophysiological findings were that anterior PPN lesions increased the firing activity in the CnF (P<0.001). Further, lesions of either PPN region decreased the coherence of alpha (8-12 Hz) band between CnF and motor cortex (MCx), and increased the beta (12-30 Hz) oscillatory synchronization between EPN and the MCx. Lesions of the PPN in rats had complex effects on oscillatory neuronal activity of the CnF and the BG network, which may contribute to the understanding of the pathophysiology of gait disturbance in PD.
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Affiliation(s)
- X Jin
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - K Schwabe
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - J K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - M Alam
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
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26
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Fasano A, Aquino CC, Krauss JK, Honey CR, Bloem BR. Axial disability and deep brain stimulation in patients with Parkinson disease. NATURE REVIEWS. NEUROLOGY 2015. [PMID: 25582445 DOI: 10.1038/nrneurol.2014.252.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Camila C Aquino
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Christopher R Honey
- Division of Neurosurgery at the University of British Columbia, 8105-2775 Laurel Street, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, PO Box 9101, 6500 HB Nijmegen, Netherlands
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27
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Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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28
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Treatments for Neurological Gait and Balance Disturbance: The Use of Noninvasive Electrical Brain Stimulation. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/573862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurological gait disorders are a common cause of falls, morbidity, and mortality, particularly amongst the elderly. Neurological gait and balance impairment has, however, proved notoriously difficult to treat. The following review discusses some of the first experiments to modulate gait and balance in healthy adults using anodal transcranial direct current stimulation (tDCS) by stimulating both cerebral hemispheres simultaneously. We review and discuss published data using this novel tDCS approach, in combination with physical therapy, to treat locomotor and balance disorders in patients with small vessel disease (leukoaraiosis) and Parkinson’s disease. Finally, we review the use of bihemispheric anodal tDCS to treat gait impairment in patients with stroke in the subacute phase. The findings of these studies suggest that noninvasive electrical stimulation techniques may be a useful adjunct to physical therapy in patients with neurological gait disorders, but further mutlicentre randomized sham-controlled studies are needed to evaluate whether experimental tDCS use can translate into mainstream clinical practice for the treatment of neurological gait disorders.
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