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Borgheai SB, Opri E, Isbaine F, Cole E, Deligani RJ, Laxpati N, Risk BB, Willie JT, Gross RE, Yong NA, McIntyre CC, Miocinovic S. Neural pathway activation in the subthalamic region depends on stimulation polarity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.01.24306044. [PMID: 38746250 PMCID: PMC11092741 DOI: 10.1101/2024.05.01.24306044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD); however, there is limited understanding of which subthalamic pathways are recruited in response to stimulation. Here, by focusing on the polarity of the stimulus waveform (cathodic vs. anodic), our goal was to elucidate biophysical mechanisms that underlie electrical stimulation in the human brain. In clinical studies, cathodic stimulation more easily triggers behavioral responses, but anodic DBS broadens the therapeutic window. This suggests that neural pathways involved respond preferentially depending on stimulus polarity. To experimentally compare the activation of therapeutically relevant pathways during cathodic and anodic subthalamic nucleus (STN) DBS, pathway activation was quantified by measuring evoked potentials resulting from antidromic or orthodromic activation in 15 PD patients undergoing DBS implantation. Cortical evoked potentials (cEP) were recorded using subdural electrocorticography, DBS local evoked potentials (DLEP) were recorded from non-stimulating contacts and EMG activity was recorded from arm and face muscles. We measured: 1) the amplitude of short-latency cEP, previously demonstrated to reflect activation of the cortico-STN hyperdirect pathway, 2) DLEP amplitude thought to reflect activation of STN-globus pallidus (GP) pathway, and 3) amplitudes of very short-latency cEP and motor evoked potentials (mEP) for activation of cortico-spinal/bulbar tract (CSBT). We constructed recruitment and strength-duration curves for each EP/pathway to compare the excitability for different stimulation polarities. We compared experimental data with the most advanced DBS computational models. Our results provide experimental evidence that subcortical cathodic and anodic stimulation activate the same pathways in the STN region and that cathodic stimulation is in general more efficient. However, relative efficiency varies for different pathways so that anodic stimulation is the least efficient in activating CSBT, more efficient in activating the HDP and as efficient as cathodic in activating STN-GP pathway. Our experiments confirm biophysical model predictions regarding neural activations in the central nervous system and provide evidence that stimulus polarity has differential effects on passing axons, terminal synapses, and local neurons. Comparison of experimental results with clinical DBS studies provides further evidence that the hyperdirect pathway may be involved in the therapeutic mechanisms of DBS.
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Bao S, Kim H, Shettigar NB, Li Y, Lei Y. Personalized depth-specific neuromodulation of the human primary motor cortex via ultrasound. J Physiol 2024; 602:933-948. [PMID: 38358314 DOI: 10.1113/jp285613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Non-invasive brain stimulation has the potential to boost neuronal plasticity in the primary motor cortex (M1), but it remains unclear whether the stimulation of both superficial and deep layers of the human motor cortex can effectively promote M1 plasticity. Here, we leveraged transcranial ultrasound stimulation (TUS) to precisely target M1 circuits at depths of approximately 5 mm and 16 mm from the cortical surface. Initially, we generated computed tomography images from each participant's individual anatomical magnetic resonance images (MRI), which allowed for the generation of accurate acoustic simulations. This process ensured that personalized TUS was administered exactly to the targeted depths within M1 for each participant. Using long-term depression and long-term potentiation (LTD/LTP) theta-burst stimulation paradigms, we examined whether TUS over distinct depths of M1 could induce LTD/LTP plasticity. Our findings indicated that continuous theta-burst TUS-induced LTD-like plasticity with both superficial and deep M1 stimulation, persisting for at least 30 min. In comparison, sham TUS did not significantly alter M1 excitability. Moreover, intermittent theta-burst TUS did not result in the induction of LTP- or LTD-like plasticity with either superficial or deep M1 stimulation. These findings suggest that the induction of M1 plasticity can be achieved with ultrasound stimulation targeting distinct depths of M1, which is contingent on the characteristics of TUS. KEY POINTS: The study integrated personalized transcranial ultrasound stimulation (TUS) with electrophysiology to determine whether TUS targeting superficial and deep layers of the human motor cortex (M1) could elicit long-term depression (LTD) or long-term potentiation (LTP) plastic changes. Utilizing acoustic simulations derived from individualized pseudo-computed tomography scans, we ensured the precision of TUS delivery to the intended M1 depths for each participant. Continuous theta-burst TUS targeting both the superficial and deep layers of M1 resulted in the emergence of LTD-like plasticity, lasting for at least 30 min. Administering intermittent theta-burst TUS to both the superficial and deep layers of M1 did not lead to the induction of LTP- or LTD-like plastic changes. We suggest that theta-burst TUS targeting distinct depths of M1 can induce plasticity, but this effect is dependent on specific TUS parameters.
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Affiliation(s)
- Shancheng Bao
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
| | - Hakjoo Kim
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
| | - Nandan B Shettigar
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
- Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Yue Li
- Department of Neuroscience & Experimental Therapeutics, Texas A&M University, College Station, Texas, USA
| | - Yuming Lei
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
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Feys O, Wens V, Rovai A, Schuind S, Rikir E, Legros B, De Tiège X, Gaspard N. Delayed effective connectivity characterizes the epileptogenic zone during stereo-EEG. Clin Neurophysiol 2024; 158:59-68. [PMID: 38183887 DOI: 10.1016/j.clinph.2023.12.013] [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: 09/25/2023] [Revised: 11/11/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE Single-pulse electrical stimulations (SPES) can elicit normal and abnormal responses that might characterize the epileptogenic zone, including spikes, high-frequency oscillations and cortico-cortical evoked potentials (CCEPs). In this study, we investigate their association with the epileptogenic zone during stereoelectroencephalography (SEEG) in 28 patients with refractory focal epilepsy. METHODS Characteristics of CCEPs (distance-corrected or -uncorrected latency, amplitude and the connectivity index) and the occurrence of spikes and ripples were assessed. Responses within the epileptogenic zone and within the non-involved zone were compared using receiver operating characteristics curves and analysis of variance (ANOVA) either in all patients, patients with well-delineated epileptogenic zone, and patients older than 15 years old. RESULTS We found an increase in distance-corrected CCEPs latency after stimulation within the epileptogenic zone (area under the curve = 0.71, 0.72, 0.70, ANOVA significant after false discovery rate correction). CONCLUSIONS The increased distance-corrected CCEPs latency suggests that neuronal propagation velocity is altered within the epileptogenic network. This association might reflect effective connectivity changes at cortico-cortical or cortico-subcortico-cortical levels. Other responses were not associated with the epileptogenic zone, including the CCEPs amplitude, the connectivity index, the occurrences of induced ripples and spikes. The discrepancy with previous descriptions may be explained by different spatial brain sampling between subdural and depth electrodes. SIGNIFICANCE Increased distance-corrected CCEPs latency, indicating delayed effective connectivity, characterizes the epileptogenic zone. This marker could be used to help tailor surgical resection limits after SEEG.
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Affiliation(s)
- Odile Feys
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Neurology, Bruxelles, Belgium; Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroanatomie et Neuroimagerie translationnelles (LN(2)T), Bruxelles, Belgium.
| | - Vincent Wens
- Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroanatomie et Neuroimagerie translationnelles (LN(2)T), Bruxelles, Belgium; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Translational Neuroimaging, Bruxelles, Belgium
| | - Antonin Rovai
- Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroanatomie et Neuroimagerie translationnelles (LN(2)T), Bruxelles, Belgium; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Translational Neuroimaging, Bruxelles, Belgium
| | - Sophie Schuind
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Neurosurgery, Bruxelles, Belgium
| | - Estelle Rikir
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Neurology, Bruxelles, Belgium
| | - Benjamin Legros
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Neurology, Bruxelles, Belgium
| | - Xavier De Tiège
- Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroanatomie et Neuroimagerie translationnelles (LN(2)T), Bruxelles, Belgium; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Translational Neuroimaging, Bruxelles, Belgium
| | - Nicolas Gaspard
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Department of Neurology, Bruxelles, Belgium; Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratory of Experimental Neurology, Bruxelles, Belgium; Yale University, Department of Neurology, New Haven, CT, USA
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Ojeda Valencia G, Gregg NM, Huang H, Lundstrom BN, Brinkmann BH, Pal Attia T, Van Gompel JJ, Bernstein MA, In MH, Huston J, Worrell GA, Miller KJ, Hermes D. Signatures of Electrical Stimulation Driven Network Interactions in the Human Limbic System. J Neurosci 2023; 43:6697-6711. [PMID: 37620159 PMCID: PMC10538586 DOI: 10.1523/jneurosci.2201-22.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health of brain networks. The human limbic network, often targeted for brain stimulation therapy, is involved in emotion and memory processing. Previous anatomic, neurophysiological, and functional studies suggest distinct subsystems within the limbic network (Rolls, 2015). Studies using intracranial electrical stimulation, however, have emphasized the similarities of the evoked waveforms across the limbic network. We test whether these subsystems have distinct stimulation-driven signatures. In eight patients (four male, four female) with drug-resistant epilepsy, we stimulated the limbic system with single-pulse electrical stimulation. Reliable corticocortical evoked potentials (CCEPs) were measured between hippocampus and the posterior cingulate cortex (PCC) and between the amygdala and the anterior cingulate cortex (ACC). However, the CCEP waveform in the PCC after hippocampal stimulation showed a unique and reliable morphology, which we term the "limbic Hippocampus-Anterior nucleus of the thalamus-Posterior cingulate, HAP-wave." This limbic HAP-wave was visually distinct and separately decoded from the CCEP waveform in ACC after amygdala stimulation. Diffusion MRI data show that the measured end points in the PCC overlap with the end points of the parolfactory cingulum bundle rather than the parahippocampal cingulum, suggesting that the limbic HAP-wave may travel through fornix, mammillary bodies, and the anterior nucleus of the thalamus (ANT). This was further confirmed by stimulating the ANT, which evoked the same limbic HAP-wave but with an earlier latency. Limbic subsystems have unique stimulation-evoked signatures that may be used in the future to help network pathology diagnosis.SIGNIFICANCE STATEMENT The limbic system is often compromised in diverse clinical conditions, such as epilepsy or Alzheimer's disease, and characterizing its typical circuit responses may provide diagnostic insight. Stimulation-evoked waveforms have been used in the motor system to diagnose circuit pathology. We translate this framework to limbic subsystems using human intracranial stereo EEG (sEEG) recordings that measure deeper brain areas. Our sEEG recordings describe a stimulation-evoked waveform characteristic to the memory and spatial subsystem of the limbic network that we term the "limbic HAP-wave." The limbic HAP-wave follows anatomic white matter pathways from hippocampus to thalamus to the posterior cingulum and shows promise as a distinct biomarker of signaling in the human brain memory and spatial limbic network.
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Affiliation(s)
- Gabriela Ojeda Valencia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Nicholas M Gregg
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Harvey Huang
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Brian N Lundstrom
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | | | - Tal Pal Attia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Matt A Bernstein
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Myung-Ho In
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - John Huston
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Gregory A Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Kai J Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
- Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
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Campbell BA, Favi Bocca L, Tiefenbach J, Hogue O, Nagel SJ, Rammo R, Escobar Sanabria D, Machado AG, Baker KB. Myogenic and cortical evoked potentials vary as a function of stimulus pulse geometry delivered in the subthalamic nucleus of Parkinson's disease patients. Front Neurol 2023; 14:1216916. [PMID: 37693765 PMCID: PMC10484227 DOI: 10.3389/fneur.2023.1216916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction The therapeutic efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) may be limited for some patients by the presence of stimulation-related side effects. Such effects are most often attributed to electrical current spread beyond the target region. Prior computational modeling studies have suggested that changing the degree of asymmetry of the individual phases of the biphasic, stimulus pulse may allow for more selective activation of neural elements in the target region. To the extent that different neural elements contribute to the therapeutic vs. side-effect inducing effects of DBS, such improved selectivity may provide a new parameter for optimizing DBS to increase the therapeutic window. Methods We investigated the effect of six different pulse geometries on cortical and myogenic evoked potentials in eight patients with PD whose leads were temporarily externalized following STN DBS implant surgery. DBS-cortical evoked potentials were quantified using peak to peak measurements and wavelets and myogenic potentials were quantified using RMS. Results We found that the slope of the recruitment curves differed significantly as a function of pulse geometry for both the cortical- and myogenic responses. Notably, this effect was observed most frequently when stimulation was delivered using a monopolar, as opposed to a bipolar, configuration. Discussion Manipulating pulse geometry results in differential physiological effects at both the cortical and neuromuscular level. Exploiting these differences may help to expand DBS' therapeutic window and support the potential for incorporating pulse geometry as an additional parameter for optimizing therapeutic benefit.
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Affiliation(s)
- Brett A. Campbell
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
| | - Leonardo Favi Bocca
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
| | - Jakov Tiefenbach
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia Hogue
- Center for Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Sean J. Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Richard Rammo
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - David Escobar Sanabria
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G. Machado
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Kenneth B. Baker
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
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Cassar IR, Grill WM. The Therapeutic Frequency Profile of Subthalamic Nucleus Deep Brain Stimulation in Rats Is Shaped by Antidromic Spike Failure. J Neurosci 2023; 43:5114-5127. [PMID: 37328290 PMCID: PMC10324992 DOI: 10.1523/jneurosci.1798-22.2023] [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: 09/20/2022] [Revised: 05/22/2023] [Accepted: 06/10/2023] [Indexed: 06/18/2023] Open
Abstract
The therapeutic mechanisms of subthalamic nucleus (STN) deep brain stimulation (DBS) may depend on antidromic activation of cortex via the hyperdirect pathway. However, hyperdirect pathway neurons cannot reliably follow high-stimulation frequencies, and the spike failure rate appears to correlate with symptom relief as a function of stimulation frequency. We hypothesized that antidromic spike failure contributes to the cortical desynchronization caused by DBS. We measured in vivo evoked cortical activity in female Sprague Dawley rats and developed a computational model of cortical activation from STN DBS. We modeled stochastic antidromic spike failure to determine how spike failure affected the desynchronization of pathophysiological oscillatory activity in cortex. We found that high-frequency STN DBS desynchronized pathologic oscillations via the masking of intrinsic spiking through a combination of spike collision, refractoriness, and synaptic depletion. Antidromic spike failure shaped the parabolic relationship between DBS frequency and cortical desynchronization, with maximum desynchronization at ∼130 Hz. These findings reveal that antidromic spike failure plays a critical role in mediating the dependency of symptom relief on stimulation frequency.SIGNIFICANCE STATEMENT Deep brain stimulation (DBS) is a highly effective neuromodulation therapy, yet it remains uncertain why conventionally used stimulation frequencies (e.g., ∼130 Hz) are optimal. In this study, we demonstrate a potential explanation for the stimulation frequency dependency of DBS through a combination of in vivo experimental measurements and computational modeling. We show that high-frequency stimulation can desynchronize pathologic firing patterns in populations of neurons by inducing an informational lesion. However, sporadic spike failure at these high frequencies limits the efficacy of the informational lesion, yielding a parabolic profile with optimal effects at ∼130 Hz. This work provides a potential explanation for the therapeutic mechanism of DBS, and highlights the importance of considering spike failure in mechanistic models of DBS.
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Affiliation(s)
- Isaac R Cassar
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708
- Departments of Electrical and Computer Engineering, Neurobiology, and Neurosurgery, Duke University, Durham, North Carolina 27708
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7
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Bahners BH, Spooner RK, Hartmann CJ, Schnitzler A, Florin E. Subthalamic stimulation evoked cortical responses relate to motor performance in Parkinson's disease. Brain Stimul 2023; 16:561-563. [PMID: 36878426 DOI: 10.1016/j.brs.2023.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/04/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Rachel K Spooner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Christian J Hartmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany; Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany; Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany.
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Peeters J, Boogers A, Van Bogaert T, Davidoff H, Gransier R, Wouters J, Nuttin B, Mc Laughlin M. Electrophysiologic Evidence That Directional Deep Brain Stimulation Activates Distinct Neural Circuits in Patients With Parkinson Disease. Neuromodulation 2023; 26:403-413. [PMID: 35088733 DOI: 10.1016/j.neurom.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) delivered via multicontact leads implanted in the basal ganglia is an established therapy to treat Parkinson disease (PD). However, the different neural circuits that can be modulated through stimulation on different DBS contacts are poorly understood. Evidence shows that electrically stimulating the subthalamic nucleus (STN) causes a therapeutic effect through antidromic activation of the hyperdirect pathway-a monosynaptic connection from the cortex to the STN. Recent studies suggest that stimulating the substantia nigra pars reticulata (SNr) may improve gait. The advent of directional DBS leads now provides a spatially precise means to probe these neural circuits and better understand how DBS affects distinct neural networks. MATERIALS AND METHODS We measured cortical evoked potentials (EPs) using electroencephalography (EEG) in response to low-frequency DBS using the different directional DBS contacts in eight patients with PD. RESULTS A short-latency EP at 3 milliseconds originating from the primary motor cortex appeared largest in amplitude when stimulating DBS contacts closest to the dorsolateral STN (p < 0.001). A long-latency EP at 10 milliseconds originating from the premotor cortex appeared strongest for DBS contacts closest to the SNr (p < 0.0001). CONCLUSIONS Our results show that at the individual patient level, electrical stimulation of different nuclei produces distinct EP signatures. Our approach could be used to identify the functional location of each DBS contact and thus help patient-specific DBS programming. CLINICAL TRIAL REGISTRATION The ClinicalTrials.gov registration number for the study is NCT04658641.
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Affiliation(s)
- Jana Peeters
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| | - Alexandra Boogers
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Neurology, UZ Leuven, Leuven, Belgium
| | - Tine Van Bogaert
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hannah Davidoff
- Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Robin Gransier
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Bart Nuttin
- Division of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Neurosurgery, UZ Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Krämer SD, Schuhmann MK, Volkmann J, Fluri F. Deep Brain Stimulation in the Subthalamic Nucleus Can Improve Skilled Forelimb Movements and Retune Dynamics of Striatal Networks in a Rat Stroke Model. Int J Mol Sci 2022; 23:ijms232415862. [PMID: 36555504 PMCID: PMC9779486 DOI: 10.3390/ijms232415862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/03/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
Recovery of upper limb (UL) impairment after stroke is limited in stroke survivors. Since stroke can be considered as a network disorder, neuromodulation may be an approach to improve UL motor dysfunction. Here, we evaluated the effect of high-frequency stimulation (HFS) of the subthalamic nucleus (STN) in rats on forelimb grasping using the single-pellet reaching (SPR) test after stroke and determined costimulated brain regions during STN-HFS using 2-[18F]Fluoro-2-deoxyglucose-([18F]FDG)-positron emission tomography (PET). After a 4-week training of SPR, photothrombotic stroke was induced in the sensorimotor cortex of the dominant hemisphere. Thereafter, an electrode was implanted in the STN ipsilateral to the infarction, followed by a continuous STN-HFS or sham stimulation for 7 days. On postinterventional day 2 and 7, an SPR test was performed during STN-HFS. Success rate of grasping was compared between these two time points. [18F]FDG-PET was conducted on day 2 and 3 after stroke, without and with STN-HFS, respectively. STN-HFS resulted in a significant improvement of SPR compared to sham stimulation. During STN-HFS, a significantly higher [18F]FDG-uptake was observed in the corticosubthalamic/pallidosubthalamic circuit, particularly ipsilateral to the stimulated side. Additionally, STN-HFS led to an increased glucose metabolism within the brainstem. These data demonstrate that STN-HFS supports rehabilitation of skilled forelimb movements, probably by retuning dysfunctional motor centers within the cerebral network.
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Affiliation(s)
- Stefanie D. Krämer
- Radiopharmaceutical Sciences/Biopharmacy, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Michael K. Schuhmann
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080 Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080 Würzburg, Germany
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080 Würzburg, Germany
- Correspondence: author: ; Tel.: +49-931-201-23653
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Campbell BA, Favi Bocca L, Escobar Sanabria D, Almeida J, Rammo R, Nagel SJ, Machado AG, Baker KB. The impact of pulse timing on cortical and subthalamic nucleus deep brain stimulation evoked potentials. Front Hum Neurosci 2022; 16:1009223. [PMID: 36204716 PMCID: PMC9532054 DOI: 10.3389/fnhum.2022.1009223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
The impact of pulse timing is an important factor in our understanding of how to effectively modulate the basal ganglia thalamocortical (BGTC) circuit. Single pulse low-frequency DBS-evoked potentials generated through electrical stimulation of the subthalamic nucleus (STN) provide insight into circuit activation, but how the long-latency components change as a function of pulse timing is not well-understood. We investigated how timing between stimulation pulses delivered in the STN region influence the neural activity in the STN and cortex. DBS leads implanted in the STN of five patients with Parkinson's disease were temporarily externalized, allowing for the delivery of paired pulses with inter-pulse intervals (IPIs) ranging from 0.2 to 10 ms. Neural activation was measured through local field potential (LFP) recordings from the DBS lead and scalp EEG. DBS-evoked potentials were computed using contacts positioned in dorsolateral STN as determined through co-registered post-operative imaging. We quantified the degree to which distinct IPIs influenced the amplitude of evoked responses across frequencies and time using the wavelet transform and power spectral density curves. The beta frequency content of the DBS evoked responses in the STN and scalp EEG increased as a function of pulse-interval timing. Pulse intervals <1.0 ms apart were associated with minimal to no change in the evoked response. IPIs from 1.5 to 3.0 ms yielded a significant increase in the evoked response, while those >4 ms produced modest, but non-significant growth. Beta frequency activity in the scalp EEG and STN LFP response was maximal when IPIs were between 1.5 and 4.0 ms. These results demonstrate that long-latency components of DBS-evoked responses are pre-dominantly in the beta frequency range and that pulse interval timing impacts the level of BGTC circuit activation.
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Affiliation(s)
- Brett A. Campbell
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Leonardo Favi Bocca
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - David Escobar Sanabria
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Julio Almeida
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Richard Rammo
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sean J. Nagel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G. Machado
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kenneth B. Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Kenneth B. Baker
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11
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Siebner HR, Funke K, Aberra AS, Antal A, Bestmann S, Chen R, Classen J, Davare M, Di Lazzaro V, Fox PT, Hallett M, Karabanov AN, Kesselheim J, Beck MM, Koch G, Liebetanz D, Meunier S, Miniussi C, Paulus W, Peterchev AV, Popa T, Ridding MC, Thielscher A, Ziemann U, Rothwell JC, Ugawa Y. Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper. Clin Neurophysiol 2022; 140:59-97. [PMID: 35738037 PMCID: PMC9753778 DOI: 10.1016/j.clinph.2022.04.022] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/14/2022] [Accepted: 04/15/2022] [Indexed: 12/11/2022]
Abstract
Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool.
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Affiliation(s)
- Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Klaus Funke
- Department of Neurophysiology, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - Aman S Aberra
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Sven Bestmann
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Robert Chen
- Krembil Brain Institute, University Health Network and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Marco Davare
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Anke N Karabanov
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Nutrition and Exercise, University of Copenhagen, Copenhagen, Denmark
| | - Janine Kesselheim
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mikkel M Beck
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Non-invasive Brain Stimulation Unit, Laboratorio di NeurologiaClinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Sabine Meunier
- Sorbonne Université, Faculté de Médecine, INSERM U 1127, CNRS 4 UMR 7225, Institut du Cerveau, F-75013, Paris, France
| | - Carlo Miniussi
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di DioFatebenefratelli, Brescia, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Angel V Peterchev
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA; Department of Electrical & Computer Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, School of Medicine, Duke University, Durham, NC, USA
| | - Traian Popa
- Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Michael C Ridding
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ulf Ziemann
- Department of Neurology & Stroke, University Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yoshikazu Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Centre, Advanced Clinical Research Centre, Fukushima Medical University, Fukushima, Japan
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12
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Dale J, Schmidt SL, Mitchell K, Turner DA, Grill WM. Evoked potentials generated by deep brain stimulation for Parkinson's disease. Brain Stimul 2022; 15:1040-1047. [DOI: 10.1016/j.brs.2022.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/18/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
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13
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Cassar IR, Grill WM. The cortical evoked potential corresponds with deep brain stimulation efficacy in rats. J Neurophysiol 2022; 127:1253-1268. [PMID: 35389751 PMCID: PMC9054265 DOI: 10.1152/jn.00353.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 01/21/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) antidromically activates the motor cortex (M1), and this cortical activation appears to play a role in the treatment of hypokinetic motor behaviors (Gradinaru V, Mogri M, Thompson KR, Henderson JM, Deisseroth K. Science 324: 354-359, 2009; Yu C, Cassar IR, Sambangi J, Grill WM. J Neurosci 40: 4323-4334, 2020). The synchronous antidromic activation takes the form of a short-latency cortical evoked potential (cEP) in electrocorticography (ECoG) recordings of M1. We assessed the utility of the cEP as a biomarker for STN DBS in unilateral 6-hydroxydopamine-lesioned female Sprague Dawley rats, with stimulating electrodes implanted in the STN and the ECoG recorded above M1. We quantified the correlations of the cEP magnitude and latency with changes in motor behavior from DBS and compared them to the correlation between motor behaviors and several commonly used spectral-based biomarkers. The cEP features correlated strongly with motor behaviors and were highly consistent across animals, whereas the spectral biomarkers correlated weakly with motor behaviors and were highly variable across animals. The cEP may thus be a useful biomarker for assessing the therapeutic efficacy of DBS parameters, as its features strongly correlate with motor behavior, it is consistent across time and subjects, it can be recorded under anesthesia, and it is simple to quantify with a large signal-to-noise ratio, enabling rapid, real-time evaluation. Additionally, our work provides further evidence that antidromic cortical activation mediates changes in motor behavior from STN DBS and that the dependence of DBS efficacy on stimulation frequency may be related to antidromic spike failure.NEW & NOTEWORTHY We characterize a new potential biomarker for deep brain stimulation (DBS), the cortical evoked potential (cEP), and demonstrate that it exhibits a robust correlation with motor behaviors as a function of stimulation frequency. The cEP may thus be a useful clinical biomarker for changes in motor behavior. This work also provides insight into the cortical mechanisms of DBS, suggesting that motor behaviors are strongly affected by the rate of antidromic spike failure during DBS.
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Affiliation(s)
- Isaac R Cassar
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Department of Neurobiology, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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14
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Bingham CS, McIntyre CC. Subthalamic deep brain stimulation of an anatomically detailed model of the human hyperdirect pathway. J Neurophysiol 2022; 127:1209-1220. [PMID: 35320026 PMCID: PMC9054256 DOI: 10.1152/jn.00004.2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
The motor hyperdirect pathway (HDP) is considered a key target in the treatment of Parkinson's disease with subthalamic deep brain stimulation (DBS). This hypothesis is partially derived from the association of HDP activation with evoked potentials (EPs) generated in the motor cortex and subthalamic nucleus (STN) after a DBS pulse. However, the biophysical details of how and when DBS-induced action potentials (APs) in HDP neurons reach their terminations in the cortex or STN remain unclear. Therefore, we used an anatomically detailed representation of the motor HDP, as well as the internal capsule (IC), in a model of human subthalamic DBS to explore AP activation and transmission in the HDP and IC. Our results show that small diameter HDP axons exhibited AP initiation in their subthalamic terminal arbor, which resulted in relatively long transmission latencies to cortex (∼3.5-8 ms). Alternatively, large diameter HDP axons were most likely to be directly activated in the capsular region, which resulted in short transmission times to the cortex (∼1-3 ms). However, those large diameter HDP antidromic APs would be indistinguishable from any other IC axons that were also activated by the stimulus. Conversely, DBS-induced APs in both small and large diameter HDP axons reached their synaptic boutons in the STN with similar timings, but both spanned a wide temporal range (∼0.5-5 ms). We also found that using anodic or bipolar stimulation helped to bias activation of the HDP over the IC. These computational results provide useful information for linking HDP activation with EP recordings in clinical experiments.NEW & NOTEWORTHY We used biophysical models to study pathway recruitment and conduction latencies of the hyperdirect pathway (HDP) in response to subthalamic deep brain stimulation (DBS). The model system allowed us to assess the influence of increased anatomical realism on pathway activity and the possibility of identifying HDP activity in evoked potentials (EPs) recorded in either the subthalamic nucleus (STN) or cortex. The model predicts that HDP activation is accentuated by complex axonal branching in the STN.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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15
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Hyperdirect connectivity of opercular speech network to the subthalamic nucleus. Cell Rep 2022; 38:110477. [PMID: 35263607 PMCID: PMC8971827 DOI: 10.1016/j.celrep.2022.110477] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/18/2022] Open
Abstract
How the basal ganglia participate in the uniquely human behavior of speech is poorly understood, despite their known role in modulating critical aspects of cognitive and motor behavior. The subthalamic nucleus (STN) is well positioned to facilitate basal ganglia functions critical for speech. Using electrocorticography in patients undergoing awake deep brain stimulation (DBS) surgery, evidence is reported for a left opercular hyperdirect pathway in humans via stimulating the STN and examining antidromic-evoked activity in the left temporal, parietal, and frontal opercular cortex. These high-resolution cortical and subcortical mapping data provide evidence for hyperdirect connectivity between the inferior frontal gyrus and the STN. In addition, evoked potential data are consistent with the presence of monosynaptic projections from areas of the opercular ections may be unique to humans, evolving alongside the ability for speech. Using electrical stimulation of the subthalamic nucleus and simultaneous cortical recordings in individuals undergoing deep brain stimulation, Jorge et al. provide electrophysiological evidence for a hyperdirect pathway to the basal ganglia from cortical areas that control sensory and motor-planning aspects of speech.
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16
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Bahners BH, Waterstraat G, Kannenberg S, Curio G, Schnitzler A, Nikulin V, Florin E. Electrophysiological characterization of the hyperdirect pathway and its functional relevance for subthalamic deep brain stimulation. Exp Neurol 2022; 352:114031. [PMID: 35247373 DOI: 10.1016/j.expneurol.2022.114031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
The subthalamic nucleus (STN) receives input from various cortical areas via hyperdirect pathway (HDP) which bypasses the basal-ganglia loop. Recently, the HDP has gained increasing interest, because of its relevance for STN deep brain stimulation (DBS). To understand the HDP's role cortical responses evoked by STN-DBS have been investigated. These responses have short (<2 ms), medium (2-15 ms), and long (20-70 ms) latencies. Medium-latency responses are supposed to represent antidromic cortical activations via HDP. Together with long-latency responses the medium responses can potentially be used as biomarker of DBS efficacy as well as side effects. We here propose that the activation sequence of the cortical evoked responses can be conceptualized as high frequency oscillations (HFO) for signal analysis. HFO might therefore serve as marker for antidromic activation. Using existing knowledge on HFO recordings, this approach allows data analyses and physiological modeling to advance the pathophysiological understanding of cortical DBS-evoked high-frequency activity.
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Affiliation(s)
- Bahne Hendrik Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gunnar Waterstraat
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurophysics Group, Department of Neurology, Berlin, Germany
| | - Silja Kannenberg
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gabriel Curio
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurophysics Group, Department of Neurology, Berlin, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Vadim Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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17
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Sand D, Arkadir D, Abu Snineh M, Marmor O, Israel Z, Bergman H, Hassin-Baer S, Israeli-Korn S, Peremen Z, Geva AB, Eitan R. Deep Brain Stimulation Can Differentiate Subregions of the Human Subthalamic Nucleus Area by EEG Biomarkers. Front Syst Neurosci 2021; 15:747681. [PMID: 34744647 PMCID: PMC8565520 DOI: 10.3389/fnsys.2021.747681] [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: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Precise lead localization is crucial for an optimal clinical outcome of subthalamic nucleus (STN) deep brain stimulation (DBS) treatment in patients with Parkinson's disease (PD). Currently, anatomical measures, as well as invasive intraoperative electrophysiological recordings, are used to locate DBS electrodes. The objective of this study was to find an alternative electrophysiology tool for STN DBS lead localization. Methods: Sixty-one postoperative electrophysiology recording sessions were obtained from 17 DBS-treated patients with PD. An intraoperative physiological method automatically detected STN borders and subregions. Postoperative EEG cortical activity was measured, while STN low frequency stimulation (LFS) was applied to different areas inside and outside the STN. Machine learning models were used to differentiate stimulation locations, based on EEG analysis of engineered features. Results: A machine learning algorithm identified the top 25 evoked response potentials (ERPs), engineered features that can differentiate inside and outside STN stimulation locations as well as within STN stimulation locations. Evoked responses in the medial and ipsilateral fronto-central areas were found to be most significant for predicting the location of STN stimulation. Two-class linear support vector machine (SVM) predicted the inside (dorso-lateral region, DLR, and ventro-medial region, VMR) vs. outside [zona incerta, ZI, STN stimulation classification with an accuracy of 0.98 and 0.82 for ZI vs. VMR and ZI vs. DLR, respectively, and an accuracy of 0.77 for the within STN (DLR vs. VMR)]. Multiclass linear SVM predicted all areas with an accuracy of 0.82 for the outside and within STN stimulation locations (ZI vs. DLR vs. VMR). Conclusions: Electroencephalogram biomarkers can use low-frequency STN stimulation to localize STN DBS electrodes to ZI, DLR, and VMR STN subregions. These models can be used for both intraoperative electrode localization and postoperative stimulation programming sessions, and have a potential to improve STN DBS clinical outcomes.
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Affiliation(s)
- Daniel Sand
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel.,Edmond and Lily Safra Center for Brain Research, Hebrew University of Jerusalem, Jerusalem, Israel.,Elminda Ltd., Herzliya, Israel
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Muneer Abu Snineh
- Department of Neurology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Odeya Marmor
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zvi Israel
- Brain Division, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel.,Edmond and Lily Safra Center for Brain Research, Hebrew University of Jerusalem, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Hassin-Baer
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simon Israeli-Korn
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Amir B Geva
- Department of Electrical and Computer Engineering, Ben Gurion University, Beer-Sheva, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel.,Brain Division, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Neuropsychiatry Unit, Jerusalem Mental Health Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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18
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Ma KY, Cai XY, Wang XT, Wang ZX, Huang WM, Wu ZY, Feng ZY, Shen Y. Three-Dimensional Heterogeneity of Cerebellar Interposed Nucleus-Recipient Zones in the Thalamic Nuclei. Neurosci Bull 2021; 37:1529-1541. [PMID: 34609736 DOI: 10.1007/s12264-021-00780-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
The cerebellum is conceptualized as a processor of complex movements and is also endowed with roles in cognitive and emotional behaviors. Although the axons of deep cerebellar nuclei are known to project to primary thalamic nuclei, macroscopic investigation of the characteristics of these projections, such as the spatial distribution of recipient zones, is lacking. Here, we studied the output of the cerebellar interposed nucleus (IpN) to the ventrolateral (VL) and centrolateral (CL) thalamic nuclei using electrophysiological recording in vivo and trans-synaptic viral tracing. We found that IpN stimulation induced mono-synaptic evoked potentials (EPs) in the VL but not the CL region. Furthermore, both the EPs induced by the IpN and the innervation of IpN projections displayed substantial heterogeneity across the VL region in three-dimensional space. These findings indicate that the recipient zones of IpN inputs vary between and within thalamic nuclei and may differentially control thalamo-cortical networks.
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Affiliation(s)
- Kuang-Yi Ma
- Department of Physiology and Department of Neurology of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Xin-Yu Cai
- Department of Physiology and Department of Neurology of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Xin-Tai Wang
- Department of Physiology and Department of Neurology of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zhao-Xiang Wang
- Key Laboratory of Biomedical Engineering of the Ministry of Education, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou, 310013, China
| | - Wan-Meng Huang
- Department of Physiology and Department of Neurology of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in the Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zhou-Yan Feng
- Key Laboratory of Biomedical Engineering of the Ministry of Education, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou, 310013, China
| | - Ying Shen
- Department of Physiology and Department of Neurology of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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19
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Bingham CS, Parent M, McIntyre CC. Histology-driven model of the macaque motor hyperdirect pathway. Brain Struct Funct 2021; 226:2087-2097. [PMID: 34091730 DOI: 10.1007/s00429-021-02307-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
Emerging appreciation for the hyperdirect pathway (HDP) as an important cortical glutamatergic input to the subthalamic nucleus (STN) has motivated a wide range of recent investigations on its role in motor control, as well as the mechanisms of subthalamic deep brain stimulation (DBS). However, the pathway anatomy and terminal arbor morphometry by which the HDP links cortical and subthalamic activity are incompletely understood. One critical hindrance to advancing understanding is the lack of anatomically detailed population models which can help explain how HDP pathway anatomy and neuronal biophysics give rise to spatiotemporal patterns of stimulus-response activity observed in vivo. Therefore, the goal of this study was to establish a population model of motor HDP axons through application of generative algorithms constrained by recent histology and imaging data. The products of this effort include a de novo macaque brain atlas, detailed statistical analysis of histological reconstructions of macaque motor HDP axons, and the generation of 10,000 morphometrically constrained synthetic motor HDP axons. The synthetic HDP axons exhibited a 3.8% mean error with respect to parametric distributions of the fiber target volume, total length, number of bifurcations, bifurcation angles, meander angles, and segment lengths measured in BDA-labeled HDP axon reconstructions. As such, this large population of synthetic motor HDP axons represents an anatomically based foundation for biophysical simulations that can be coupled to electrophysiological and/or behavioral measurements, with the goal of better understanding the role of the HDP in motor system activity.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Case Western Reserve University, 2103 Cornell Road, Rm 6224, Cleveland, OH, 44106, USA
| | - Martin Parent
- CERVO Brain Research Center, Department of Psychiatry and Neuroscience, Faculty of Medicine, University of Laval, Quebec, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, 2103 Cornell Road, Rm 6224, Cleveland, OH, 44106, USA.
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20
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Farokhniaee A, Lowery MM. Cortical network effects of subthalamic deep brain stimulation in a thalamo-cortical microcircuit model. J Neural Eng 2021; 18. [DOI: 10.1088/1741-2552/abee50] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/12/2021] [Indexed: 11/12/2022]
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21
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Wasserman D, Valero-Cabré A, Dali M, Stengel C, Boyer A, Rheault F, Bonnetblanc F, Mandonnet E. Axono-cortical evoked potentials as a new method of IONM for preserving the motor control network: a first study in three cases. Acta Neurochir (Wien) 2021; 163:919-935. [PMID: 33161475 DOI: 10.1007/s00701-020-04636-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND White matter stimulation in an awake patient is currently the gold standard for identification of functional pathways. Despite the robustness and reproducibility of this method, very little is known about the electrophysiological mechanisms underlying the functional disruption. Axono-cortical evoked potentials (ACEPs) provide a reliable technique to explore these mechanisms. OBJECTIVE To describe the shape and spatial patterns of ACEPs recorded when stimulating the white matter of the caudal part of the right superior frontal gyrus while recording in the precentral gyrus. METHODS We report on three patients operated on under awake condition for a right superior frontal diffuse low-grade glioma. Functional sites were identified in the posterior wall of the cavity, whose 2-3-mA stimulation generated an arrest of movement. Once the resection was done, axono-cortical potentials were evoked: recording electrodes were put over the precentral gyrus, while stimulating at 1 Hz the white matter functional sites during 30-60 s. Unitary evoked potentials were averaged off-line. Waveform was visually analyzed, defining peaks and troughs, with quantitative measurements of their amplitudes and latencies. Spatial patterns of ACEPs were compared with patients' own and HCP-derived structural connectomics. RESULTS Axono-cortical evoked potentials (ACEPs) were obtained and exhibited complex shapes and spatial patterns that correlated only partially with structural connectivity patterns. CONCLUSION ACEPs is a new IONM methodology that could both contribute to elucidate the propagation of neuronal activity within a distributed network when stimulating white matter and provide a new technique for preserving motor control abilities during brain tumor resections.
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Affiliation(s)
- Demian Wasserman
- Parietal, Inria Saclay Ile-de-France, CEA, Université Paris-Sud, Palaiseau, France
| | | | - Mélissa Dali
- Institut Neuro-PSI - UMR 9197, CNRS, Université Paris-Saclay, Gif-Sur-Yvette, France
- Department of Neurosurgery, Lariboisière Hospital, APHP, 2 rue Ambroise Paré, 75010, Paris, France
| | - Chloé Stengel
- Frontlab, Institut du Cerveau, CNRS UMR 7225, INSERM U1127, Paris, France
| | - Anthony Boyer
- Brain Stimulation and Systems Neuroscience, INSERM U1216, Grenoble, France
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab, Department of Computer Science, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Emmanuel Mandonnet
- Frontlab, Institut du Cerveau, CNRS UMR 7225, INSERM U1127, Paris, France.
- Department of Neurosurgery, Lariboisière Hospital, APHP, 2 rue Ambroise Paré, 75010, Paris, France.
- Université de Paris, Paris, France.
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22
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Howell B, Isbaine F, Willie JT, Opri E, Gross RE, De Hemptinne C, Starr PA, McIntyre CC, Miocinovic S. Image-based biophysical modeling predicts cortical potentials evoked with subthalamic deep brain stimulation. Brain Stimul 2021; 14:549-563. [PMID: 33757931 DOI: 10.1016/j.brs.2021.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Subthalamic deep brain stimulation (DBS) is an effective surgical treatment for Parkinson's disease and continues to advance technologically with an enormous parameter space. As such, in-silico DBS modeling systems have become common tools for research and development, but their underlying methods have yet to be standardized and validated. OBJECTIVE Evaluate the accuracy of patient-specific estimates of neural pathway activations in the subthalamic region against intracranial, cortical evoked potential (EP) recordings. METHODS Pathway activations were modeled in eleven patients using the latest advances in connectomic modeling of subthalamic DBS, focusing on the hyperdirect pathway (HDP) and corticospinal/bulbar tract (CSBT) for their relevance in human research studies. Correlations between pathway activations and respective EP amplitudes were quantified. RESULTS Good model performance required accurate lead localization and image fusions, as well as appropriate selection of fiber diameter in the biophysical model. While optimal model parameters varied across patients, good performance could be achieved using a global set of parameters that explained 60% and 73% of electrophysiologic activations of CSBT and HDP, respectively. Moreover, restricted models fit to only EP amplitudes of eight standard (monopolar and bipolar) electrode configurations were able to extrapolate variation in EP amplitudes across other directional electrode configurations and stimulation parameters, with no significant reduction in model performance across the cohort. CONCLUSIONS Our findings demonstrate that connectomic models of DBS with sufficient anatomical and electrical details can predict recruitment dynamics of white matter. These results will help to define connectomic modeling standards for preoperative surgical targeting and postoperative patient programming applications.
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Affiliation(s)
- Bryan Howell
- Department of Biomedical Engineering, Case Western Reserve University, USA
| | | | - Jon T Willie
- Department of Neurosurgery, Emory University, USA
| | - Enrico Opri
- Department of Neurology, Emory University, USA
| | | | | | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, USA
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23
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Gronlier E, Vendramini E, Volle J, Wozniak-Kwasniewska A, Antón Santos N, Coizet V, Duveau V, David O. Single-pulse electrical stimulation methodology in freely moving rat. J Neurosci Methods 2021; 353:109092. [PMID: 33549638 DOI: 10.1016/j.jneumeth.2021.109092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEP) are becoming popular to infer brain connectivity and cortical excitability in implanted refractory epilepsy patients. Our goal was to transfer this methodology to the freely moving rodent. NEW METHOD CCEP were recorded on freely moving Sprague-Dawley rats, from cortical and subcortical areas using depth electrodes. Electrical stimulation was applied using 1 ms biphasic current pulse, cathodic first, at a frequency of 0.5 Hz, with intensities ranging from 0.2 to 0.8 mA. Data were then processed in a similar fashion to human clinical studies, which included epoch selection, artefact correction and smart averaging. RESULTS For a large range of tested intensities, we recorded CCEPs with very good signal to noise ratio and reproducibility between animals, without any behavioral modification. The CCEP were composed of different components according to recorded and stimulated sites, similarly to human recordings. COMPARISON WITH EXISTING METHODS We minimally adapted a clinically-motivated methodology to a freely moving rodent model to achieve high translational relevance of future preclinical studies. CONCLUSIONS Our results indicate that the CCEP methodology can be applied to freely moving rodents and transferred to preclinical research. This will be of interest to address various neuroscientific questions, in physiological and pathological conditions.
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Affiliation(s)
- Eloïse Gronlier
- SynapCell SAS, Saint-Ismier, France; Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, Grenoble, France.
| | - Estelle Vendramini
- Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, Grenoble, France
| | | | | | - Noelia Antón Santos
- Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, Grenoble, France
| | - Véronique Coizet
- Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, Grenoble, France
| | | | - Olivier David
- Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, Grenoble, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
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24
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Escobar Sanabria D, Johnson LA, Yu Y, Busby Z, Nebeck S, Zhang J, Harel N, Johnson MD, Molnar GF, Vitek JL. Real-time suppression and amplification of frequency-specific neural activity using stimulation evoked oscillations. Brain Stimul 2020; 13:1732-1742. [PMID: 33035727 PMCID: PMC7722151 DOI: 10.1016/j.brs.2020.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Approaches to predictably control neural oscillations are needed to understand their causal role in brain function in healthy or diseased states and to advance the development of neuromodulation therapies. OBJECTIVE We present a closed-loop neural control and optimization framework to actively suppress or amplify low-frequency neural oscillations observed in local field potentials in real-time by using electrical stimulation. The rationale behind this control approach and our working hypothesis is that neural oscillatory activity evoked by electrical pulses can suppress or amplify spontaneous oscillations via destructive or constructive interference when the pulses are continuously delivered with appropriate amplitudes and at precise phases of the modulated oscillations in a closed-loop scheme. METHODS We tested our hypothesis in two nonhuman primates that exhibited a robust increase in low-frequency (8-30 Hz) oscillatory power in the subthalamic nucleus (STN) following administration of the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). To test our neural control approach, we targeted 8-17 Hz oscillations and used electrode arrays and electrical stimulation waveforms similar to those used in humans chronically implanted with brain stimulation systems. Stimulation parameters that maximize the suppression or amplification of neural oscillations were predicted using mathematical models of the stimulation evoked oscillations. RESULTS Our neural control and optimization approach was capable of actively and robustly suppressing or amplifying oscillations in the targeted frequency band (8-17 Hz) in real-time in the studied subjects. CONCLUSIONS The results from this study support our hypothesis and suggest that the proposed neural control framework allows one to characterize in controlled experiments the functional role of frequency-specific neural oscillations by using electrodes and stimulation waveforms currently being employed in humans.
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Affiliation(s)
| | - Luke A Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Ying Yu
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Zachary Busby
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Shane Nebeck
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jianyu Zhang
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Noam Harel
- Department of Radiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Gregory F Molnar
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA.
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25
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Kumaravelu K, Tomlinson T, Callier T, Sombeck J, Bensmaia SJ, Miller LE, Grill WM. A comprehensive model-based framework for optimal design of biomimetic patterns of electrical stimulation for prosthetic sensation. J Neural Eng 2020; 17:046045. [PMID: 32759488 PMCID: PMC8559728 DOI: 10.1088/1741-2552/abacd8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Touch and proprioception are essential to motor function as shown by the movement deficits that result from the loss of these senses, e.g. due to neuropathy of sensory nerves. To achieve a high-performance brain-controlled prosthetic arm/hand thus requires the restoration of somatosensation, perhaps through intracortical microstimulation (ICMS) of somatosensory cortex (S1). The challenge is to generate patterns of neuronal activation that evoke interpretable percepts. We present a framework to design optimal spatiotemporal patterns of ICMS (STIM) that evoke naturalistic patterns of neuronal activity and demonstrate performance superior to four previous approaches. APPROACH We recorded multiunit activity from S1 during a center-out reach task (from proprioceptive neurons in Brodmann's area 2) and during application of skin indentations (from cutaneous neurons in Brodmann's area 1). We implemented a computational model of a cortical hypercolumn and used a genetic algorithm to design STIM that evoked patterns of model neuron activity that mimicked their experimentally-measured counterparts. Finally, from the ICMS patterns, the evoked neuronal activity, and the stimulus parameters that gave rise to it, we trained a recurrent neural network (RNN) to learn the mapping function between the physical stimulus and the biomimetic stimulation pattern, i.e. the sensory encoder to be integrated into a neuroprosthetic device. MAIN RESULTS We identified ICMS patterns that evoked simulated responses that closely approximated the measured responses for neurons within 50 µm of the electrode tip. The RNN-based sensory encoder generalized well to untrained limb movements or skin indentations. STIM designed using the model-based optimization approach outperformed STIM designed using existing linear and nonlinear mappings. SIGNIFICANCE The proposed framework produces an encoder that converts limb state or patterns of pressure exerted onto the prosthetic hand into STIM that evoke naturalistic patterns of neuronal activation.
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Affiliation(s)
| | | | - Thierri Callier
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Joseph Sombeck
- Department of Biomedical Engineering, Northwestern University, Chicago, IL
| | - Sliman J. Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Lee E. Miller
- Department of Biomedical Engineering, Northwestern University, Chicago, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Deptartment of Physiology, Northwestern University, Chicago, IL
| | - Warren M. Grill
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
- Department of Neurobiology, Duke University, Durham, NC
- Department of Neurosurgery, Duke University, Durham, NC
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26
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Weaver KE, Caldwell DJ, Cronin JA, Kuo CH, Kogan M, Houston B, Sanchez V, Martinez V, Ojemann JG, Rane S, Ko AL. Concurrent Deep Brain Stimulation Reduces the Direct Cortical Stimulation Necessary for Motor Output. Mov Disord 2020; 35:2348-2353. [PMID: 32914888 DOI: 10.1002/mds.28255] [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: 03/06/2020] [Revised: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Converging literatures suggest that deep brain stimulation (DBS) in Parkinson's disease affects multiple circuit mechanisms. One proposed mechanism is the normalization of primary motor cortex (M1) pathophysiology via effects on the hyperdirect pathway. OBJECTIVES We hypothesized that DBS would reduce the current intensity necessary to modulate motor-evoked potentials from focally applied direct cortical stimulation (DCS). METHODS Intraoperative subthalamic DBS, DCS, and preoperative diffusion tensor imaging data were acquired in 8 patients with Parkinson's disease. RESULTS In 7 of 8 patients, DBS significantly reduced the M1 DCS current intensity required to elicit motor-evoked potentials. This neuromodulation was specific to select DBS bipolar configurations. In addition, the volume of activated tissue models of these configurations were significantly associated with overlap of the hyperdirect pathway. CONCLUSIONS DBS reduces the current necessary to elicit a motor-evoked potential using DCS. This supports a circuit mechanism of DBS effectiveness, potentially involving the hyperdirect pathway that speculatively may underlie reductions in hypokinetic abnormalities in Parkinson's disease. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kurt E Weaver
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Graduate Program in Neuroscience, University of Washington School of Medicine, Seattle, Washington, USA.,Center for NeuroTechnologies, University of Washington School of Medicine, Seattle, Washington, USA
| | - David J Caldwell
- Graduate Program in Neuroscience, University of Washington School of Medicine, Seattle, Washington, USA.,Department of BioEngineering, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeneva A Cronin
- Graduate Program in Neuroscience, University of Washington School of Medicine, Seattle, Washington, USA.,Department of BioEngineering, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Michael Kogan
- Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - Brady Houston
- Dept of Electrical Engineering, University of Washington School of Medicine, Seattle, Washington, USA
| | - Victor Sanchez
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vicente Martinez
- Department of Rehabilitative Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Graduate Program in Neuroscience, University of Washington School of Medicine, Seattle, Washington, USA.,Center for NeuroTechnologies, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Swati Rane
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew L Ko
- Graduate Program in Neuroscience, University of Washington School of Medicine, Seattle, Washington, USA.,Center for NeuroTechnologies, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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27
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Ramirez-Zamora A, Giordano J, Gunduz A, Alcantara J, Cagle JN, Cernera S, Difuntorum P, Eisinger RS, Gomez J, Long S, Parks B, Wong JK, Chiu S, Patel B, Grill WM, Walker HC, Little SJ, Gilron R, Tinkhauser G, Thevathasan W, Sinclair NC, Lozano AM, Foltynie T, Fasano A, Sheth SA, Scangos K, Sanger TD, Miller J, Brumback AC, Rajasethupathy P, McIntyre C, Schlachter L, Suthana N, Kubu C, Sankary LR, Herrera-Ferrá K, Goetz S, Cheeran B, Steinke GK, Hess C, Almeida L, Deeb W, Foote KD, Okun MS. Proceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and Technology. Front Hum Neurosci 2020; 14:54. [PMID: 32292333 PMCID: PMC7134196 DOI: 10.3389/fnhum.2020.00054] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
The Seventh Annual Deep Brain Stimulation (DBS) Think Tank held on September 8th of 2019 addressed the most current: (1) use and utility of complex neurophysiological signals for development of adaptive neurostimulation to improve clinical outcomes; (2) Advancements in recent neuromodulation techniques to treat neuropsychiatric disorders; (3) New developments in optogenetics and DBS; (4) The use of augmented Virtual reality (VR) and neuromodulation; (5) commercially available technologies; and (6) ethical issues arising in and from research and use of DBS. These advances serve as both "markers of progress" and challenges and opportunities for ongoing address, engagement, and deliberation as we move to improve the functional capabilities and translational value of DBS. It is in this light that these proceedings are presented to inform the field and initiate ongoing discourse. As consistent with the intent, and spirit of this, and prior DBS Think Tanks, the overarching goal is to continue to develop multidisciplinary collaborations to rapidly advance the field and ultimately improve patient outcomes.
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Affiliation(s)
- Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - James Giordano
- Departments of Neurology and Biochemistry, and Neuroethics Studies Program—Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Jose Alcantara
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Jackson N. Cagle
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Stephanie Cernera
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Parker Difuntorum
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Robert S. Eisinger
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Julieth Gomez
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Sarah Long
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Brandon Parks
- J. Crayton Pruitt Family Department of Biomedical Engineering, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Shannon Chiu
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Bhavana Patel
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Warren M. Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Harrison C. Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Simon J. Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Ro’ee Gilron
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and the University of Bern, Bern, Switzerland
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom
| | - Wesley Thevathasan
- Department of Neurology, The Royal Melbourne and Austin Hospitals, University of Melbourne, Melbourne, VIC, Australia
- Medical Bionics Department, University of Melbourne, East Melbourne, VIC, Australia
- Bionics Institute, East Melbourne, VIC, Australia
| | - Nicholas C. Sinclair
- Medical Bionics Department, University of Melbourne, East Melbourne, VIC, Australia
- Bionics Institute, East Melbourne, VIC, Australia
| | - Andres M. Lozano
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Thomas Foltynie
- Institute of Neurology, University College London, London, United Kingdom
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Krembil Brain Institute, Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Sameer A. Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Katherine Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Terence D. Sanger
- Department of Biomedical Engineering, Neurology, Biokinesiology, University of Southern California, Los Angeles, CA, United States
| | - Jonathan Miller
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Audrey C. Brumback
- Departments of Neurology and Pediatrics at Dell Medical School and the Center for Learning and Memory, University of Texas at Austin, Austin, TX, United States
| | - Priya Rajasethupathy
- Laboratory for Neural Dynamics and Cognition, Rockefeller University, New York, NY, United States
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Cameron McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Leslie Schlachter
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Cynthia Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Lauren R. Sankary
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, United States
| | | | - Steven Goetz
- Medtronic Neuromodulation, Minneapolis, MN, United States
| | - Binith Cheeran
- Neuromodulation Division, Abbott, Plano, TX, United States
| | - G. Karl Steinke
- Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Christopher Hess
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Wissam Deeb
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Kelly D. Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
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Latency of subthalamic nucleus deep brain stimulation-evoked cortical activity as a potential biomarker for postoperative motor side effects. Clin Neurophysiol 2020; 131:1221-1229. [PMID: 32299006 DOI: 10.1016/j.clinph.2020.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Here, we investigate whether cortical activation predicts motor side effects of deep brain stimulation (DBS) and whether these potential biomarkers have utility under general anesthesia. METHODS We recorded scalp potentials elicited by DBS during surgery (n = 11), both awake and under general anesthesia, and in an independent ambulatory cohort (n = 8). Across a range of stimulus configurations, we measured the amplitude and timing of short- and long-latency response components and linked them to motor side effects. RESULTS Regardless of anesthesia state, in both cohorts, DBS settings with capsular side effects elicited early responses with peak latencies clustering at <1 ms. This early response was preserved under anesthesia in all participants (11/11). In contrast, the long-latency components were suppressed completely in 6/11 participants. Finally, the latency of the earliest response could predict the presence of postoperative motor side effects both awake and under general anesthesia (84.8% and 75.8% accuracy, awake and under anesthesia, respectively). CONCLUSION DBS elicits short-latency cortical activation, both awake and under general anesthesia, which appears to reveal interactions between the stimulus and the corticospinal tract. SIGNIFICANCE Short-latency evoked cortical activity can potentially be used to aid both DBS lead placement and post-operative programming.
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Lu CW, Malaga KA, Chou KL, Chestek CA, Patil PG. High density microelectrode recording predicts span of therapeutic tissue activation volumes in subthalamic deep brain stimulation for Parkinson disease. Brain Stimul 2020; 13:412-419. [DOI: 10.1016/j.brs.2019.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/16/2023] Open
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Biophysical reconstruction of the signal conduction underlying short-latency cortical evoked potentials generated by subthalamic deep brain stimulation. Clin Neurophysiol 2019; 131:542-547. [PMID: 31757636 DOI: 10.1016/j.clinph.2019.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/05/2019] [Accepted: 09/10/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Direct activation of the hyperdirect (HD) pathway has been linked to therapeutic benefit from subthalamic deep brain stimulation (DBS) for the treatment of Parkinson's disease (PD). We sought to quantify the axonal conduction biophysics of corticofugal axons directly stimulated by subthalamic DBS and reconcile those findings with short-latency cortical evoked potential (EP) results. METHODS We used a detailed computational model of human subthalamic DBS to quantify axonal activation and conduction. Signal propagation to cortex was evaluated for medium (5.7 µm), large (10.0 µm), and exceptionally large (15.0 µm) diameter corticofugal axons associated with either internal capsule (IC) fibers of passage or the HD pathway. We then compared the modeling results to human cortical EP measurements that have described an exceptionally fast component (EP0) occurring ~1 ms after the stimulus pulse, a fast component (EP1) at ~3 ms, and a slower component (EP2) at ~5 ms. RESULTS Subthalamic stimulation of the HD pathway with large and medium diameter axons propagated action potentials to cortex with timings that coincide with the EP1 and EP2 signals, respectively. Only direct activation of exceptionally large diameter fibers in the IC generated signals that could approach the EP0 timing. However, the action potential biophysics do not generally support the existence of a cortical EP less than 1.5 ms after DBS onset. CONCLUSIONS The EP1 and EP2 signals can be biophysically linked to antidromic activation of the HD pathway. SIGNIFICANCE Theoretical reconstruction of cortical EPs from subthalamic DBS demonstrate a convergence of anatomical, biophysical, and electrophysiological results.
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Phase-Dependent Suppression of Beta Oscillations in Parkinson's Disease Patients. J Neurosci 2019; 39:1119-1134. [PMID: 30552179 PMCID: PMC6363933 DOI: 10.1523/jneurosci.1913-18.2018] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/16/2022] Open
Abstract
Synchronized oscillations within and between brain areas facilitate normal processing, but are often amplified in disease. A prominent example is the abnormally sustained beta-frequency (∼20 Hz) oscillations recorded from the cortex and subthalamic nucleus of Parkinson's disease patients. Computational modeling suggests that the amplitude of such oscillations could be modulated by applying stimulation at a specific phase. Such a strategy would allow selective targeting of the oscillation, with relatively little effect on other activity parameters. Here, activity was recorded from 10 awake, parkinsonian patients (6 male, 4 female human subjects) undergoing functional neurosurgery. We demonstrate that stimulation arriving on a particular patient-specific phase of the beta oscillation over consecutive cycles could suppress the amplitude of this pathophysiological activity by up to 40%, while amplification effects were relatively weak. Suppressive effects were accompanied by a reduction in the rhythmic output of subthalamic nucleus (STN) neurons and synchronization with the mesial cortex. While stimulation could alter the spiking pattern of STN neurons, there was no net effect on firing rate, suggesting that reduced beta synchrony was a result of alterations to the relative timing of spiking activity, rather than an overall change in excitability. Together, these results identify a novel intrinsic property of cortico-basal ganglia synchrony that suggests the phase of ongoing neural oscillations could be a viable and effective control signal for the treatment of Parkinson's disease. This work has potential implications for other brain diseases with exaggerated neuronal synchronization and for probing the function of rhythmic activity in the healthy brain.SIGNIFICANCE STATEMENT In Parkinson's disease (PD), movement impairment is correlated with exaggerated beta frequency oscillations in the cerebral cortex and subthalamic nucleus (STN). Using a novel method of stimulation in PD patients undergoing neurosurgery, we demonstrate that STN beta oscillations can be suppressed when consecutive electrical pulses arrive at a specific phase of the oscillation. This effect is likely because of interrupting the timing of neuronal activity rather than excitability, as stimulation altered the firing pattern of STN spiking without changing overall rate. These findings show the potential of oscillation phase as an input for "closed-loop" stimulation, which could provide a valuable neuromodulation strategy for the treatment of brain disorders and for elucidating the role of neuronal oscillations in the healthy brain.
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Cortical Potentials Evoked by Subthalamic Stimulation Demonstrate a Short Latency Hyperdirect Pathway in Humans. J Neurosci 2018; 38:9129-9141. [PMID: 30201770 DOI: 10.1523/jneurosci.1327-18.2018] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022] Open
Abstract
A monosynaptic projection from the cortex to the subthalamic nucleus is thought to have an important role in basal ganglia function and in the mechanism of therapeutic subthalamic deep-brain stimulation, but in humans the evidence for its existence is limited. We sought physiological confirmation of the cortico-subthalamic hyperdirect pathway using invasive recording techniques in patients with Parkinson's disease (9 men, 1 woman). We measured sensorimotor cortical evoked potentials using a temporary subdural strip electrode in response to low-frequency deep-brain stimulation in patients undergoing awake subthalamic or pallidal lead implantations. Evoked potentials were grouped into very short latency (<2 ms), short latency (2-10 ms), and long latency (10-100 ms) from the onset of the stimulus pulse. Subthalamic and pallidal stimulation resulted in very short-latency evoked potentials at 1.5 ms in the primary motor cortex accompanied by EMG-evoked potentials consistent with corticospinal tract activation. Subthalamic, but not pallidal stimulation, resulted in three short-latency evoked potentials at 2.8, 5.8, and 7.7 ms in a widespread cortical distribution, consistent with antidromic activation of the hyperdirect pathway. Long-latency potentials were evoked by both targets, with subthalamic responses lagging pallidal responses by 10-20 ms, consistent with orthodromic activation of the thalamocortical pathway. The amplitude of the first short-latency evoked potential was predictive of the chronic therapeutic stimulation contact.SIGNIFICANCE STATEMENT This is the first physiological demonstration of the corticosubthalamic hyperdirect pathway and its topography at high spatial resolution in humans. We studied cortical potentials evoked by deep-brain stimulation in patients with Parkinson's disease undergoing awake lead implantation surgery. Subthalamic stimulation resulted in multiple short-latency responses consistent with activation of hyperdirect pathway, whereas no such response was present during pallidal stimulation. We contrast these findings with very short latency, direct corticospinal tract activations, and long-latency responses evoked through polysynaptic orthodromic projections. These findings underscore the importance of incorporating the hyperdirect pathway into models of human basal ganglia function.
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Oza CS, Brocker DT, Behrend CE, Grill WM. Patterned low-frequency deep brain stimulation induces motor deficits and modulates cortex-basal ganglia neural activity in healthy rats. J Neurophysiol 2018; 120:2410-2422. [PMID: 30089019 DOI: 10.1152/jn.00929.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for movement disorders, including Parkinson's disease (PD), although the mechanisms of action remain unclear. Abnormal oscillatory neural activity is correlated with motor symptoms, and pharmacological or DBS treatment that alleviates motor symptoms appears to suppress abnormal oscillations. However, whether such oscillatory activity is causal of motor deficits such as tremor remains unclear. Our goal was to generate abnormal oscillatory activity in the cortex-basal ganglia loop using patterned subthalamic nucleus DBS and to quantify motor behavior in awake healthy rats. Stimulation patterns were designed via model-based optimization to increase power in the low-frequency (7-11 Hz) band because these oscillations are associated with the emergence of motor symptoms in the 6-hydroxydopamine lesioned rat model of parkinsonism. We measured motor activity using a head-mounted accelerometer, as well as quantified neural activity in cortex and globus pallidus (GP), in response to 5 stimulation patterns that generated a range of 7- to 11-Hz spectral power. Stimulation patterns induced oscillatory activity in the low-frequency band in the cortex and GP and caused tremor, whereas control patterns and regular 50-Hz DBS did not generate any such effects. Neural and motor-evoked responses observed during stimulation were synchronous and time-locked to stimulation bursts within the patterns. These results identified elements of irregular patterns of stimulation that were correlated with tremor and tremor-related neural activity in the cortex and basal ganglia and may lead to the identification of the oscillatory activity and structures associated with the generation of tremor activity. NEW & NOTEWORTHY Subthalamic nucleus deep brain stimulation is a promising therapy for movement disorders such as Parkinson's disease. Several groups reported correlation between suppression of abnormal oscillatory activity in the cortex-basal ganglia and motor symptoms, but it remains unclear whether such oscillations play a causal role in the emergence of motor symptoms. We demonstrate generation of tremor and pathological oscillatory activity in otherwise healthy rats by stimulation with patterns that produced increases in low-frequency oscillatory activity.
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Affiliation(s)
- Chintan S Oza
- Department of Biomedical Engineering, Duke University , Durham, North Carolina
| | - David T Brocker
- Department of Biomedical Engineering, Duke University , Durham, North Carolina
| | - Christina E Behrend
- Department of Biomedical Engineering, Duke University , Durham, North Carolina.,School of Medicine, Duke University , Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University , Durham, North Carolina.,Department of Neurobiology, Duke University , Durham, North Carolina.,Department of Neurosurgery, Duke University , Durham, North Carolina
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