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Middlebrooks EH, Szaflarski JP, Begnaud J, Thaker A, Henderson K, Bolding M, Sellers JA, Allendorfer J. Compatibility of Standard Vagus Nerve Stimulation and Investigational Microburst Vagus Nerve Stimulation Therapy with fMRI. AJNR Am J Neuroradiol 2024:ajnr.A8235. [PMID: 38448165 DOI: 10.3174/ajnr.a8235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
Vagus nerve stimulation devices are conditionally approved for MR imaging with stimulation turned off, and the requirement to modify the stimulation settings may be a barrier to scanning in some radiology practices. There is increasing interest in studying the effects of stimulation during MR imaging/fMRI. This study evaluated the safety of standard and investigational microburst vagus nerve stimulation therapies during MR imaging/fMRI. A prospective, multicenter study was conducted in patients with an investigational vagus nerve stimulation device that delivered either standard or investigational microburst vagus nerve stimulation. Thirty participants underwent sequential MR imaging and fMRI scans, encompassing 188 total hours of scan time (62.7 hours with standard vagus nerve stimulation and 125.3 hours with investigational microburst vagus nerve stimulation). No adverse events were reported with active stimulation during MR imaging or during 12 months of follow-up. Our results support the safety of standard and investigational microburst vagus nerve stimulation therapy during MR imaging and fMRI scans.
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Affiliation(s)
- Erik H Middlebrooks
- From the Department of Neuroradiology (E.H.M.), Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Jerzy P Szaflarski
- Department of Neurology (J.P.S., M.B., J.A.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason Begnaud
- Neuromodulation Division (J.B., K.H.), LivaNova USA, Houston, Texas
| | - Ashesh Thaker
- Departmentd of Neuroradiology (A.T.) and Radiology, Denver Health, University of Colorado School of Medicine, Denver, Colorado
| | - Kenny Henderson
- Neuromodulation Division (J.B., K.H.), LivaNova USA, Houston, Texas
| | - Mark Bolding
- Department of Neurology (J.P.S., M.B., J.A.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jill A Sellers
- Sellers Communications LLC (J.A.S.), Springfield, Missouri
| | - Jane Allendorfer
- Department of Neurology (J.P.S., M.B., J.A.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Szaflarski JP, Allendorfer JB, Begnaud J, Ranuzzi G, Shamshiri E, Verner R. Optimized microburst VNS elicits fMRI responses beyond thalamic-specific response from standard VNS. Ann Clin Transl Neurol 2024; 11:1135-1147. [PMID: 38532258 DOI: 10.1002/acn3.52029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE In parallel to standard vagus nerve stimulation (VNS), microburst stimulation delivery has been developed. We evaluated the fMRI-related signal changes associated with standard and optimized microburst stimulation in a proof-of-concept study (NCT03446664). METHODS Twenty-nine drug-resistant epilepsy patients were prospectively implanted with VNS. Three 3T fMRI scans were collected 2 weeks postimplantation. The maximum tolerated VNS intensity was determined prior to each scan starting at 0.125 mA with 0.125 mA increments. FMRI scans were block-design with alternating 30 sec stimulation [ON] and 30 sec no stimulation [OFF]: Scan 1 utilized standard VNS and Scan 3 optimized microburst parameters to determine target settings. Semi-automated on-site fMRI data processing utilized ON-OFF block modeling to determine VNS-related fMRI activation per stimulation setting. Anatomical thalamic mask was used to derive highest mean thalamic t-value for determination of microburst stimulation parameters. Paired t-tests corrected at P < 0.05 examined differences in fMRI responses to each stimulation type. RESULTS Standard and microburst stimulation intensities at Scans 1 and 3 were similar (P = 0.16). Thalamic fMRI responses were obtained in 28 participants (19 with focal; 9 with generalized seizures). Group activation maps showed standard VNS elicited thalamic activation while optimized microburst VNS showed widespread activation patterns including thalamus. Comparison of stimulation types revealed significantly greater cerebellar, midbrain, and parietal fMRI signal changes in microburst compared to standard VNS. These differences were not associated with seizure responses. INTERPRETATION While standard and optimized microburst VNS elicited thalamic activation, microburst also engaged other brain regions. Relationship between these fMRI activation patterns and clinical response warrants further investigation. CLINICAL TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT03446664).
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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De Falco E, Solcà M, Bernasconi F, Babo-Rebelo M, Young N, Sammartino F, Tallon-Baudry C, Navarro V, Rezai AR, Krishna V, Blanke O. Single neurons in the thalamus and subthalamic nucleus process cardiac and respiratory signals in humans. Proc Natl Acad Sci U S A 2024; 121:e2316365121. [PMID: 38451949 PMCID: PMC10945861 DOI: 10.1073/pnas.2316365121] [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: 09/27/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
Visceral signals are constantly processed by our central nervous system, enable homeostatic regulation, and influence perception, emotion, and cognition. While visceral processes at the cortical level have been extensively studied using non-invasive imaging techniques, very few studies have investigated how this information is processed at the single neuron level, both in humans and animals. Subcortical regions, relaying signals from peripheral interoceptors to cortical structures, are particularly understudied and how visceral information is processed in thalamic and subthalamic structures remains largely unknown. Here, we took advantage of intraoperative microelectrode recordings in patients undergoing surgery for deep brain stimulation (DBS) to investigate the activity of single neurons related to cardiac and respiratory functions in three subcortical regions: ventral intermedius nucleus (Vim) and ventral caudalis nucleus (Vc) of the thalamus, and subthalamic nucleus (STN). We report that the activity of a large portion of the recorded neurons (about 70%) was modulated by either the heartbeat, the cardiac inter-beat interval, or the respiration. These cardiac and respiratory response patterns varied largely across neurons both in terms of timing and their kind of modulation. A substantial proportion of these visceral neurons (30%) was responsive to more than one of the tested signals, underlining specialization and integration of cardiac and respiratory signals in STN and thalamic neurons. By extensively describing single unit activity related to cardiorespiratory function in thalamic and subthalamic neurons, our results highlight the major role of these subcortical regions in the processing of visceral signals.
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Affiliation(s)
- Emanuela De Falco
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
- Department of Neuroscience, Rockefeller Neuroscience Institute–West Virginia University, Morgantown, WV26505
| | - Marco Solcà
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
- Department of Psychiatry, University Hospital Geneva, Geneva1205, Switzerland
| | - Fosco Bernasconi
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
| | - Mariana Babo-Rebelo
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
| | - Nicole Young
- Medical Department, SpecialtyCare, Brentwood, TN37027
| | - Francesco Sammartino
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH43210
| | - Catherine Tallon-Baudry
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d’Etudes Cognitives, École normale supérieure-Paris Sciences et Lettres University, Inserm, Paris75005, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm, CNRS, Assistance Publique - Hôpitaux de Paris, Epilepsy Unit, Hôpital de la Pitié-Salpêtrière, Paris75013, France
| | - Ali R. Rezai
- Department of Neurosurgery, Rockefeller Neuroscience Institute—West Virginia University, Morgantown, WV26505
| | - Vibhor Krishna
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Durham, NC27516
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
- Department of Clinical Neurosciences, University Hospital Geneva, Geneva1205, Switzerland
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Drees C, Afra P, Verner R, Kaye L, Keith A, Jiang M, Szaflarski JP, Nichol K. Feasibility study of microburst VNS therapy in drug-resistant focal and generalized epilepsy. Brain Stimul 2024; 17:382-391. [PMID: 38499287 DOI: 10.1016/j.brs.2024.03.010] [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: 09/20/2023] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) at low frequencies (≤30 Hz) has been an established treatment for drug-resistant epilepsy (DRE) for over 25 years. OBJECTIVE To examine the initial safety and efficacy performance of an investigational, high-frequency (≥250 Hz) VNS paradigm herein called "Microburst VNS" (μVNS). μVNS consists of short, high-frequency bursts of electrical pulses believed to preferentially modulate certain brain regions. METHODS Thirty-three (33) participants were enrolled into an exploratory feasibility study, 21 with focal-onset seizures and 12 with generalized-onset seizures. Participants were titrated to a personalized target dose of μVNS using an investigational fMRI protocol. Participants were then followed for up to 12 months, with visits every 3 months, and monitored for side-effects at all time points. This study was registered as NCT03446664 on February 27th, 2018. RESULTS The device was well-tolerated. Reported adverse events were consistent with typical low frequency VNS outcomes and tended to diminish in severity over time, including dysphonia, cough, dyspnea, and implant site pain. After 12 months of μVNS, the mean seizure frequency reduction for all seizures was 61.3% (median reduction: 70.4%; 90% CI of median: 48.9%-83.3%). The 12-month responder rate (≥50% reduction) was 63.3% (90% CI: 46.7%-77.9%) and the super-responder rate (≥80% reduction) was 40% (90% CI: 25.0%-56.6%). Participants with focal-onset seizures appeared to benefit similarly to participants with generalized-onset seizures (mean reduction in seizures at 12 months: 62.6% focal [n = 19], versus 59.0% generalized [n = 11]). CONCLUSION Overall, μVNS appears to be safe and potentially a promising therapeutic alternative to traditional VNS. It merits further investigation in randomized controlled trials which will help determine the impact of investigational variables and which patients are most suitable for this novel therapy.
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Affiliation(s)
- Cornelia Drees
- Mayo Clinic Arizona, Department of Neurology, Phoenix, AZ, USA; University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA
| | - Pegah Afra
- University of Utah School of Medicine, Department of Neurology, Salt Lake City, UT, USA; Weill-Cornell Medicine, Department of Neurology, New York, NY, USA; University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ryan Verner
- LivaNova PLC (or a Subsidiary), Department of Clinical and Medical Affairs, London, UK
| | - Lesley Kaye
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA
| | - Amy Keith
- LivaNova PLC (or a Subsidiary), Department of Clinical and Medical Affairs, London, UK
| | - Mei Jiang
- LivaNova PLC (or a Subsidiary), Department Statistics and Data Science, London, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham School of Medicine, Department of Neurology, Birmingham, AL, USA
| | - Kathryn Nichol
- LivaNova PLC (or a Subsidiary), Department of Clinical and Medical Affairs, London, UK.
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Verner R, Szaflarski JP, Allendorfer JB, Vonck K, Giannicola G. Modulation of the thalamus by microburst vagus nerve stimulation: a feasibility study protocol. Front Neurol 2023; 14:1169161. [PMID: 37384278 PMCID: PMC10299807 DOI: 10.3389/fneur.2023.1169161] [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: 02/18/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] Open
Abstract
Vagus nerve stimulation (VNS) was the first device-based therapy for epilepsy, having launched in 1994 in Europe and 1997 in the United States. Since then, significant advances in the understanding of the mechanism of action of VNS and the central neurocircuitry that VNS modulates have impacted how the therapy is practically implemented. However, there has been little change to VNS stimulation parameters since the late 1990s. Short bursts of high frequency stimulation have been of increasing interest to other neuromodulation targets e.g., the spine, and these high frequency bursts elicit unique effects in the central nervous system, especially when applied to the vagus nerve. In the current study, we describe a protocol design that is aimed to assess the impact of high frequency bursts of stimulation, called "Microburst VNS", in subjects with refractory focal and generalized epilepsies treated with this novel stimulation pattern in addition to standard anti-seizure medications. This protocol also employed an investigational, fMRI-guided titration protocol that permits personalized dosing of Microburst VNS among the treated population depending on the thalamic blood-oxygen-level-dependent signal. The study was registered on clinicaltrials.gov (NCT03446664). The first subject was enrolled in 2018 and the final results are expected in 2023.
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Affiliation(s)
- Ryan Verner
- Clinical and Medical Affairs, LivaNova PLC (or a subsidiary), London, United Kingdom
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Gaia Giannicola
- Clinical and Medical Affairs, LivaNova PLC (or a subsidiary), London, United Kingdom
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Farrand A, Jacquemet V, Verner R, Owens M, Beaumont E. Vagus nerve stimulation parameters evoke differential neuronal responses in the locus coeruleus. Physiol Rep 2023; 11:e15633. [PMID: 36905173 PMCID: PMC10006695 DOI: 10.14814/phy2.15633] [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: 01/19/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Vagus nerve stimulation (VNS) is used to treat drug-resistant epilepsy and depression, with additional applications under investigation. The noradrenergic center locus coeruleus (LC) is vital for VNS effects; however, the impact of varying stimulation parameters on LC activation is poorly understood. This study characterized LC activation across VNS parameters. Extracellular activity was recorded in rats' left LC while 11 VNS paradigms, utilizing variable frequencies and bursting characteristics, were pseudorandomly delivered to the left cervical vagus for five cycles. Neurons' change from baseline firing rate and timing response profiles were assessed. The proportion of neurons categorized as responders over 5 VNS cycles doubled in comparison to the first VNS cycle (p < 0.001) for all VNS paradigms, demonstrating an amplification effect. The percentage of positively consistent/positive responders increased for standard VNS paradigms with frequencies ≥10 Hz and for bursting paradigms with shorter interburst intervals and more pulses per burst. The synchrony between pairs of LC neurons increased during bursting VNS but not standard paradigms. Also, the probability of evoking a direct response during bursting VNS was higher with longer interburst intervals and a higher number of pulses per burst. Standard paradigms between 10-30 Hz best positively activates LC with consistency to VNS while the best bursting paradigm to increase activity was 300 Hz, seven pulses per burst separated by 1 s. Bursting VNS was effective in increasing synchrony between pairs of neurons, suggesting a common network recruitment originating from vagal afferents. These results indicate differential activation of LC neurons depending on the VNS parameters delivered.
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Affiliation(s)
- Ariana Farrand
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Vincent Jacquemet
- Department of Pharmacology and PhysiologyInstitute of Biomedical Engineering, University of MontrealMontrealQuebecCanada
- Research CenterSacred Heart Hospital of MontrealMontrealQuebecCanada
| | - Ryan Verner
- Neuromodulation DivisionLivaNova PLCHoustonTexasUSA
| | - Misty Owens
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Eric Beaumont
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
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Rembado I, Song W, Su DK, Levari A, Shupe LE, Perlmutter S, Fetz E, Zanos S. Cortical Responses to Vagus Nerve Stimulation Are Modulated by Brain State in Nonhuman Primates. Cereb Cortex 2021; 31:5289-5307. [PMID: 34151377 PMCID: PMC8567998 DOI: 10.1093/cercor/bhab158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/30/2023] Open
Abstract
Vagus nerve stimulation (VNS) has been tested as therapy for several brain disorders and as a means to modulate cortical excitability and brain plasticity. Cortical effects of VNS, manifesting as vagal-evoked potentials (VEPs), are thought to arise from activation of ascending cholinergic and noradrenergic systems. However, it is unknown whether those effects are modulated by brain state at the time of stimulation. In 2 freely behaving macaque monkeys, we delivered short trains of 5 pulses to the left cervical vagus nerve at different frequencies (5-300 Hz) while recording local field potentials (LFPs) from sites in contralateral prefrontal, sensorimotor and parietal cortical areas. Brain states were inferred from spectral components of LFPs and the presence of overt movement: active awake, resting awake, REM sleep and NREM sleep. VNS elicited VEPs in all sampled cortical areas. VEPs comprised early (<70 ms), intermediate (70-250 ms) and late (>250 ms) components. The magnitude of the intermediate and late components was largest during NREM sleep and smallest during wakefulness, whereas that of the early component was not modulated by brain state. VEPs during NREM were larger for stimuli delivered at the depolarized phase of ongoing delta oscillations. Higher pulsing frequencies generated larger VEPs. These short VNS trains did not affect brain state transitions during wakefulness or sleep. Our findings suggest that ongoing brain state modulates the evoked effects of VNS on cortical activity. This has implications for the role of ongoing cortical activity and brain state in shaping cortical responses to peripheral stimuli, for the modulation of vagal interoceptive signaling by cortical activity, and for the dose calibration of VNS therapies.
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Affiliation(s)
- Irene Rembado
- MindScope Program, Allen Institute, 615 Westlake Ave N., Seattle, WA 98103, USA
| | - Weiguo Song
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset NY 11030, USA
| | - David K Su
- Providence Regional Medical Center Cranial Joint and Spine Clinic, Everett, WA 98201, USA
| | - Ariel Levari
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Larry E Shupe
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Steve Perlmutter
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Eberhard Fetz
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset NY 11030, USA
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Suarez-Roca H, Mamoun N, Sigurdson MI, Maixner W. Baroreceptor Modulation of the Cardiovascular System, Pain, Consciousness, and Cognition. Compr Physiol 2021; 11:1373-1423. [PMID: 33577130 DOI: 10.1002/cphy.c190038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain cardiovascular homeostasis by coordinating the responses to external and internal environmental stressors. While it is well known that carotid and cardiopulmonary baroreceptors modulate sympathetic vasomotor and parasympathetic cardiac neural autonomic drive, to avoid excessive fluctuations in vascular tone and maintain intravascular volume, there is increasing recognition that baroreceptors also modulate a wide range of non-cardiovascular physiological responses via projections from the nucleus of the solitary tract to regions of the central nervous system, including the spinal cord. These projections regulate pain perception, sleep, consciousness, and cognition. In this article, we summarize the physiology of baroreceptor pathways and responses to baroreceptor activation with an emphasis on the mechanisms influencing cardiovascular function, pain perception, consciousness, and cognition. Understanding baroreceptor-mediated effects on cardiac and extra-cardiac autonomic activities will further our understanding of the pathophysiology of multiple common clinical conditions, such as chronic pain, disorders of consciousness (e.g., abnormalities in sleep-wake), and cognitive impairment, which may result in the identification and implementation of novel treatment modalities. © 2021 American Physiological Society. Compr Physiol 11:1373-1423, 2021.
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Affiliation(s)
- Heberto Suarez-Roca
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina, USA
| | - Negmeldeen Mamoun
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Martin I Sigurdson
- Department of Anesthesiology and Critical Care Medicine, Landspitali, University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - William Maixner
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina, USA
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Levichkina EV, Busygina II, Pigareva ML, Pigarev IN. The Mysterious Island: Insula and Its Dual Function in Sleep and Wakefulness. Front Syst Neurosci 2021; 14:592660. [PMID: 33643002 PMCID: PMC7904873 DOI: 10.3389/fnsys.2020.592660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022] Open
Abstract
In the recent sleep studies, it was shown that afferentation of many cortical areas switches during sleep to the interoceptive one. However, it was unclear whether the insular cortex, which is often considered as the main cortical visceral representation, maintains the same effective connectivity in both states of vigilance, or processes interoceptive information predominantly in one state. We investigated neuronal responses of the cat insular cortex to electrical stimulations of the intestinal wall delivered during wakefulness and natural sleep. Marked increase was observed in the number of insular neurons responding to this stimulation in sleep comparing to wakefulness, and enlarged amplitudes of evoked local field potentials were found as well. Moreover, most of the cells responding to intestinal stimulation in wakefulness never responded to identical stimuli during sleep and vice versa. It was also shown that applied low intensity intestinal stimulations had never compromised sleep quality. In addition, experiments with microstimulation of the insular cortex and recording of intestinal myoelectric activity demonstrated that effective insula-to-gut propagation also happened only during sleep. On the other hand, the same insular stimulations in wakefulness led to contractions of orofacial muscles. The evoked face movements gradually disappeared in the course of sleep development. These findings demonstrate that pattern of efficient afferent and efferent connections of the insular cortex changes with transition from wakefulness to sleep.
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Affiliation(s)
- Ekaterina V. Levichkina
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, Moscow, Russia
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Irina I. Busygina
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Marina L. Pigareva
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Ivan N. Pigarev
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, Moscow, Russia
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10
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Farrand AQ, Verner RS, McGuire RM, Helke KL, Hinson VK, Boger HA. Differential effects of vagus nerve stimulation paradigms guide clinical development for Parkinson's disease. Brain Stimul 2020; 13:1323-1332. [PMID: 32629028 DOI: 10.1016/j.brs.2020.06.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) modifies brain rhythms in the locus coeruleus (LC) via the solitary nucleus. Degeneration of the LC in Parkinson's disease (PD) is an early catalyst of the spreading neurodegenerative process, suggesting that stimulating LC output with VNS has the potential to modify disease progression. We previously showed in a lesion PD model that VNS delivered twice daily reduced neuroinflammation and motor deficits, and attenuated tyrosine hydroxylase (TH)-positive cell loss. OBJECTIVE The goal of this study was to characterize the differential effects of three clinically-relevant VNS paradigms in a PD lesion model. METHODS Eleven days after DSP-4 (N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine, noradrenergic lesion, administered systemically)/6-OHDA (6-hydroxydopamine, dopaminergic lesion, administered intrastriatally) rats were implanted with VNS devices, and received either low-frequency VNS, standard-frequency VNS, or high-frequency microburst VNS. After 10 days of treatment and behavioral assessment, rats were euthanized, right prefrontal cortex (PFC) was dissected for norepinephrine assessment, and the left striatum, bilateral substantia nigra (SN), and LC were sectioned for immunohistochemical detection of catecholamine neurons, α-synuclein, astrocytes, and microglia. RESULTS At higher VNS frequencies, specifically microburst VNS, greater improvements occurred in motor function, attenuation of TH-positive cell loss in SN and LC, and norepinephrine concentration in the PFC. Additionally, higher VNS frequencies resulted in lower intrasomal α-synuclein accumulation and glial density in the SN. CONCLUSIONS These data indicate that higher stimulation frequencies provided the greatest attenuation of behavioral and pathological markers in this PD model, indicating therapeutic potential for these VNS paradigms.
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Affiliation(s)
- Ariana Q Farrand
- Department of Neuroscience and Center on Aging, Medical University of South Carolina, 173 Ashley Ave, BSB Suite 403, MSC 510, Charleston, SC, 29425, USA
| | - Ryan S Verner
- Neuromodulation Division of LivaNova, PLC, 100 Cyberonics Blvd, Houston, TX, 77058, USA
| | - Ryan M McGuire
- Neuromodulation Division of LivaNova, PLC, 100 Cyberonics Blvd, Houston, TX, 77058, USA
| | - Kristi L Helke
- Department of Comparative Medicine, 114 Doughty St, STB 648, MSC 777; Department of Pathology and Laboratory Medicine, 165 Ashley Ave, Children's Hospital 309, MSC 908, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Vanessa K Hinson
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 309, MSC 606, Charleston, SC, 29425, USA
| | - Heather A Boger
- Department of Neuroscience and Center on Aging, Medical University of South Carolina, 173 Ashley Ave, BSB Suite 403, MSC 510, Charleston, SC, 29425, USA.
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Szabó CÁ, Salinas FS, Papanastassiou AM, Begnaud J, Ravan M, Eggleston KS, Shade R, Lutz C, De La Garza M. High-frequency burst vagal nerve simulation therapy in a natural primate model of genetic generalized epilepsy. Epilepsy Res 2017; 138:46-52. [PMID: 29059589 PMCID: PMC5856459 DOI: 10.1016/j.eplepsyres.2017.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/24/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Since the approval of Vagal Nerve Stimulation (VNS) Therapy for medically refractory focal epilepsies in 1997, it has been also reported to be effective for a wide range of generalized seizures types and epilepsy syndromes. Instead of conventional VNS Therapy delivered at 20-30Hz signal frequencies, this study evaluates efficacy and tolerability of high-frequency burst VNS in a natural animal model for genetic generalized epilepsy (GGE), the epileptic baboon. METHODS Two female baboons (B1 P.h. Hamadryas and B2 P.h. Anubis x Cynocephalus) were selected because of frequently witnessed generalized tonic-clonic seizures (GTCS) for VNS implantation. High-frequency burst VNS Therapy was initiated after a 4-5 week baseline; different VNS settings (0.25, 2 or 2.5mA, 300Hz, 4 vs 7 pulses, 0.5-2.5s interburst interval, and intermittent stimulation for 1-2 vs for 24h per day) were tested over the subsequent 19 weeks, which included a 4-6 week wash-out period. GTCS frequencies were quantified for each setting, while seizure duration and postictal recovery times were compared to baseline. Scalp EEG studies were performed at almost every setting, including intermittent light stimulation (ILS) to evaluate photosensitivity. Pre-ILS ictal and interictal discharge rates, as well as ILS responses were compared between trials. The Novel Object test was used to assess potential treatment effects on behavior. RESULTS High-frequency burst VNS Therapy reduced GTCS frequencies at all treatment settings in both baboons, except when output currents were reduced (0.25mA) or intermittent stimulation was restricted (to 1-2h/day). Seizure duration and postictal recovery times were unchanged. Scalp EEG studies did not demonstrate treatment-related decrease of ictal or interictal epileptic discharges or photosensitivity, but continuous treatment for 120-180s during ILS appeared to reduce photoparoxysmal responses. High-frequency burst VNS Therapy was well-tolerated by both baboons, without cardiac or behavioral changes. Repetitive muscle contractions involving the neck and left shoulder girdle were observed intermittently, most commonly at 0.5 interburst intervals, but these were transient, resolving with a few cycles of stimulation and not noted in wakefulness. CONCLUSIONS This preclinical pilot study demonstrates efficacy and tolerability of high-frequency burst VNS Therapy in the baboon model of GGE. The muscle contractions may be due to aberrant propagation of the stimulus along the vagal nerve or to the ansa cervicalis, but can be reduced by minimal adjustment of current output or stimulus duration.
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Affiliation(s)
- C Á Szabó
- Department of Neurology, UT Health San Antonio, San Antonio, TX, United States; South Texas Comprehensive Epilepsy Center, University Health System, San Antonio, TX, United States.
| | - F S Salinas
- Research Imaging Institute, UT Health San Antonio, San Antonio, TX, United States
| | - A M Papanastassiou
- South Texas Comprehensive Epilepsy Center, University Health System, San Antonio, TX, United States; Department of Neurosurgery, UT Health San Antonio, San Antonio, TX, United States
| | - J Begnaud
- LivaNova, Houston, TX, United States
| | - M Ravan
- LivaNova, Houston, TX, United States
| | | | - R Shade
- Southwest National Primate Research Center, Texas Biomed, San Antonio, TX, United States
| | - C Lutz
- Southwest National Primate Research Center, Texas Biomed, San Antonio, TX, United States
| | - M De La Garza
- Southwest National Primate Research Center, Texas Biomed, San Antonio, TX, United States
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12
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Strigo IA, Craig ADB. Interoception, homeostatic emotions and sympathovagal balance. Philos Trans R Soc Lond B Biol Sci 2016; 371:20160010. [PMID: 28080968 PMCID: PMC5062099 DOI: 10.1098/rstb.2016.0010] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 12/16/2022] Open
Abstract
We briefly review the evidence for distinct neuroanatomical substrates that underlie interoception in humans, and we explain how they substantialize feelings from the body (in the insular cortex) that are conjoined with homeostatic motivations that guide adaptive behaviours (in the cingulate cortex). This hierarchical sensorimotor architecture coincides with the limbic cortical architecture that underlies emotions, and thus we regard interoceptive feelings and their conjoint motivations as homeostatic emotions We describe how bivalent feelings, emotions and sympathovagal balance can be organized and regulated efficiently in the bicameral forebrain as asymmetric positive/negative, approach/avoidance and parasympathetic/sympathetic components. We provide original evidence supporting this organization from studies of cardiorespiratory vagal activity in monkeys and functional imaging studies in healthy humans showing activation modulated by paced breathing and passively viewed emotional images. The neuroanatomical architecture of interoception provides deep insight into the functional organization of all emotional feelings and behaviours in humans.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
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Affiliation(s)
- Irina A Strigo
- Research Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94121, USA
| | - Arthur D Bud Craig
- Neurosurgery Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA
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13
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Feng MH, He ZG, Liu BW, Li ZX, Wu DZ, Liu SG, Xiang HB. Parafascicular nucleus circuits: Implications for the alteration of gastrointestinal functions during epileptogenesis. Epilepsy Behav 2016; 64:295-298. [PMID: 27773642 DOI: 10.1016/j.yebeh.2016.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 07/14/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mao-Hui Feng
- Department of Oncology, Wuhan Peritoneal Cancer Clinical Medical Research Center, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, No. 169 Donghu Road, Wuhan, Hubei 430071, PR China.
| | - Zhi-Gang He
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Bao-Wen Liu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Zhi-Xiao Li
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Duo-Zhi Wu
- Department of Anesthesiology, People's Hospital of Hainan Province, Haikou, Hainan 570311, PR China.
| | - San-Guang Liu
- Department of Hepatobiliary Surgery, The Second Hospital, Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.
| | - Hong-Bing Xiang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
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14
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Chen M, He ZG, Liu BW, Li ZX, Liu SG, Xiang HB. Parafascicular nucleus-heart neural crosstalk: Implications for seizure-induced myocardial stunning. Epilepsy Behav 2016; 63:135-137. [PMID: 27539366 DOI: 10.1016/j.yebeh.2016.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Ming Chen
- Department of Anesthesiology, Hubei Maternal and Child Health Hospital, Wuhan 430070, PR China
| | - Zhi-Gang He
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Bao-Wen Liu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Zhi-Xiao Li
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - San-Guang Liu
- Department of Hepatobiliary Surgery, The Second Hospital, Hebei Medical University, Shijiazhuang 050000, Hebei, PR China.
| | - Hong-Bing Xiang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
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Jiao J, Sevcencu C, Jensen W, Yang X, Harreby KR. The Influence of Vagus Nerve and Spinal Cord Stimulation on the Ictal Fast Ripple Activity in a Spike-and-Wave Rat Model of Seizures. Neuromodulation 2016; 19:292-8. [PMID: 26817965 DOI: 10.1111/ner.12395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/15/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fast ripple (FR) activity has received increasing attention as a potential epileptic marker. The current knowledge on how neurostimulation affects FRs is, however, very limited. In this study, we assess the influence of the vagus nerve stimulation (VNS) and spinal cord stimulation (SCS) frequency on ictal FRs associated with spike-and-wave (SW) seizures. METHODS SW discharges were induced and maintained by an infusion of pentylenetetrazol in rat. During ongoing SW seizures, SCS was conducted at 30, 80, 130, and 180 Hz and VNS at 10, 30, 80, 130, and 180 Hz. The FRs were derived from intracortical recordings and the FR rate was used for quantifying the level of FR activity. RESULTS The FR rate was significantly correlated (r = 0.81) with the level of total pentylenetetrazol dose. Compared with no stimulation intervals, SCS conducted at 80, 130, and 180 Hz significantly reduced the normalized FR rate by 24, 38, and 44%, respectively. Similarly, VNS conducted at 30, 80, 130, and 180 Hz significantly reduced the normalized FR rate by 23, 40, 61, and 65%, respectively. CONCLUSIONS In the present model of sustained SW seizures, the FR rate was proportional with the severity of the SW seizures. Both SCS and VNS attenuated the FR rate and this attenuation was consistently strongest at the higher stimulation frequencies. Our results suggest that SCS may induce some of the same antiepileptic effects as VNS.
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Affiliation(s)
- Jianhang Jiao
- Faculty of Medicine, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Cristian Sevcencu
- Faculty of Medicine, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Winnie Jensen
- Faculty of Medicine, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Xiaoyu Yang
- Department of Spine Surgery, Orthopedics Hospital, Second Hospital, Jilin University, Changchun, China
| | - Kristian R Harreby
- Faculty of Medicine, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Aroused with heart: Modulation of heartbeat evoked potential by arousal induction and its oscillatory correlates. Sci Rep 2015; 5:15717. [PMID: 26503014 PMCID: PMC4621540 DOI: 10.1038/srep15717] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/02/2015] [Indexed: 11/08/2022] Open
Abstract
Recent studies showed that the visceral information is constantly processed by the brain, thereby potentially influencing cognition. One index of such process is the heartbeat evoked potential (HEP), an ERP component related to the cortical processing of the heartbeat. The HEP is sensitive to a number of factors such as motivation, attention, pain, which are associated with higher levels of arousal. However, the role of arousal and its associated brain oscillations on the HEP has not been characterized, yet it could underlie the previous findings. Here we analysed the effects of high- (HA) and low-arousal (LA) induction on the HEP. Further, we investigated the brain oscillations and their role in the HEP in response to HA and LA inductions. As compared to LA, HA was associated with a higher HEP and lower alpha oscillations. Interestingly, individual differences in the HEP modulation by arousal induction were correlated with alpha oscillations. In particular, participants with higher alpha power during the arousal inductions showed a larger HEP in response to HA compared to LA. In summary, we demonstrated that arousal induction affects the cortical processing of heartbeats; and that the alpha oscillations may modulate this effect.
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17
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Martlé V, Raedt R, Waelbers T, Smolders I, Vonck K, Boon P, Van Ham L, Duchateau L, Bhatti S. The Effect of Vagus Nerve Stimulation on CSF Monoamines and the PTZ Seizure Threshold in Dogs. Brain Stimul 2015; 8:1-6. [DOI: 10.1016/j.brs.2014.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/31/2014] [Accepted: 07/13/2014] [Indexed: 11/25/2022] Open
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Chen S, Wang S, Rong P, Liu J, Zhang H, Zhang J. Acupuncture for refractory epilepsy: role of thalamus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:950631. [PMID: 25548594 PMCID: PMC4273587 DOI: 10.1155/2014/950631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 12/29/2022]
Abstract
Neurostimulation procedures like vagus nerve stimulation (VNS) and deep brain stimulation have been used to treat refractory epilepsy and other neurological disorders. While holding promise, they are invasive interventions with serious complications and adverse effects. Moreover, their efficacies are modest with less seizure free. Acupuncture is a simple, safe, and effective traditional healing modality for a wide range of diseases including pain and epilepsy. Thalamus takes critical role in sensory transmission and is highly involved in epilepsy genesis particularly the absence epilepsy. Considering thalamus serves as a convergent structure for both acupuncture and VNS and the thalamic neuronal activities can be modulated by acupuncture, we propose that acupuncture could be a promising therapy or at least a screening tool to select suitable candidates for those invasive modalities in the management of refractory epilepsy.
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Affiliation(s)
- Shuping Chen
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shubin Wang
- China General Meitan Hospital, Beijing 100028, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Junling Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hongqi Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong
| | - Jianliang Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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19
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Evaluation of heart rate variability in dogs during standard and microburst vagus nerve stimulation: a pilot study. Vet J 2014; 202:651-3. [PMID: 25296848 DOI: 10.1016/j.tvjl.2014.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022]
Abstract
Vagus nerve stimulation (VNS) is an established treatment for epilepsy and depression in human patients, but in both humans and dogs, optimal stimulation parameters remain unknown. Delivering afferent bursts of stimulation may be promising as a means of increasing efficacy, but evaluation of potential effects on the heart due to unavoidable efferent stimulation is required. The present study investigated heart rate variability (HRV) in healthy Beagle dogs treated with 1 h of sham, standard or microburst left-sided VNS in a crossover design. No significant differences were found between the stimulation paradigms for any of the cardiac parameters. Short-term left-sided VNS, including a novel bursting pattern (microburst VNS), had no statistically significant effect on HRV in ambulatory healthy dogs. Studies in a larger number of animals with long-term VNS are recommended.
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20
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Martlé V, Peremans K, Raedt R, Vermeire S, Vonck K, Boon P, Van Ham L, Tshamala M, Caemaert J, Dobbeleir A, Duchateau L, Waelbers T, Gielen I, Bhatti S. Regional brain perfusion changes during standard and microburst vagus nerve stimulation in dogs. Epilepsy Res 2014; 108:616-22. [DOI: 10.1016/j.eplepsyres.2014.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/16/2014] [Accepted: 02/03/2014] [Indexed: 11/16/2022]
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21
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Fan PC, Peng SSF, Yen RF, Shieh JY, Kuo MF. Neuroimaging and electroencephalographic changes after vagus nerve stimulation in a boy with medically intractable myoclonic astatic epilepsy. J Formos Med Assoc 2014; 113:258-63. [DOI: 10.1016/j.jfma.2013.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 01/30/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
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22
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Alexander GM, McNamara JO. Vagus nerve stimulation elevates seizure threshold in the kindling model. Epilepsia 2012; 53:2043-52. [DOI: 10.1111/j.1528-1167.2012.03646.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Urbano FJ, Kezunovic N, Hyde J, Simon C, Beck P, Garcia-Rill E. Gamma band activity in the reticular activating system. Front Neurol 2012; 3:6. [PMID: 22319508 PMCID: PMC3269033 DOI: 10.3389/fneur.2012.00006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 01/06/2012] [Indexed: 12/24/2022] Open
Abstract
This review considers recent evidence showing that cells in three regions of the reticular activating system (RAS) exhibit gamma band activity, and describes the mechanisms behind such manifestation. Specifically, we discuss how cells in the mesopontine pedunculopontine nucleus (PPN), intralaminar parafascicular nucleus (Pf), and pontine subcoeruleus nucleus dorsalis (SubCD) all fire in the beta/gamma band range when maximally activated, but no higher. The mechanisms behind this ceiling effect have been recently elucidated. We describe recent findings showing that every cell in the PPN have high-threshold, voltage-dependent P/Q-type calcium channels that are essential, while N-type calcium channels are permissive, to gamma band activity. Every cell in the Pf also showed that P/Q-type and N-type calcium channels are responsible for this activity. On the other hand, every SubCD cell exhibited sodium-dependent subthreshold oscillations. A novel mechanism for sleep–wake control based on well-known transmitter interactions, electrical coupling, and gamma band activity is described. The data presented here on inherent gamma band activity demonstrates the global nature of sleep–wake oscillation that is orchestrated by brainstem–thalamic mechanism, and questions the undue importance given to the hypothalamus for regulation of sleep–wakefulness. The discovery of gamma band activity in the RAS follows recent reports of such activity in other subcortical regions like the hippocampus and cerebellum. We hypothesize that, rather than participating in the temporal binding of sensory events as seen in the cortex, gamma band activity manifested in the RAS may help stabilize coherence related to arousal, providing a stable activation state during waking and paradoxical sleep. Most of our thoughts and actions are driven by pre-conscious processes. We speculate that continuous sensory input will induce gamma band activity in the RAS that could participate in the processes of pre-conscious awareness, and provide the essential stream of information for the formulation of many of our actions.
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Affiliation(s)
- Francisco J Urbano
- Instituto de Fisiología, Biología Molecular y Neurociencias, Consejo Nacional de Investigaciones Científicas y Técnicas, University of Buenos Aires Buenos Aires, Argentina
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Aalbers M, Vles J, Klinkenberg S, Hoogland G, Majoie M, Rijkers K. Animal models for vagus nerve stimulation in epilepsy. Exp Neurol 2011; 230:167-75. [PMID: 21565191 DOI: 10.1016/j.expneurol.2011.04.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/15/2011] [Accepted: 04/14/2011] [Indexed: 10/18/2022]
Abstract
Vagus nerve stimulation (VNS) is a moderately effective adjunctive treatment for patients suffering from medically refractory epilepsy and is explored as a treatment option for several other disorders. The present review provides a critical appraisal of the studies on VNS in animal models of seizures and epilepsy. So far, these studies mostly applied short-term VNS in seizure models, demonstrating that VNS can suppress and prevent seizures and affect epileptogenesis. However, the mechanism of action is still largely unknown. Moreover, studies with a clinically more relevant setup where VNS is chronically applied in epilepsy models are scarce. Future directions for research and the application of this technology in animal models of epilepsy are discussed.
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Affiliation(s)
- Marlien Aalbers
- School for Mental Health & Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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The parafascicular thalamic nucleus concomitantly influences behavioral flexibility and dorsomedial striatal acetylcholine output in rats. J Neurosci 2010; 30:14390-8. [PMID: 20980596 DOI: 10.1523/jneurosci.2167-10.2010] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recent evidence suggests that a circuit involving the centromedian-parafascicular (Pf) thalamus and basal ganglia is critical for a shift away from biased actions. In particular, excitatory input from the Pf onto striatal cholinergic neurons may facilitate behavioral flexibility. Accumulating evidence indicates that an endogenous increase in dorsomedial striatal acetylcholine (ACh) output enhances behavioral flexibility. The present experiments investigated whether the rat (Rattus norvegicus) Pf supports flexibility during reversal learning, in part, by modifying dorsomedial striatal ACh output. This was determined first by examining the effects of Pf inactivation, through infusion of the GABA agonists baclofen and muscimol, on place acquisition and reversal learning. Additional experiments examined Pf inactivation on dorsomedial striatal ACh output during reversal learning and a resting condition. Behavioral testing was performed in a cross-maze. In vivo microdialysis combined with HPLC/electrochemical detection was used to sample ACh from the dorsomedial striatum. Pf inactivation selectively impaired reversal learning in a dose-dependent manner. A subsequent study showed that an increase in dorsomedial striatal ACh efflux (∼30% above basal levels) during reversal learning was blocked by Pf inactivation, which concomitantly impaired reversal learning. In the resting condition, a dose of baclofen and muscimol that blocked a behaviorally induced increase in dorsomedial striatal ACh output did not reduce basal ACh efflux. Together, the present findings indicate that the Pf is an intralaminar thalamic nucleus critical for behavioral flexibility, in part, by directly affecting striatal ACh output under conditions that require a shift in choice patterns.
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Terry R. Vagus nerve stimulation: a proven therapy for treatment of epilepsy strives to improve efficacy and expand applications. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2009:4631-4. [PMID: 19963855 DOI: 10.1109/iembs.2009.5332676] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vagus nerve stimulation (VNS) is an approved therapy for the treatment of adult patients and adolescents aged 12 years and older who have partial onset seizures refractory to antiepileptic medications. More than 50,000 patients worldwide have been implanted with the VNS system. Work continues to understand the mechanism of action of VNS with the goal of improving the treatment, particularly to identify patients who will be helped by VNS, to develop a closed-loop seizure detection system, and to improve the selection of stimulation parameters. VNS has also been approved for treatment-resistant depression, and it may have utility in the treatment of a variety of other medical disorders.
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Affiliation(s)
- Reese Terry
- Stockholder of Cyberonics Inc., 100 Cyberonics Blvd, Houston, Texas, USA.
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Gao HR, Shi TF, Yang CX, Zhang D, Zhang GW, Zhang Y, Jiao RS, Zhang H, Xu MY. The effect of dopamine on pain-related neurons in the parafascicular nucleus of rats. J Neural Transm (Vienna) 2010; 117:585-91. [PMID: 20358234 DOI: 10.1007/s00702-010-0398-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 03/17/2010] [Indexed: 11/24/2022]
Abstract
Dopamine (DA) regulates pain perception in the central nervous system (CNS). However, the mechanism of the action of DA in pain-related neurons of the parafascicular nucleus (Pf) is not clear. The present study aimed to determine the effect of DA and its receptor antagonist, droperidol on the pain-evoked responses of the pain-excited neurons (PEN) and pain-inhibited neurons (PIN) in the Pf of rats and to analyze the mechanisms underlying this effect. The trains of electric impulses applied to the sciatic nerve were used as noxious stimulation. The discharges of PEN and PIN in the Pf were recorded by using a glass microelectrode. The results showed that, in the Pf, intra-Pf microinjection of DA (5 microg/0.5 microl) increased the frequency of noxious stimulation-induced discharges of the PEN and decreased the frequency of those of the PIN, while the intra-Pf administration of droperidol (0.15 microg/0.5 microl) produced an opposite effect. On the basis of the above-mentioned findings, we could conclude that DA and its receptors in the Pf are involved in the modulation of the nociceptive response by regulating the discharges of PEN and PIN.
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Affiliation(s)
- H-R Gao
- Laboratory of Neural Electrophysiology, Department of Physiology, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, Heilongjiang 150081, China
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Schachter SC, Guttag J, Schiff SJ, Schomer DL. Advances in the application of technology to epilepsy: the CIMIT/NIO Epilepsy Innovation Summit. Epilepsy Behav 2009; 16:3-46. [PMID: 19780225 PMCID: PMC8118381 DOI: 10.1016/j.yebeh.2009.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In 2008, a group of clinicians, scientists, engineers, and industry representatives met to discuss advances in the application of engineering technologies to the diagnosis and treatment of patients with epilepsy. The presentations also provided a guide for further technological development, specifically in the evaluation of patients for epilepsy surgery, seizure onset detection and seizure prediction, intracranial treatment systems, and extracranial treatment systems. This article summarizes the discussions and demonstrates that cross-disciplinary interactions can catalyze collaborations between physicians and engineers to address and solve many of the pressing unmet needs in epilepsy.
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Affiliation(s)
- Steven C Schachter
- Center for Integration of Medicine and Innovative Technology, Boston, MA, USA.
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Ye M, Hayar A, Garcia-Rill E. Cholinergic responses and intrinsic membrane properties of developing thalamic parafascicular neurons. J Neurophysiol 2009; 102:774-85. [PMID: 19474169 DOI: 10.1152/jn.91132.2008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parafascicular (Pf) neurons receive cholinergic input from the pedunculopontine nucleus (PPN), which is active during waking and REM sleep. There is a developmental decrease in REM sleep in humans between birth and puberty and 10-30 days in rat. Previous studies have established an increase in muscarinic and 5-HT1 serotonergic receptor-mediated inhibition and a transition from excitatory to inhibitory GABA(A) responses in the PPN during the developmental decrease in REM sleep. However, no studies have been conducted on the responses of Pf cells to the cholinergic input from the PPN during development, which is a major target of ascending cholinergic projections and may be an important mechanism for the generation of rhythmic oscillations in the cortex. Whole cell patch-clamp recordings were performed in 9- to 20-day-old rat Pf neurons in parasagittal slices, and responses to the cholinergic agonist carbachol (CAR) were determined. Three types of responses were identified: inhibitory (55.3%), excitatory (31.1%), and biphasic (fast inhibitory followed by slow excitatory, 6.8%), whereas 6.8% of cells showed no response. The proportion of CAR-inhibited Pf neurons increased with development. Experiments using cholinergic antagonists showed that M2 receptors mediated the inhibitory response, whereas excitatory modulation involved M1, nicotinic, and probably M3 or M5 receptors, and the biphasic response was caused by the activation of multiple types of muscarinic receptors. Compared with CAR-inhibited cells, CAR-excited Pf cells showed 1) a decreased membrane time constant, 2) higher density of hyperpolarization-activated channels (I(h)), 3) lower input resistance (R(in)), 4) lower action potential threshold, and 5) shorter half-width duration of action potentials. Some Pf cells exhibited spikelets, and all were excited by CAR. During development, we observed decreases in I(h) density, R(in), time constant, and action potential half-width. These results suggest that cholinergic modulation of Pf differentially affects separate populations, perhaps including electrically coupled cells. Pf cells tend to show decreased excitability and cholinergic activation during the developmental decrease in REM sleep.
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Affiliation(s)
- Meijun Ye
- Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Xiao H, Zhai DX, Yan BB, Wang JH, Xu WS, Wang GY, Bai SS, Kong QF, Sun B, Wang DD, Jin DJ, Li HL. A role for the parafascicular thalamic nucleus in the development of morphine dependence and withdrawal. Brain Res 2009; 1271:74-82. [PMID: 19332040 DOI: 10.1016/j.brainres.2009.02.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 01/20/2009] [Accepted: 02/27/2009] [Indexed: 11/26/2022]
Abstract
The parafascicular thalamic nucleus (nPf) is a critical relay in the ascending system that mediates motor control in the central nervous system (CNS). Yet, little is known about whether or not the nPf is involved in the development of morphine dependence and withdrawal. In the present study, kainic acid was used to chemically destroy the nPf in Wistar rats, and morphine dependence and withdrawal models were established. Morphine withdrawal symptoms score was evaluated in each group. An electrophysiological method was used to measure the changes in spontaneous discharge of nPf neurons. mu-Opioid receptor (MOR) mRNA level in nPf was detected using semi-quantitative RT-PCR. The ultrastructural alterations were examined by transmission electron microscopy. Results showed that the bilateral lesion of nPf had a marked influence on the development of morphine dependence and withdrawal. In order to address the mechanisms underlying, we found: (1) the average frequency and sum of nPf neurons that exhibited spontaneous discharge were increased in the morphine withdrawal group in comparison with the sham model group (P<0.05); (2) MOR mRNA level in the nPf of the morphine dependence group was decreased in comparison with that of the sham model group (1.45+/-0.38 vs. 5.37+/-0.94, P<0.01). In the morphine withdrawal group, which underwent 40 h withdrawal, the MOR mRNA level was higher than that in the morphine dependence group (2.97+/-0.73 vs. 1.45+/-0.38, P<0.05) but still lower than that in the sham model group (P<0.05); (3) the ultrastructural injuries of nPf neurons, which were in the nucleus, organelles and neuropil, were marked in the morphine dependent and withdrawal groups. Our study indicated that nPf played an important role in the development of morphine dependence and withdrawal. The results suggest that nPf may become a therapeutic target for treating morphine withdrawal syndrome.
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Affiliation(s)
- Hui Xiao
- Department of Otorhinolaryngology, the Second Affiliated Clinic College of Harbin Medical University, 150081, China
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Foo KS, Brismar H, Broberger C. Distribution and neuropeptide coexistence of nucleobindin-2 mRNA/nesfatin-like immunoreactivity in the rat CNS. Neuroscience 2008; 156:563-79. [PMID: 18761059 DOI: 10.1016/j.neuroscience.2008.07.054] [Citation(s) in RCA: 200] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 07/14/2008] [Accepted: 07/19/2008] [Indexed: 12/29/2022]
Abstract
The protein fragment nesfatin-1 was recently implicated in the control of food intake. Central administration of this fragment results in anorexia and reduced body weight gain, whereas antisense or immunological nesfatin-1 antagonism causes increased food intake and overweight. Nesfatin-1 is derived from the precursor nucleobindin-2 (NUCB2). To identify the neurocircuitry underpinning the catabolic effects of NUCB2/nesfatin-1, we have used in situ hybridization and immunohistochemistry to map the distribution of this protein and its mRNA in the rat CNS and performed double-labeling experiments to localize its expression to functionally defined neuronal populations. These experiments confirm previous observations but also present several novel NUCB2 cell populations. Both NUCB2 mRNA and nesfatin-like immunoreactivity was most concentrated in the hypothalamus, in the supraoptic, paraventricular, periventricular and arcuate nuclei and the lateral hypothalamic area/perifornical region. Additionally, outside of the hypothalamus, labeling was observed in the thalamic parafascicular nucleus, the Edinger-Westphal nucleus, locus coeruleus, ventral raphe system, nucleus of solitary tract and in the preganglionic sympathetic intermediolateral cell column of the spinal cord, and the pituitary anterior and intermediate lobes. In neurons, immunoreactivity was almost exclusively confined to perikarya and primary dendrites with virtually no labeling of axonal terminals. Double-labeling immunohistochemistry revealed colocalization of nesfatin with vasopressin and oxytocin in magnocellular neuroendocrine neurons, thyrotropin-releasing hormone, corticotropin-releasing hormone, somatostatin, neurotensin, and growth-hormone-releasing hormone in parvocellular neuroendocrine neurons, pro-opiomelanocortin (but not neuropeptide Y) in the arcuate nucleus and melanin-concentrating hormone (but not hypocretin) in the lateral hypothalamus. Furthermore, nesfatin was extensively colocalized with cocaine- and amphetamine-regulated transcript in almost all NUCB2-expressing brain regions. These data reveal a wider distribution of NUCB2/nesfatin-1 than previously known, suggesting that the metabolic actions of this protein may involve not only feeding behavior but also endocrine and autonomic effects on energy expenditure. In addition, the subcellular distribution of nesfatin-like immunoreactivity indicates that this protein may not be processed like a conventional secreted neuromodulator.
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Affiliation(s)
- K S Foo
- Department of Neuroscience, Karolinska Institutet, Retzius v. 8, 17177 Stockholm, Sweden
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Ito S, Craig AD. Striatal projections of the vagal-responsive region of the thalamic parafascicular nucleus in macaque monkeys. J Comp Neurol 2008; 506:301-27. [PMID: 18022943 DOI: 10.1002/cne.21513] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We recently reported that the thalamic parafascicular nucleus (Pf) in monkeys is strongly activated by vagus nerve afferents. The main forebrain target of Pf is the striatum, but the specific striatal regions receiving visceral input via this pathway are unknown. We examined the projections of this region by injecting anterograde tracers into the vagus evoked potential (VEP) focus in Pf of macaque monkeys. The VEP was strongest lateral and anterior to the habenulointerpeduncular tract, but it was distributed across the entire horizontal extent of the ventral half of Pf. All injections produced labeled terminals in the caudate (Cd), especially the Cd tail and the adjacent ventral posterior Pu. Terminations occurred throughout the Cd head and body but spared the most anterior and dorsolateral parts. Injections in more anterior and lateral portions of Pf produced progressively more terminations in Pu, mainly in the precommissural region and the medial aspect of posterior Pu. Dual injections of different tracers revealed overlapping projections with interdigitated strands of striatal terminations from separate regions of Pf as well as the posteromedial to anterolateral topographic gradient of increasing Pf projections to Pu. An injection in the most anteromedial portion of Pf produced strong labeling in the ventral striatum. Thus, Pf transmits viscerosensory information to the "associative" and "limbic" territories of the striatum. These findings suggest the broad involvement of homeostatic afferent activity in striatal function and perhaps a role for the striatum in autonomic function.
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Affiliation(s)
- S Ito
- Atkinson Research Laboratory, Barrow Neurological Institute, Phoenix, Arizona 85013, USA.
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Abstract
Brain stimulation has been receiving increasing attention as an alternative therapy for epilepsy that cannot be treated by either antiepileptic medication or surgical resection of the epileptogenic focus. The stimulation methods include transcranial magnetic stimulation (TMS) or electrical stimulation by implanted devices of the vagus nerve (VNS), deep brain structures (DBS) (thalamic or hippocampal), cerebellar or cortical areas. TMS is the simplest and least invasive approach. However, the most common epileptogenic areas (mesial temporal structures) probably lie too deep beneath the surface of the skull for effective TMS. The efficacy of VNS in reducing the frequency or severity of seizures is quite variable and depends on many factors which are currently investigated. VNS is well-tolerated and approved in many countries. DBS is much more invasive than either TMS or VNS. Currently, a number of targets for DBS are investigated including caudate, centromedian or anterior thalamic nuclei, and subthalamic nucleus. Direct stimulation of the epileptic cortical focus is another approach to the neuromodulation in epilepsy. Finally, another line of research investigates the usefulness of implantable seizure detection devices. The current chapter presents the most important evidence on the above methods. Furthermore, other important issues are reviewed such as the selection criteria of patients for brain stimulation and the potential role of brain stimulation in the treatment of depression in epileptic patients.
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Affiliation(s)
- W H Theodore
- Clinical Epilepsy Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
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