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Wang B, Peterchev AV, Gaugain G, Ilmoniemi RJ, Grill WM, Bikson M, Nikolayev D. Quasistatic approximation in neuromodulation. J Neural Eng 2024; 21:041002. [PMID: 38994790 DOI: 10.1088/1741-2552/ad625e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
We define and explain the quasistatic approximation (QSA) as applied to field modeling for electrical and magnetic stimulation. Neuromodulation analysis pipelines include discrete stages, and QSA is applied specifically when calculating the electric and magnetic fields generated in tissues by a given stimulation dose. QSA simplifies the modeling equations to support tractable analysis, enhanced understanding, and computational efficiency. The application of QSA in neuromodulation is based on four underlying assumptions: (A1) no wave propagation or self-induction in tissue, (A2) linear tissue properties, (A3) purely resistive tissue, and (A4) non-dispersive tissue. As a consequence of these assumptions, each tissue is assigned a fixed conductivity, and the simplified equations (e.g. Laplace's equation) are solved for the spatial distribution of the field, which is separated from the field's temporal waveform. Recognizing that electrical tissue properties may be more complex, we explain how QSA can be embedded in parallel or iterative pipelines to model frequency dependence or nonlinearity of conductivity. We survey the history and validity of QSA across specific applications, such as microstimulation, deep brain stimulation, spinal cord stimulation, transcranial electrical stimulation, and transcranial magnetic stimulation. The precise definition and explanation of QSA in neuromodulation are essential for rigor when using QSA models or testing their limits.
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Affiliation(s)
- Boshuo Wang
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, United States of America
| | - Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, United States of America
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
- Department of Neurosurgery, Duke University, Durham, NC 27710, United States of America
| | - Gabriel Gaugain
- Institut d'Électronique et des Technologies du numéRique (IETR UMR 6164), CNRS / University of Rennes, 35000 Rennes, France
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Warren M Grill
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, United States of America
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
- Department of Neurosurgery, Duke University, Durham, NC 27710, United States of America
- Department of Neurobiology, Duke University, Durham, NC 27710, United States of America
| | - Marom Bikson
- The City College of New York, New York, NY 11238, United States of America
| | - Denys Nikolayev
- Institut d'Électronique et des Technologies du numéRique (IETR UMR 6164), CNRS / University of Rennes, 35000 Rennes, France
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2
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Ciotti F, John R, Katic Secerovic N, Gozzi N, Cimolato A, Jayaprakash N, Song W, Toth V, Zanos T, Zanos S, Raspopovic S. Towards enhanced functionality of vagus neuroprostheses through in silico optimized stimulation. Nat Commun 2024; 15:6119. [PMID: 39033186 PMCID: PMC11271449 DOI: 10.1038/s41467-024-50523-6] [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: 02/23/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024] Open
Abstract
Bioelectronic therapies modulating the vagus nerve are promising for cardiovascular, inflammatory, and mental disorders. Clinical applications are however limited by side-effects such as breathing obstruction and headache caused by non-specific stimulation. To design selective and functional stimulation, we engineered VaStim, a realistic and efficient in-silico model. We developed a protocol to personalize VaStim in-vivo using simple muscle responses, successfully reproducing experimental observations, by combining models with trials conducted on five pigs. Through optimized algorithms, VaStim simulated the complete fiber population in minutes, including often omitted unmyelinated fibers which constitute 80% of the nerve. The model suggested that all Aα-fibers across the nerve affect laryngeal muscle, while heart rate changes were caused by B-efferents in specific fascicles. It predicted that tripolar paradigms could reduce laryngeal activity by 70% compared to typically used protocols. VaStim may serve as a model for developing neuromodulation therapies by maximizing efficacy and specificity, reducing animal experimentation.
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Affiliation(s)
- Federico Ciotti
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Robert John
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Natalija Katic Secerovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
- The Mihajlo Pupin Institute, University of Belgrade, Belgrade, Serbia
| | - Noemi Gozzi
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Andrea Cimolato
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Naveen Jayaprakash
- Northwell Health, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Weiguo Song
- Northwell Health, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Viktor Toth
- Northwell Health, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Theodoros Zanos
- Northwell Health, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Stavros Zanos
- Northwell Health, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland.
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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3
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Wu Y, Hu K, Liu S. Computational models advance deep brain stimulation for Parkinson's disease. NETWORK (BRISTOL, ENGLAND) 2024:1-32. [PMID: 38923890 DOI: 10.1080/0954898x.2024.2361799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
Deep brain stimulation(DBS) has become an effective intervention for advanced Parkinson's disease(PD), but the exact mechanism of DBS is still unclear. In this review, we discuss the history of DBS, the anatomy and internal architecture of the basal ganglia (BG), the abnormal pathological changes of the BG in PD, and how computational models can help understand and advance DBS. We also describe two types of models: mathematical theoretical models and clinical predictive models. Mathematical theoretical models simulate neurons or neural networks of BG to shed light on the mechanistic principle underlying DBS, while clinical predictive models focus more on patients' outcomes, helping to adapt treatment plans for each patient and advance novel electrode designs. Finally, we provide insights and an outlook on future technologies.
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Affiliation(s)
- Yongtong Wu
- School of Mathematics, South China University of Technology, Guangzhou, Guangdong, China
| | - Kejia Hu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenquan Liu
- School of Mathematics, South China University of Technology, Guangzhou, Guangdong, China
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4
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Rogers ER, Capogrosso M, Lempka SF. Biophysics of Frequency-Dependent Variation in Paresthesia and Pain Relief during Spinal Cord Stimulation. J Neurosci 2024; 44:e2199232024. [PMID: 38744531 PMCID: PMC11211721 DOI: 10.1523/jneurosci.2199-23.2024] [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: 11/20/2023] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
The neurophysiological effects of spinal cord stimulation (SCS) for chronic pain are poorly understood, resulting in inefficient failure-prone programming protocols and inadequate pain relief. Nonetheless, novel stimulation patterns are regularly introduced and adopted clinically. Traditionally, paresthetic sensation is considered necessary for pain relief, although novel paradigms provide analgesia without paresthesia. However, like pain relief, the neurophysiological underpinnings of SCS-induced paresthesia are unknown. Here, we paired biophysical modeling with clinical paresthesia thresholds (of both sexes) to investigate how stimulation frequency affects the neural response to SCS relevant to paresthesia and analgesia. Specifically, we modeled the dorsal column (DC) axonal response, dorsal column nucleus (DCN) synaptic transmission, conduction failure within DC fiber collaterals, and dorsal horn network output. Importantly, we found that high-frequency stimulation reduces DC fiber activation thresholds, which in turn accurately predicts clinical paresthesia perception thresholds. Furthermore, we show that high-frequency SCS produces asynchronous DC fiber spiking and ultimately asynchronous DCN output, offering a plausible biophysical basis for why high-frequency SCS is less comfortable and produces qualitatively different sensation than low-frequency stimulation. Finally, we demonstrate that the model dorsal horn network output is sensitive to SCS-inherent variations in spike timing, which could contribute to heterogeneous pain relief across patients. Importantly, we show that model DC fiber collaterals cannot reliably follow high-frequency stimulation, strongly affecting the network output and typically producing antinociceptive effects at high frequencies. Altogether, these findings clarify how SCS affects the nervous system and provide insight into the biophysics of paresthesia generation and pain relief.
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Affiliation(s)
- Evan R Rogers
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan 48109
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan 48109
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan 48109
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Abdollahi N, Prescott SA. Impact of Extracellular Current Flow on Action Potential Propagation in Myelinated Axons. J Neurosci 2024; 44:e0569242024. [PMID: 38688722 PMCID: PMC11211723 DOI: 10.1523/jneurosci.0569-24.2024] [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: 03/25/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Myelinated axons conduct action potentials, or spikes, in a saltatory manner. Inward current caused by a spike occurring at one node of Ranvier spreads axially to the next node, which regenerates the spike when depolarized enough for voltage-gated sodium channels to activate, and so on. The rate at which this process progresses dictates the velocity at which the spike is conducted and depends on several factors including axial resistivity and axon diameter that directly affect axial current. Here we show through computational simulations in modified double-cable axon models that conduction velocity also depends on extracellular factors whose effects can be explained by their indirect influence on axial current. Specifically, we show that a conventional double-cable model, with its outside layer connected to ground, transmits less axial current than a model whose outside layer is less absorptive. A more resistive barrier exists when an axon is packed tightly between other myelinated fibers, for example. We show that realistically resistive boundary conditions can significantly increase the velocity and energy efficiency of spike propagation, while also protecting against propagation failure. Certain factors like myelin thickness may be less important than typically thought if extracellular conditions are more resistive than normally considered. We also show how realistically resistive boundary conditions affect ephaptic interactions. Overall, these results highlight the unappreciated importance of extracellular conditions for axon function.
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Affiliation(s)
- Nooshin Abdollahi
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Steven A Prescott
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
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Aljeradat B, Kumar D, Abdulmuizz S, Kundu M, Almealawy YF, Batarseh DR, Atallah O, Ennabe M, Alsarafandi M, Alan A, Weinand M. Neuromodulation and the Gut-Brain Axis: Therapeutic Mechanisms and Implications for Gastrointestinal and Neurological Disorders. PATHOPHYSIOLOGY 2024; 31:244-268. [PMID: 38804299 PMCID: PMC11130832 DOI: 10.3390/pathophysiology31020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
The gut-brain axis (GBA) represents a complex, bidirectional communication network that intricately connects the gastrointestinal tract with the central nervous system (CNS). Understanding and intervening in this axis opens a pathway for therapeutic advancements for neurological and gastrointestinal diseases where the GBA has been proposed to play a role in the pathophysiology. In light of this, the current review assesses the effectiveness of neuromodulation techniques in treating neurological and gastrointestinal disorders by modulating the GBA, involving key elements such as gut microbiota, neurotrophic factors, and proinflammatory cytokines. Through a comprehensive literature review encompassing PubMed, Google Scholar, Web of Science, and the Cochrane Library, this research highlights the role played by the GBA in neurological and gastrointestinal diseases, in addition to the impact of neuromodulation on the management of these conditions which include both gastrointestinal (irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastroesophageal reflux disease (GERD)) and neurological disorders (Parkinson's disease (PD), Alzheimer's disease (AD), autism spectrum disorder (ASD), and neuropsychiatric disorders). Despite existing challenges, the ability of neuromodulation to adjust disrupted neural pathways, alleviate pain, and mitigate inflammation is significant in improving the quality of life for patients, thereby offering exciting prospects for future advancements in patient care.
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Affiliation(s)
- Baha’ Aljeradat
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Danisha Kumar
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sulaiman Abdulmuizz
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Health Sciences, University of Ilorin, Ilorin 240003, Kwara, Nigeria
| | - Mrinmoy Kundu
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751029, India
| | - Yasser F. Almealawy
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Faculty of Medicine, University of Kufa, Kufa P.O. Box 21, Iraq
| | - Dima Ratib Batarseh
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Oday Atallah
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Michelle Ennabe
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, The University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Muath Alsarafandi
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, Islamic University of Gaza, Rafa Refugee Camp, Rafa P.O. Box 108, Palestine
- Faculty of Medicine, Islamic University of Gaza, Gaza P.O. Box 108, Palestine
| | - Albert Alan
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
| | - Martin Weinand
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
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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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Patrick EE, Fleeting CR, Patel DR, Casauay JT, Patel A, Shepherd H, Wong JK. Modeling the volume of tissue activated in deep brain stimulation and its clinical influence: a review. Front Hum Neurosci 2024; 18:1333183. [PMID: 38660012 PMCID: PMC11039793 DOI: 10.3389/fnhum.2024.1333183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Deep brain stimulation (DBS) is a neuromodulatory therapy that has been FDA approved for the treatment of various disorders, including but not limited to, movement disorders (e.g., Parkinson's disease and essential tremor), epilepsy, and obsessive-compulsive disorder. Computational methods for estimating the volume of tissue activated (VTA), coupled with brain imaging techniques, form the basis of models that are being generated from retrospective clinical studies for predicting DBS patient outcomes. For instance, VTA models are used to generate target-and network-based probabilistic stimulation maps that play a crucial role in predicting DBS treatment outcomes. This review defines the methods for calculation of tissue activation (or modulation) including ones that use heuristic and clinically derived estimates and more computationally involved ones that rely on finite-element methods and biophysical axon models. We define model parameters and provide a comparison of commercial, open-source, and academic simulation platforms available for integrated neuroimaging and neural activation prediction. In addition, we review clinical studies that use these modeling methods as a function of disease. By describing the tissue-activation modeling methods and highlighting their application in clinical studies, we provide the neural engineering and clinical neuromodulation communities with perspectives that may influence the adoption of modeling methods for future DBS studies.
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Affiliation(s)
- Erin E. Patrick
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Chance R. Fleeting
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Drashti R. Patel
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jed T. Casauay
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Aashay Patel
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Hunter Shepherd
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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9
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Bower KL, Noecker AM, Frankemolle-Gilbert AM, McIntyre CC. Model-Based Analysis of Pathway Recruitment During Subthalamic Deep Brain Stimulation. Neuromodulation 2024; 27:455-463. [PMID: 37097269 PMCID: PMC10598236 DOI: 10.1016/j.neurom.2023.02.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Subthalamic deep brain stimulation (DBS) is an established clinical therapy, but an anatomically clear definition of the underlying neural target(s) of the stimulation remains elusive. Patient-specific models of DBS are commonly used tools in the search for stimulation targets, and recent iterations of those models are focused on characterizing the brain connections that are activated by DBS. OBJECTIVE The goal of this study was to quantify axonal pathway activation in the subthalamic region from DBS at different electrode locations and stimulation settings. MATERIALS AND METHODS We used an anatomically and electrically detailed computational model of subthalamic DBS to generate recruitment curves for eight different axonal pathways of interest, at three generalized DBS electrode locations in the subthalamic nucleus (STN) (ie, central STN, dorsal STN, posterior STN). These simulations were performed with three levels of DBS electrode localization uncertainty (ie, 0.5 mm, 1.0 mm, 1.5 mm). RESULTS The recruitment curves highlight the diversity of pathways that are theoretically activated with subthalamic DBS, in addition to the dependence of the stimulation location and parameter settings on the pathway activation estimates. The three generalized DBS locations exhibited distinct pathway recruitment curve profiles, suggesting that each stimulation location would have a different effect on network activity patterns. We also found that the use of anodic stimuli could help limit activation of the internal capsule relative to other pathways. However, incorporating realistic levels of DBS electrode localization uncertainty in the models substantially limits their predictive capabilities. CONCLUSIONS Subtle differences in stimulation location and/or parameter settings can impact the collection of pathways that are activated during subthalamic DBS.
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Affiliation(s)
- Kelsey L Bower
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA.
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10
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Ng PR, Bush A, Vissani M, McIntyre CC, Richardson RM. Biophysical Principles and Computational Modeling of Deep Brain Stimulation. Neuromodulation 2024; 27:422-439. [PMID: 37204360 DOI: 10.1016/j.neurom.2023.04.471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) has revolutionized the treatment of neurological disorders, yet the mechanisms of DBS are still under investigation. Computational models are important in silico tools for elucidating these underlying principles and potentially for personalizing DBS therapy to individual patients. The basic principles underlying neurostimulation computational models, however, are not well known in the clinical neuromodulation community. OBJECTIVE In this study, we present a tutorial on the derivation of computational models of DBS and outline the biophysical contributions of electrodes, stimulation parameters, and tissue substrates to the effects of DBS. RESULTS Given that many aspects of DBS are difficult to characterize experimentally, computational models have played an important role in understanding how material, size, shape, and contact segmentation influence device biocompatibility, energy efficiency, the spatial spread of the electric field, and the specificity of neural activation. Neural activation is dictated by stimulation parameters including frequency, current vs voltage control, amplitude, pulse width, polarity configurations, and waveform. These parameters also affect the potential for tissue damage, energy efficiency, the spatial spread of the electric field, and the specificity of neural activation. Activation of the neural substrate also is influenced by the encapsulation layer surrounding the electrode, the conductivity of the surrounding tissue, and the size and orientation of white matter fibers. These properties modulate the effects of the electric field and determine the ultimate therapeutic response. CONCLUSION This article describes biophysical principles that are useful for understanding the mechanisms of neurostimulation.
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Affiliation(s)
| | - Alan Bush
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Matteo Vissani
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Robert Mark Richardson
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
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11
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Dadarlat MC, Sun YJ, Stryker MP. Activity-dependent recruitment of inhibition and excitation in the awake mammalian cortex during electrical stimulation. Neuron 2024; 112:821-834.e4. [PMID: 38134920 PMCID: PMC10949925 DOI: 10.1016/j.neuron.2023.11.022] [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: 11/17/2022] [Revised: 08/04/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Electrical stimulation is an effective tool for mapping and altering brain connectivity, with applications ranging from treating pharmacology-resistant neurological disorders to providing sensory feedback for neural prostheses. Paramount to the success of these applications is the ability to manipulate electrical currents to precisely control evoked neural activity patterns. However, little is known about stimulation-evoked responses in inhibitory neurons nor how stimulation-evoked activity patterns depend on ongoing neural activity. In this study, we used 2-photon imaging and cell-type specific labeling to measure single-cell responses of excitatory and inhibitory neurons to electrical stimuli in the visual cortex of awake mice. Our data revealed strong interactions between electrical stimulation and pre-stimulus activity of single neurons in awake animals and distinct recruitment and response patterns for excitatory and inhibitory neurons. This work demonstrates the importance of cell-type-specific labeling of neurons in future studies.
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Affiliation(s)
- Maria C Dadarlat
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94158, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47906, USA.
| | - Yujiao Jennifer Sun
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94158, USA; Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Michael P Stryker
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94158, USA
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12
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Peña E, Pelot NA, Grill WM. Computational models of compound nerve action potentials: Efficient filter-based methods to quantify effects of tissue conductivities, conduction distance, and nerve fiber parameters. PLoS Comput Biol 2024; 20:e1011833. [PMID: 38427699 PMCID: PMC10936855 DOI: 10.1371/journal.pcbi.1011833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/13/2024] [Accepted: 01/16/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Peripheral nerve recordings can enhance the efficacy of neurostimulation therapies by providing a feedback signal to adjust stimulation settings for greater efficacy or reduced side effects. Computational models can accelerate the development of interfaces with high signal-to-noise ratio and selective recording. However, validation and tuning of model outputs against in vivo recordings remains computationally prohibitive due to the large number of fibers in a nerve. METHODS We designed and implemented highly efficient modeling methods for simulating electrically evoked compound nerve action potential (CNAP) signals. The method simulated a subset of fiber diameters present in the nerve using NEURON, interpolated action potential templates across fiber diameters, and filtered the templates with a weighting function derived from fiber-specific conduction velocity and electromagnetic reciprocity outputs of a volume conductor model. We applied the methods to simulate CNAPs from rat cervical vagus nerve. RESULTS Brute force simulation of a rat vagal CNAP with all 1,759 myelinated and 13,283 unmyelinated fibers in NEURON required 286 and 15,860 CPU hours, respectively, while filtering interpolated templates required 30 and 38 seconds on a desktop computer while maintaining accuracy. Modeled CNAP amplitude could vary by over two orders of magnitude depending on tissue conductivities and cuff opening within experimentally relevant ranges. Conduction distance and fiber diameter distribution also strongly influenced the modeled CNAP amplitude, shape, and latency. Modeled and in vivo signals had comparable shape, amplitude, and latency for myelinated fibers but not for unmyelinated fibers. CONCLUSIONS Highly efficient methods of modeling neural recordings quantified the large impact that tissue properties, conduction distance, and nerve fiber parameters have on CNAPs. These methods expand the computational accessibility of neural recording models, enable efficient model tuning for validation, and facilitate the design of novel recording interfaces for neurostimulation feedback and understanding physiological systems.
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Affiliation(s)
- Edgar Peña
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Nicole A. Pelot
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Warren M. Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
- Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
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13
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Vardalakis N, Aussel A, Rougier NP, Wagner FB. A dynamical computational model of theta generation in hippocampal circuits to study theta-gamma oscillations during neurostimulation. eLife 2024; 12:RP87356. [PMID: 38354040 PMCID: PMC10942594 DOI: 10.7554/elife.87356] [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] [Indexed: 02/16/2024] Open
Abstract
Neurostimulation of the hippocampal formation has shown promising results for modulating memory but the underlying mechanisms remain unclear. In particular, the effects on hippocampal theta-nested gamma oscillations and theta phase reset, which are both crucial for memory processes, are unknown. Moreover, these effects cannot be investigated using current computational models, which consider theta oscillations with a fixed amplitude and phase velocity. Here, we developed a novel computational model that includes the medial septum, represented as a set of abstract Kuramoto oscillators producing a dynamical theta rhythm with phase reset, and the hippocampal formation, composed of biophysically realistic neurons and able to generate theta-nested gamma oscillations under theta drive. We showed that, for theta inputs just below the threshold to induce self-sustained theta-nested gamma oscillations, a single stimulation pulse could switch the network behavior from non-oscillatory to a state producing sustained oscillations. Next, we demonstrated that, for a weaker theta input, pulse train stimulation at the theta frequency could transiently restore seemingly physiological oscillations. Importantly, the presence of phase reset influenced whether these two effects depended on the phase at which stimulation onset was delivered, which has practical implications for designing neurostimulation protocols that are triggered by the phase of ongoing theta oscillations. This novel model opens new avenues for studying the effects of neurostimulation on the hippocampal formation. Furthermore, our hybrid approach that combines different levels of abstraction could be extended in future work to other neural circuits that produce dynamical brain rhythms.
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Affiliation(s)
- Nikolaos Vardalakis
- University of Bordeaux, CNRS, IMNBordeauxFrance
- University of Bordeaux, INRIA, IMNBordeauxFrance
| | - Amélie Aussel
- University of Bordeaux, CNRS, IMNBordeauxFrance
- University of Bordeaux, INRIA, IMNBordeauxFrance
- University of Bordeaux, CNRS, Bordeaux INPTalenceFrance
| | - Nicolas P Rougier
- University of Bordeaux, CNRS, IMNBordeauxFrance
- University of Bordeaux, INRIA, IMNBordeauxFrance
- University of Bordeaux, CNRS, Bordeaux INPTalenceFrance
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14
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Kamagata K, Andica C, Uchida W, Takabayashi K, Saito Y, Lukies M, Hagiwara A, Fujita S, Akashi T, Wada A, Hori M, Kamiya K, Zalesky A, Aoki S. Advancements in Diffusion MRI Tractography for Neurosurgery. Invest Radiol 2024; 59:13-25. [PMID: 37707839 DOI: 10.1097/rli.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
ABSTRACT Diffusion magnetic resonance imaging tractography is a noninvasive technique that enables the visualization and quantification of white matter tracts within the brain. It is extensively used in preoperative planning for brain tumors, epilepsy, and functional neurosurgical procedures such as deep brain stimulation. Over the past 25 years, significant advancements have been made in imaging acquisition, fiber direction estimation, and tracking methods, resulting in considerable improvements in tractography accuracy. The technique enables the mapping of functionally critical pathways around surgical sites to avoid permanent functional disability. When the limitations are adequately acknowledged and considered, tractography can serve as a valuable tool to safeguard critical white matter tracts and provides insight regarding changes in normal white matter and structural connectivity of the whole brain beyond local lesions. In functional neurosurgical procedures such as deep brain stimulation, it plays a significant role in optimizing stimulation sites and parameters to maximize therapeutic efficacy and can be used as a direct target for therapy. These insights can aid in patient risk stratification and prognosis. This article aims to discuss state-of-the-art tractography methodologies and their applications in preoperative planning and highlight the challenges and new prospects for the use of tractography in daily clinical practice.
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Affiliation(s)
- Koji Kamagata
- From the Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan (K.K., C.A., W.U., K.T., Y.S., A.H., S.F., T.A., A.W., S.A.); Faculty of Health Data Science, Juntendo University, Chiba, Japan (C.A., S.A.); Department of Radiology, Alfred Health, Melbourne, Victoria, Australia (M.L.); Department of Radiology, University of Tokyo, Tokyo, Japan (S.F.); Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan (M.H., K.K.); Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, Victoria, Australia (A.Z.); and Melbourne School of Engineering, University of Melbourne, Melbourne, Victoria, Australia (A.Z.)
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15
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Xu W, Wang J, Li XN, Liang J, Song L, Wu Y, Liu Z, Sun B, Li WG. Neuronal and synaptic adaptations underlying the benefits of deep brain stimulation for Parkinson's disease. Transl Neurodegener 2023; 12:55. [PMID: 38037124 PMCID: PMC10688037 DOI: 10.1186/s40035-023-00390-w] [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: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established and effective treatment for patients with advanced Parkinson's disease (PD), yet its underlying mechanisms remain enigmatic. Optogenetics, primarily conducted in animal models, provides a unique approach that allows cell type- and projection-specific modulation that mirrors the frequency-dependent stimulus effects of DBS. Opto-DBS research in animal models plays a pivotal role in unraveling the neuronal and synaptic adaptations that contribute to the efficacy of DBS in PD treatment. DBS-induced neuronal responses rely on a complex interplay between the distributions of presynaptic inputs, frequency-dependent synaptic depression, and the intrinsic excitability of postsynaptic neurons. This orchestration leads to conversion of firing patterns, enabling both antidromic and orthodromic modulation of neural circuits. Understanding these mechanisms is vital for decoding position- and programming-dependent effects of DBS. Furthermore, patterned stimulation is emerging as a promising strategy yielding long-lasting therapeutic benefits. Research on the neuronal and synaptic adaptations to DBS may pave the way for the development of more enduring and precise modulation patterns. Advanced technologies, such as adaptive DBS or directional electrodes, can also be integrated for circuit-specific neuromodulation. These insights hold the potential to greatly improve the effectiveness of DBS and advance PD treatment to new levels.
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Affiliation(s)
- Wenying Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xin-Ni Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Jingxue Liang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Wei-Guang Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China.
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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16
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Morais PLAG, Rubio-Garrido P, de Lima RM, Córdoba-Claros A, de Nascimento ES, Cavalcante JS, Clascá F. The Arousal-Related "Central Thalamus" Stimulation Site Simultaneously Innervates Multiple High-Level Frontal and Parietal Areas. J Neurosci 2023; 43:7812-7821. [PMID: 37758474 PMCID: PMC10648518 DOI: 10.1523/jneurosci.1216-23.2023] [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: 06/30/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023] Open
Abstract
In human and nonhuman primates, deep brain stimulation applied at or near the internal medullary lamina of the thalamus [a region referred to as "central thalamus," (CT)], but not at nearby thalamic sites, elicits major changes in the level of consciousness, even in some minimally conscious brain-damaged patients. The mechanisms behind these effects remain mysterious, as the connections of CT had not been specifically mapped in primates. In marmoset monkeys (Callithrix jacchus) of both sexes, we labeled the axons originating from each of the various CT neuronal populations and analyzed their arborization patterns in the cerebral cortex and striatum. We report that, together, these CT populations innervate an array of high-level frontal, posterior parietal, and cingulate cortical areas. Some populations simultaneously target the frontal, parietal, and cingulate cortices, while others predominantly target the dorsal striatum. Our data indicate that CT stimulation can simultaneously engage a heterogeneous set of projection systems that, together, target the key nodes of the attention, executive control, and working-memory networks of the brain. Increased functional connectivity in these networks has been previously described as a signature of consciousness.SIGNIFICANCE STATEMENT In human and nonhuman primates, deep brain stimulation at a specific site near the internal medullary lamina of the thalamus ["central thalamus," (CT)] had been shown to restore arousal and awareness in anesthetized animals, as well as in some brain-damaged patients. The mechanisms behind these effects remain mysterious, as CT connections remain poorly defined in primates. In marmoset monkeys, we mapped with sensitive axon-labeling methods the pathways originated from CT. Our data indicate that stimulation applied in CT can simultaneously engage a heterogeneous set of projection systems that, together, target several key nodes of the attention, executive control, and working-memory networks of the brain. Increased functional connectivity in these networks has been previously described as a signature of consciousness.
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Affiliation(s)
- Paulo L A G Morais
- Federal University of Rio Grande do Norte, RN CEP 59078-900, Natal, Brazil
- Universidad Autónoma de Madrid, 28029 Madrid, Spain
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17
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Sandoval-Pistorius SS, Hacker ML, Waters AC, Wang J, Provenza NR, de Hemptinne C, Johnson KA, Morrison MA, Cernera S. Advances in Deep Brain Stimulation: From Mechanisms to Applications. J Neurosci 2023; 43:7575-7586. [PMID: 37940596 PMCID: PMC10634582 DOI: 10.1523/jneurosci.1427-23.2023] [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: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 11/10/2023] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target brain regions for electrical stimulation delivery. Despite its safety and efficacy, DBS remains an underutilized therapy. Advances in the field of DBS, including in technology, mechanistic understanding, and applications have the potential to expand access and use of DBS, while also improving clinical outcomes. Developments in DBS technology, such as MRI compatibility and bidirectional DBS systems capable of sensing neural activity while providing therapeutic stimulation, have enabled advances in our understanding of DBS mechanisms and its application. In this review, we summarize recent work exploring DBS modulation of target networks. We also cover current work focusing on improved programming and the development of novel stimulation paradigms that go beyond current standards of DBS, many of which are enabled by sensing-enabled DBS systems and have the potential to expand access to DBS.
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Affiliation(s)
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Allison C Waters
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Kara A Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California 94143
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California 94143
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18
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Neumann WJ, Steiner LA, Milosevic L. Neurophysiological mechanisms of deep brain stimulation across spatiotemporal resolutions. Brain 2023; 146:4456-4468. [PMID: 37450573 PMCID: PMC10629774 DOI: 10.1093/brain/awad239] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/04/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Deep brain stimulation is a neuromodulatory treatment for managing the symptoms of Parkinson's disease and other neurological and psychiatric disorders. Electrodes are chronically implanted in disease-relevant brain regions and pulsatile electrical stimulation delivery is intended to restore neurocircuit function. However, the widespread interest in the application and expansion of this clinical therapy has preceded an overarching understanding of the neurocircuit alterations invoked by deep brain stimulation. Over the years, various forms of neurophysiological evidence have emerged which demonstrate changes to brain activity across spatiotemporal resolutions; from single neuron, to local field potential, to brain-wide cortical network effects. Though fruitful, such studies have often led to debate about a singular putative mechanism. In this Update we aim to produce an integrative account of complementary instead of mutually exclusive neurophysiological effects to derive a generalizable concept of the mechanisms of deep brain stimulation. In particular, we offer a critical review of the most common historical competing theories, an updated discussion on recent literature from animal and human neurophysiological studies, and a synthesis of synaptic and network effects of deep brain stimulation across scales of observation, including micro-, meso- and macroscale circuit alterations.
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Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Leon A Steiner
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
- Department of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto M5T 1M8, Canada
| | - Luka Milosevic
- Department of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto M5T 1M8, Canada
- Institute of Biomedical Engineering, Institute of Medical Sciences, and CRANIA Neuromodulation Institute, University of Toronto, Toronto M5S 3G9, Canada
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19
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Franz D, Richter A, Köhling R. Electrophysiological insights into deep brain stimulation of the network disorder dystonia. Pflugers Arch 2023; 475:1133-1147. [PMID: 37530804 PMCID: PMC10499667 DOI: 10.1007/s00424-023-02845-5] [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: 11/24/2022] [Revised: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
Deep brain stimulation (DBS), a treatment for modulating the abnormal central neuronal circuitry, has become the standard of care nowadays and is sometimes the only option to reduce symptoms of movement disorders such as dystonia. However, on the one hand, there are still open questions regarding the pathomechanisms of dystonia and, on the other hand, the mechanisms of DBS on neuronal circuitry. That lack of knowledge limits the therapeutic effect and makes it hard to predict the outcome of DBS for individual dystonia patients. Finding electrophysiological biomarkers seems to be a promising option to enable adapted individualised DBS treatment. However, biomarker search studies cannot be conducted on patients on a large scale and experimental approaches with animal models of dystonia are needed. In this review, physiological findings of deep brain stimulation studies in humans and animal models of dystonia are summarised and the current pathophysiological concepts of dystonia are discussed.
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Affiliation(s)
- Denise Franz
- Oscar Langendorff Institute of Physiology, University Medical Center Rostock, Rostock, Germany
| | - Angelika Richter
- Institute of Pharmacology, Pharmacy and Toxicology, University of Leipzig, Leipzig, Germany
| | - Rüdiger Köhling
- Oscar Langendorff Institute of Physiology, University Medical Center Rostock, Rostock, Germany.
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20
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Qin P, Lin Q, Xie Y, Chang YC, Zanos S, Wang H, Payne S, Shivdasani MN, Tsai D, Lovell NH, Dokos S, Guo T. Modulating functionally-distinct vagus nerve fibers using microelectrodes and kilohertz frequency electrical stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082599 DOI: 10.1109/embc40787.2023.10340796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Modulation of functionally distinct nerve fibers with bioelectronic devices provides a therapeutic opportunity for various diseases. In this study, we began by developing a computational model including four major subtypes of myelinated fibers and one unmyelinated fiber. Second, we used an intrafascicular electrode to perform kHz-frequency electric stimulation to preferentially modulate a population of fibers. Our model suggests that fiber physical properties and electrode-to-fascicle distance severely impacts stimulus-response relationships. Large diameter fibers (Aα- and Aβ-) were only minimally influenced by the fascicle size and electrode location, while smaller diameter fibers (Aδ-, B- and C-) indicated a stronger dependency.Clinical Relevance- Our findings support the possibility of selectively modulating functionally-distinct nerve fibers using electrical stimulation in a small, localized region. Our model provides an effective tool to design next-generation implantable devices and therapeutic stimulation strategies toward minimizing off-target effects.
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21
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Musselman ED, Pelot NA, Grill WM. Validated computational models predict vagus nerve stimulation thresholds in preclinical animals and humans. J Neural Eng 2023; 20:10.1088/1741-2552/acda64. [PMID: 37257454 PMCID: PMC10324064 DOI: 10.1088/1741-2552/acda64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 06/02/2023]
Abstract
Objective.We demonstrated how automated simulations to characterize electrical nerve thresholds, a recently published open-source software for modeling stimulation of peripheral nerves, can be applied to simulate accurately nerve responses to electrical stimulation.Approach.We simulated vagus nerve stimulation (VNS) for humans, pigs, and rats. We informed our models using histology from sample-specific or representative nerves, device design features (i.e. cuff, waveform), published material and tissue conductivities, and realistic fiber models.Main results.Despite large differences in nerve size, cuff geometry, and stimulation waveform, the models predicted accurate activation thresholds across species and myelinated fiber types. However, our C fiber model thresholds overestimated thresholds across pulse widths, suggesting that improved models of unmyelinated nerve fibers are needed. Our models of human VNS yielded accurate thresholds to activate laryngeal motor fibers and captured the inter-individual variability for both acute and chronic implants. For B fibers, our small-diameter fiber model underestimated threshold and saturation for pulse widths >0.25 ms. Our models of pig VNS consistently captured the range ofin vivothresholds across all measured nerve and physiological responses (i.e. heart rate, Aδ/B fibers, Aγfibers, electromyography, and Aαfibers). In rats, our smallest diameter myelinated fibers accurately predicted fast fiber thresholds across short and intermediate pulse widths; slow unmyelinated fiber thresholds overestimated thresholds across shorter pulse widths, but there was overlap for pulse widths >0.3 ms.Significance.We elevated standards for models of peripheral nerve stimulation in populations of models across species, which enabled us to model accurately nerve responses, demonstrate that individual-specific differences in nerve morphology produce variability in neural and physiological responses, and predict mechanisms of VNS therapeutic and side effects.
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Affiliation(s)
- Eric D Musselman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Nicole A Pelot
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America
- Department of Neurobiology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
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22
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Pourahmad R, Saleki K, Esmaili M, Abdollahi A, Alijanizadeh P, Gholinejad MZ, Banazadeh M, Ahmadi M. Deep brain stimulation (DBS) as a therapeutic approach in gait disorders: What does it bring to the table? IBRO Neurosci Rep 2023; 14:507-513. [PMID: 37304345 PMCID: PMC10248795 DOI: 10.1016/j.ibneur.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Gait deficits are found in various degenerative central nervous system conditions, and are particularly a hallmark of Parkinson's disease (PD). While there is no cure for such neurodegenerative disorders, Levodopa is considered as the standard medication in PD patients. Often times, the therapy of severe PD consists of deep brain stimulation (DBS) of the subthalamic nucleus. Earlier research exploring the effect of gait have reported contradictory results or insufficient efficacy. A change in gait includes various parameters, such as step length, cadence, Double-stance phase duration which may be positively affected by DBS. DBS could also be effective in correcting the levodopa-induced postural sway abnormalities. Moreover, during normal walking, interaction among the subthalamic nucleus and cortex -essential regions which exert a role in locomotion- are coupled. However, during the freezing of gait, the activity is desynchronized. The mechanisms underlying DBS-induced neurobehavioral improvements in such scenarios requires further study. The present review discusses DBS in the context of gait, the benefits associated with DBS compared to standard pharmacotherapy options, and provides insights into future research.
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Affiliation(s)
- Ramtin Pourahmad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- Department of e-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences(SBMU), Tehran, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | | | - Arian Abdollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Alijanizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | | | - Mohammad Banazadeh
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mona Ahmadi
- Department of Neurology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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23
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Das A, Menon V. Concurrent- and After-Effects of Medial Temporal Lobe Stimulation on Directed Information Flow to and from Prefrontal and Parietal Cortices during Memory Formation. J Neurosci 2023; 43:3159-3175. [PMID: 36963847 PMCID: PMC10146497 DOI: 10.1523/jneurosci.1728-22.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
Electrical stimulation of the medial temporal lobe (MTL) has the potential to uncover causal circuit mechanisms underlying memory function. However, little is known about how MTL stimulation alters information flow with frontoparietal cortical regions implicated in episodic memory. We used intracranial EEG recordings from humans (14 participants, 10 females) to investigate how MTL stimulation alters directed information flow between MTL and PFC and between MTL and posterior parietal cortex (PPC). Participants performed a verbal episodic memory task during which they were presented with words and asked to recall them after a delay of ∼20 s; 50 Hz stimulation was applied to MTL electrodes on selected trials during memory encoding. Directed information flow was examined using phase transfer entropy. Behaviorally, we observed that MTL stimulation reduced memory recall. MTL stimulation decreased top-down PFC→MTL directed information flow during both memory encoding and subsequent memory recall, revealing aftereffects more than 20 s after end of stimulation. Stimulation suppressed top-down PFC→MTL influences to a greater extent than PPC→MTL. Finally, MTL→PFC information flow on stimulation trials was significantly lower for successful, compared with unsuccessful, memory recall; in contrast, MTL→ventral PPC information flow was higher for successful, compared with unsuccessful, memory recall. Together, these results demonstrate that the effects of MTL stimulation are behaviorally, regionally, and directionally specific, that MTL stimulation selectively impairs directional signaling with PFC, and that causal MTL-ventral PPC circuits support successful memory recall. Findings provide new insights into dynamic casual circuits underling episodic memory and their modulation by MTL stimulation.SIGNIFICANCE STATEMENT The medial temporal lobe (MTL) and its interactions with prefrontal and parietal cortices (PFC and PPC) play a critical role in human memory. Dysfunctional MTL-PFC and MTL-PPC circuits are prominent in psychiatric and neurologic disorders, including Alzheimer's disease and schizophrenia. Brain stimulation has emerged as a potential mechanism for enhancing memory and cognitive functions, but the underlying neurophysiological mechanisms and dynamic causal circuitry underlying bottom-up and top-down signaling involving the MTL are unknown. Here, we use intracranial EEG recordings to investigate the effects of MTL stimulation on causal signaling in key episodic memory circuits linking the MTL with PFC and PPC. Our findings have implications for translational applications aimed at realizing the promise of brain stimulation-based treatment of memory disorders.
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Affiliation(s)
- Anup Das
- Department of Psychiatry & Behavioral Sciences
| | - Vinod Menon
- Department of Psychiatry & Behavioral Sciences
- Department of Neurology & Neurological Sciences
- Stanford Neurosciences Institute, Stanford University School of Medicine, Stanford, California 94305
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24
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Benussi A, Batsikadze G, França C, Cury RG, Maas RPPWM. The Therapeutic Potential of Non-Invasive and Invasive Cerebellar Stimulation Techniques in Hereditary Ataxias. Cells 2023; 12:cells12081193. [PMID: 37190102 DOI: 10.3390/cells12081193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
The degenerative ataxias comprise a heterogeneous group of inherited and acquired disorders that are characterized by a progressive cerebellar syndrome, frequently in combination with one or more extracerebellar signs. Specific disease-modifying interventions are currently not available for many of these rare conditions, which underscores the necessity of finding effective symptomatic therapies. During the past five to ten years, an increasing number of randomized controlled trials have been conducted examining the potential of different non-invasive brain stimulation techniques to induce symptomatic improvement. In addition, a few smaller studies have explored deep brain stimulation (DBS) of the dentate nucleus as an invasive means to directly modulate cerebellar output, thereby aiming to alleviate ataxia severity. In this paper, we comprehensively review the clinical and neurophysiological effects of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and dentate nucleus DBS in patients with hereditary ataxias, as well as the presumed underlying mechanisms at the cellular and network level and perspectives for future research.
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Affiliation(s)
- Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Giorgi Batsikadze
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - Carina França
- Movement Disorders Center, Department of Neurology, University of São Paulo, São Paulo 05508-010, Brazil
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, University of São Paulo, São Paulo 05508-010, Brazil
| | - Roderick P P W M Maas
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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25
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Chernov MM, Swan CB, Leiter JC. In Search of a Feedback Signal for Closed-Loop Deep Brain Stimulation: Stimulation of the Subthalamic Nucleus Reveals Altered Glutamate Dynamics in the Globus Pallidus in Anesthetized, 6-Hydroxydopamine-Treated Rats. BIOSENSORS 2023; 13:bios13040480. [PMID: 37185555 PMCID: PMC10137023 DOI: 10.3390/bios13040480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a surgical procedure for alleviating motor symptoms of Parkinson's Disease (PD). The pattern of DBS (e.g., the electrode pairs used and the intensity of stimulation) is usually optimized by trial and error based on a subjective evaluation of motor function. We tested the hypotheses that DBS releases glutamate in selected basal ganglia nuclei and that the creation of 6-hydroxydopamine (6-OHDA)-induced nigrostriatal lesions alters glutamate release during DBS in those basal ganglia nuclei. We studied the relationship between a pseudo-random binary sequence of DBS and glutamate levels in the STN itself or in the globus pallidus (GP) in anesthetized, control, and 6-OHDA-treated rats. We characterized the stimulus-response relationships between DBS and glutamate levels using a transfer function estimated using System Identification. Stimulation of the STN elevated glutamate levels in the GP and in the STN. Although the 6-OHDA treatment did not affect glutamate dynamics in the STN during DBS in the STN, the transfer function between DBS in the STN and glutamate levels in the GP was significantly altered by the presence or absence of 6-OHDA-induced lesions. Thus, glutamate responses in the GP in the 6-OHDA-treated animals (but not in the STN) depended on dopaminergic inputs. For this reason, measuring glutamate levels in the GP may provide a useful feedback target in a closed-loop DBS device in patients with PD since the dynamics of glutamate release in the GP during DBS seem to reflect the loss of dopaminergic neurons in the SNc.
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Affiliation(s)
- Mykyta M Chernov
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH 03755, USA
| | - Christina B Swan
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH 03755, USA
| | - James C Leiter
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH 03755, USA
- The White River Junction VA Medical Center, 215 N Main St, White River Junction, VT 05009, USA
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26
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Halgren AS, Siegel Z, Golden R, Bazhenov M. Multielectrode Cortical Stimulation Selectively Induces Unidirectional Wave Propagation of Excitatory Neuronal Activity in Biophysical Neural Model. J Neurosci 2023; 43:2482-2496. [PMID: 36849415 PMCID: PMC10082457 DOI: 10.1523/jneurosci.1784-21.2023] [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: 09/01/2021] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 03/01/2023] Open
Abstract
Cortical stimulation is emerging as an experimental tool in basic research and a promising therapy for a range of neuropsychiatric conditions. As multielectrode arrays enter clinical practice, the possibility of using spatiotemporal patterns of electrical stimulation to induce desired physiological patterns has become theoretically possible, but in practice can only be implemented by trial-and-error because of a lack of predictive models. Experimental evidence increasingly establishes traveling waves as fundamental to cortical information-processing, but we lack an understanding of how to control wave properties despite rapidly improving technologies. This study uses a hybrid biophysical-anatomical and neural-computational model to predict and understand how a simple pattern of cortical surface stimulation could induce directional traveling waves via asymmetric activation of inhibitory interneurons. We found that pyramidal cells and basket cells are highly activated by the anodal electrode and minimally activated by the cathodal electrodes, while Martinotti cells are moderately activated by both electrodes but exhibit a slight preference for cathodal stimulation. Network model simulations found that this asymmetrical activation results in a traveling wave in superficial excitatory cells that propagates unidirectionally away from the electrode array. Our study reveals how asymmetric electrical stimulation can easily facilitate traveling waves by relying on two distinct types of inhibitory interneuron activity to shape and sustain the spatiotemporal dynamics of endogenous local circuit mechanisms.SIGNIFICANCE STATEMENT Electrical brain stimulation is becoming increasingly useful to probe the workings of brain and to treat a variety of neuropsychiatric disorders. However, stimulation is currently performed in a trial-and-error fashion as there are no methods to predict how different electrode arrangements and stimulation paradigms will affect brain functioning. In this study, we demonstrate a hybrid modeling approach, which makes experimentally testable predictions that bridge the gap between the microscale effects of multielectrode stimulation and the resultant circuit dynamics at the mesoscale. Our results show how custom stimulation paradigms can induce predictable, persistent changes in brain activity, which has the potential to restore normal brain function and become a powerful therapy for neurological and psychiatric conditions.
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Affiliation(s)
- Alma S Halgren
- Department of Medicine, University of California - San Diego, La Jolla, California 92093-7374
- Department of Integrative Biology, University of California - Berkeley, Berkeley, California 94720
| | - Zarek Siegel
- Department of Medicine, University of California - San Diego, La Jolla, California 92093-7374
- Neurosciences Graduate Program, University of California - San Diego, La Jolla, California 92093-7374
| | - Ryan Golden
- Department of Medicine, University of California - San Diego, La Jolla, California 92093-7374
- Neurosciences Graduate Program, University of California - San Diego, La Jolla, California 92093-7374
| | - Maxim Bazhenov
- Department of Medicine, University of California - San Diego, La Jolla, California 92093-7374
- Neurosciences Graduate Program, University of California - San Diego, La Jolla, California 92093-7374
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27
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Vargas L, Musselman ED, Grill WM, Hu X. Asynchronous axonal firing patterns evoked via continuous subthreshold kilohertz stimulation. J Neural Eng 2023; 20:10.1088/1741-2552/acc20f. [PMID: 36881885 PMCID: PMC10433012 DOI: 10.1088/1741-2552/acc20f] [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: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 03/09/2023]
Abstract
Objective.Transcutaneous electrical stimulation of peripheral nerves is a common technique to assist or rehabilitate impaired muscle activation. However, conventional stimulation paradigms activate nerve fibers synchronously with action potentials time-locked with stimulation pulses. Such synchronous activation limits fine control of muscle force due to synchronized force twitches. Accordingly, we developed a subthreshold high-frequency stimulation waveform with the goal of activating axons asynchronously.Approach.We evaluated our waveform experimentally and through model simulations. During the experiment, we delivered continuous subthreshold pulses at frequencies of 16.67, 12.5, or 10 kHz transcutaneously to the median and ulnar nerves. We obtained high-density electromyographic (EMG) signals and fingertip forces to quantify the axonal activation patterns. We used a conventional 30 Hz stimulation waveform and the associated voluntary muscle activation for comparison. We modeled stimulation of biophysically realistic myelinated mammalian axons using a simplified volume conductor model to solve for extracellular electric potentials. We compared the firing properties under kHz and conventional 30 Hz stimulation.Main results.EMG activity evoked by kHz stimulation showed high entropy values similar to voluntary EMG activity, indicating asynchronous axon firing activity. In contrast, we observed low entropy values in EMG evoked by conventional 30 Hz stimulation. The muscle forces evoked by kHz stimulation also showed more stable force profiles across repeated trials compared with 30 Hz stimulation. Our simulation results provide direct evidence of asynchronous firing patterns across a population of axons in response to kHz frequency stimulation, while 30 Hz stimulation elicited synchronized time-locked responses across the population.Significance.We demonstrate that the continuous subthreshold high-frequency stimulation waveform can elicit asynchronous axon firing patterns, which can lead to finer control of muscle forces.
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Affiliation(s)
- Luis Vargas
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Eric D Musselman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America
- Department of Neurobiology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
| | - Xiaogang Hu
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, United States of America
- Department of Kinesiology, Pennsylvania State University, University Park, PA, United States of America
- Department of Physical Medicine & Rehabilitation, Pennsylvania State Hershey College of Medicine, Hershey, PA, United States of America
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, United States of America
- Center for Neural Engineering, Pennsylvania State University, University Park, PA, United States of America
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28
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Brinda A, Slopsema JP, Butler RD, Ikramuddin S, Beall T, Guo W, Chu C, Patriat R, Braun H, Goftari M, Palnitkar T, Aman J, Schrock L, Cooper SE, Matsumoto J, Vitek JL, Harel N, Johnson MD. Lateral cerebellothalamic tract activation underlies DBS therapy for Essential Tremor. Brain Stimul 2023; 16:445-455. [PMID: 36746367 PMCID: PMC10200026 DOI: 10.1016/j.brs.2023.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND While deep brain stimulation (DBS) therapy can be effective at suppressing tremor in individuals with medication-refractory Essential Tremor, patient outcome variability remains a significant challenge across centers. Proximity of active electrodes to the cerebellothalamic tract (CTT) is likely important in suppressing tremor, but how tremor control and side effects relate to targeting parcellations within the CTT and other pathways in and around the ventral intermediate (VIM) nucleus of thalamus remain unclear. METHODS Using ultra-high field (7T) MRI, we developed high-dimensional, subject-specific pathway activation models for 23 directional DBS leads. Modeled pathway activations were compared with post-hoc analysis of clinician-optimized DBS settings, paresthesia thresholds, and dysarthria thresholds. Mixed-effect models were utilized to determine how the six parcellated regions of the CTT and how six other pathways in and around the VIM contributed to tremor suppression and induction of side effects. RESULTS The lateral portion of the CTT had the highest activation at clinical settings (p < 0.05) and a significant effect on tremor suppression (p < 0.001). Activation of the medial lemniscus and posterior-medial CTT was significantly associated with severity of paresthesias (p < 0.001). Activation of the anterior-medial CTT had a significant association with dysarthria (p < 0.05). CONCLUSIONS This study provides a detailed understanding of the fiber pathways responsible for therapy and side effects of DBS for Essential Tremor, and suggests a model-based programming approach will enable more selective activation of lateral fibers within the CTT.
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Affiliation(s)
- AnneMarie Brinda
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Julia P Slopsema
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Rebecca D Butler
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Salman Ikramuddin
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Thomas Beall
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - William Guo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Cong Chu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Remi Patriat
- Department of Radiology, CMRR, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Henry Braun
- Department of Radiology, CMRR, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Mojgan Goftari
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Tara Palnitkar
- Department of Radiology, CMRR, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Joshua Aman
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Lauren Schrock
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Scott E Cooper
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Joseph Matsumoto
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Noam Harel
- Department of Radiology, CMRR, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, MN, 55455, USA.
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29
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Bingham CS, Petersen MV, Parent M, McIntyre CC. Evolving characterization of the human hyperdirect pathway. Brain Struct Funct 2023; 228:353-365. [PMID: 36708394 PMCID: PMC10716731 DOI: 10.1007/s00429-023-02610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
The hyperdirect pathway (HDP) represents the main glutamatergic input to the subthalamic nucleus (STN), through which the motor and prefrontal cerebral cortex can modulate basal ganglia activity. Further, direct activation of the motor HDP is thought to be an important component of therapeutic deep brain stimulation (DBS), mediating the disruption of pathological oscillations. Alternatively, unintended recruitment of the prefrontal HDP may partly explain some cognitive side effects of DBS therapy. Previous work describing the HDP has focused on non-human primate (NHP) histological pathway tracings, diffusion-weighted MRI analysis of human white matter, and electrophysiology studies involving paired cortical recordings with DBS. However, none of these approaches alone yields a complete understanding of the complexities of the HDP. As such, we propose that generative modeling methods hold promise to bridge anatomy and physiology results, from both NHPs and humans, into a more detailed representation of the human HDP. Nonetheless, numerous features of the HDP remain to be experimentally described before model-based methods can simulate corticosubthalamic activity with a high degree of scientific detail. Therefore, the goals of this review are to examine the experimental evidence for HDP projections from across the primate neocortex and discuss new data which are required to improve the utility of anatomical and biophysical models of the human corticosubthalamic system.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Martin Parent
- Department of Psychiatry and Neuroscience, Laval University, Quebec, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Neurosurgery, Duke University, Durham, NC, USA.
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30
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Unal G, Poon C, FallahRad M, Thahsin M, Argyelan M, Bikson M. Quasi-static pipeline in electroconvulsive therapy computational modeling. Brain Stimul 2023; 16:607-618. [PMID: 36933652 PMCID: PMC10988926 DOI: 10.1016/j.brs.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Computational models of current flow during Electroconvulsive Therapy (ECT) rely on the quasi-static assumption, yet tissue impedance during ECT may be frequency specific and change adaptively to local electric field intensity. OBJECTIVES We systematically consider the application of the quasi-static pipeline to ECT under conditions where 1) static impedance is measured before ECT and 2) during ECT when dynamic impedance is measured. We propose an update to ECT modeling accounting for frequency-dependent impedance. METHODS The frequency content on an ECT device output is analyzed. The ECT electrode-body impedance under low-current conditions is measured with an impedance analyzer. A framework for ECT modeling under quasi-static conditions based on a single device-specific frequency (e.g., 1 kHz) is proposed. RESULTS Impedance using ECT electrodes under low-current is frequency dependent and subject specific, and can be approximated at >100 Hz with a subject-specific lumped parameter circuit model but at <100 Hz increased non-linearly. The ECT device uses a 2 μA 800 Hz test signal and reports a static impedance that approximate 1 kHz impedance. Combined with prior evidence suggesting that conductivity does not vary significantly across ECT output frequencies at high-currents (800-900 mA), we update the adaptive pipeline for ECT modeling centered at 1 kHz frequency. Based on individual MRI and adaptive skin properties, models match static impedance (at 2 μA) and dynamic impedance (at 900 mA) of four ECT subjects. CONCLUSIONS By considering ECT modeling at a single representative frequency, ECT adaptive and non-adaptive modeling can be rationalized under a quasi-static pipeline.
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Affiliation(s)
- Gozde Unal
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA.
| | - Cynthia Poon
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Mohamad FallahRad
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Myesha Thahsin
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Miklos Argyelan
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore- Long Island Jewish Health System, Manhasset, NY, 11030, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA.
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31
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Lange F, Eldebakey H, Hilgenberg A, Weigl B, Eckert M, DeSunda A, Neugebauer H, Peach R, Roothans J, Volkmann J, Reich MM. Distinct phenotypes of stimulation-induced dysarthria represent different cortical networks in STN-DBS. Parkinsonism Relat Disord 2023; 109:105347. [PMID: 36870157 DOI: 10.1016/j.parkreldis.2023.105347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus is an effective treatment of Parkinson's disease, yet it is often associated with a general deterioration of speech intelligibility. Clustering the phenotypes of dysarthria has been proposed as a strategy to tackle these stimulation-induced speech problems. METHODS In this study, we examine a cohort of 24 patients to test the real-life application of the proposed clustering and attempt to attribute the clusters to specific brain networks with two different approaches of connectivity analysis. RESULTS Both our data-driven and hypothesis-driven approaches revealed strong connections of variants of stimulation-induced dysarthria to brain regions that are known actors of motor speech control. We showed a strong connection between the spastic dysarthria type and the precentral gyrus and supplementary motor area, prompting a possible disruption of corticobulbar fibers. The connection between the strained voice dysarthria and more frontal areas hints toward a deeper disruption of the motor programming of speech production. CONCLUSIONS These results provide insights into the mechanism of stimulation-induced dysarthria in deep brain stimulation of the subthalamic nucleus and may guide reprogramming attempts for individual Parkinson's patients based on pathophysiological understanding of the affected networks.
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Affiliation(s)
- Florian Lange
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany.
| | - Hazem Eldebakey
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Alexandra Hilgenberg
- Department of Linguistics and Literature, Ludwig Maximilian University, Geschwister-Scholl-Platz 1, 80539, Munich, Germany
| | - Benedikt Weigl
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Marie Eckert
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Angela DeSunda
- Department of Linguistics, Wittelsbacherplatz 1, 97074 Würzburg Julius Maximilian University, Würzburg, Germany
| | - Hermann Neugebauer
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Robert Peach
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Jonas Roothans
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
| | - Martin M Reich
- Department of Neurology, University Hospital and Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Wuerzburg, Germany
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32
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Blanz SL, Musselman ED, Settell ML, Knudsen BE, Nicolai EN, Trevathan JK, Verner RS, Begnaud J, Skubal AC, Suminski AJ, Williams JC, Shoffstall AJ, Grill WM, Pelot NA, Ludwig KA. Spatially selective stimulation of the pig vagus nerve to modulate target effect versus side effect. J Neural Eng 2023; 20:10.1088/1741-2552/acb3fd. [PMID: 36649655 PMCID: PMC10339030 DOI: 10.1088/1741-2552/acb3fd] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/17/2023] [Indexed: 01/18/2023]
Abstract
Electrical stimulation of the cervical vagus nerve using implanted electrodes (VNS) is FDA-approved for the treatment of drug-resistant epilepsy, treatment-resistant depression, and most recently, chronic ischemic stroke rehabilitation. However, VNS is critically limited by the unwanted stimulation of nearby neck muscles-a result of non-specific stimulation activating motor nerve fibers within the vagus. Prior studies suggested that precise placement of small epineural electrodes can modify VNS therapeutic effects, such as cardiac responses. However, it remains unclear if placement can alter the balance between intended effect and limiting side effect. We used an FDA investigational device exemption approved six-contact epineural cuff to deliver VNS in pigs and quantified how epineural electrode location impacts on- and off-target VNS activation. Detailed post-mortem histology was conducted to understand how the underlying neuroanatomy impacts observed functional responses. Here we report the discovery and characterization of clear neuroanatomy-dependent differences in threshold and saturation for responses related to both effect (change in heart rate) and side effect (neck muscle contractions). The histological and electrophysiological data were used to develop and validate subject-specific computation models of VNS, creating a well-grounded quantitative framework to optimize electrode location-specific activation of nerve fibers governing intended effect versus unwanted side effect.
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Affiliation(s)
- Stephan L Blanz
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Eric D Musselman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Megan L Settell
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Bruce E Knudsen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Evan N Nicolai
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
- Mayo Clinic, Rochester, MN, United States of America
| | - James K Trevathan
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Ryan S Verner
- LivaNova USA Inc., Houston, TX, United States of America
| | - Jason Begnaud
- LivaNova USA Inc., Houston, TX, United States of America
| | - Aaron C Skubal
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Aaron J Suminski
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Justin C Williams
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Andrew J Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- APT Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Warren M Grill
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America
- Department of Neurobiology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
| | - Nicole A Pelot
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Kip A Ludwig
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
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Pagano RL, Dale CS, Campos ACP, Hamani C. Translational aspects of deep brain stimulation for chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1084701. [PMID: 36713643 PMCID: PMC9874335 DOI: 10.3389/fpain.2022.1084701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
The use of deep brain stimulation (DBS) for the treatment of chronic pain was one of the first applications of this technique in functional neurosurgery. Established brain targets in the clinic include the periaqueductal (PAG)/periventricular gray matter (PVG) and sensory thalamic nuclei. More recently, the anterior cingulum (ACC) and the ventral striatum/anterior limb of the internal capsule (VS/ALIC) have been investigated for the treatment of emotional components of pain. In the clinic, most studies showed a response in 20%-70% of patients. In various applications of DBS, animal models either provided the rationale for the development of clinical trials or were utilized as a tool to study potential mechanisms of stimulation responses. Despite the complex nature of pain and the fact that animal models cannot reliably reflect the subjective nature of this condition, multiple preparations have emerged over the years. Overall, DBS was shown to produce an antinociceptive effect in rodents when delivered to targets known to induce analgesic effects in humans, suggesting a good predictive validity. Compared to the relatively high number of clinical trials in the field, however, the number of animal studies has been somewhat limited. Additional investigation using modern neuroscience techniques could unravel the mechanisms and neurocircuitry involved in the analgesic effects of DBS and help to optimize this therapy.
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Affiliation(s)
- Rosana L. Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Camila S. Dale
- Laboratory of Neuromodulation and Experimental Pain, Department of Anatomy, University of São Paulo, São Paulo, Brazil
| | | | - Clement Hamani
- Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Toronto, ON, Canada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada,Correspondence: Clement Hamani
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Gupta A, Vardalakis N, Wagner FB. Neuroprosthetics: from sensorimotor to cognitive disorders. Commun Biol 2023; 6:14. [PMID: 36609559 PMCID: PMC9823108 DOI: 10.1038/s42003-022-04390-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Neuroprosthetics is a multidisciplinary field at the interface between neurosciences and biomedical engineering, which aims at replacing or modulating parts of the nervous system that get disrupted in neurological disorders or after injury. Although neuroprostheses have steadily evolved over the past 60 years in the field of sensory and motor disorders, their application to higher-order cognitive functions is still at a relatively preliminary stage. Nevertheless, a recent series of proof-of-concept studies suggest that electrical neuromodulation strategies might also be useful in alleviating some cognitive and memory deficits, in particular in the context of dementia. Here, we review the evolution of neuroprosthetics from sensorimotor to cognitive disorders, highlighting important common principles such as the need for neuroprosthetic systems that enable multisite bidirectional interactions with the nervous system.
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Affiliation(s)
- Ankur Gupta
- grid.462010.1Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000 Bordeaux, France
| | | | - Fabien B. Wagner
- grid.462010.1Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000 Bordeaux, France
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Beckinghausen J, Donofrio SG, Lin T, Miterko LN, White JJ, Lackey EP, Sillitoe RV. Deep Brain Stimulation of the Interposed Cerebellar Nuclei in a Conditional Genetic Mouse Model with Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:93-117. [PMID: 37338698 DOI: 10.1007/978-3-031-26220-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Dystonia is a neurological disease that is currently ranked as the third most common motor disorder. Patients exhibit repetitive and sometimes sustained muscle contractions that cause limb and body twisting and abnormal postures that impair movement. Deep brain stimulation (DBS) of the basal ganglia and thalamus can be used to improve motor function when other treatment options fail. Recently, the cerebellum has garnered interest as a DBS target for treating dystonia and other motor disorders. Here, we describe a procedure for targeting DBS electrodes to the interposed cerebellar nuclei to correct motor dysfunction in a mouse model with dystonia. Targeting cerebellar outflow pathways with neuromodulation opens new possibilities for using the expansive connectivity of the cerebellum to treat motor and non-motor diseases.
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Affiliation(s)
- Jaclyn Beckinghausen
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Sarah G Donofrio
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Tao Lin
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Lauren N Miterko
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
| | - Joshua J White
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Elizabeth P Lackey
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Roy V Sillitoe
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA.
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA.
- Development, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX, USA.
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Lai Y, He N, Wei H, Deng L, Zhou H, Li J, Kaiser M, Zhang C, Li D, Sun B. Value of functional connectivity in outcome prediction for pallidal stimulation in Parkinson disease. J Neurosurg 2023; 138:27-37. [PMID: 35523258 DOI: 10.3171/2022.3.jns212732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Functional connectivity shows the ability to predict the outcome of subthalamic nucleus deep brain stimulation (DBS) in Parkinson disease (PD). However, evidence supporting its value in predicting the outcome of globus pallidus internus (GPi) DBS remains scarce. In this study the authors investigated patient-specific functional connectivity related to GPi DBS outcome in PD and established connectivity models for outcome prediction. METHODS The authors reviewed the outcomes of 21 patients with PD who received bilateral GPi DBS and presurgical functional MRI at the Ruijin Hospital. The connectivity profiles within cortical areas identified as relevant to DBS outcome in the literature were calculated using the intersection of the volume of tissue activated (VTA) and the local structures as the seeds. Combined with the leave-one-out cross-validation strategy, models of the optimal connectivity profile were constructed to predict outcome. RESULTS Connectivity between the pallidal areas and primary motor area, supplementary motor area (SMA), and premotor cortex was identified through the literature as related to GPi DBS outcome. The similarity between the connectivity profile within the primary motor area, SMA, pre-SMA, and premotor cortex seeding from the VTA-GPi intersection from an out-of-sample patient and the constructed in-sample optimal connectivity profile predicts GPi DBS outcome (R = 0.58, p = 0.006). The predictions on average deviated by 13.1% ± 11.3% from actual improvements. On the contrary, connectivity profiles seeding from the GPi (R = -0.12, p = 0.603), the VTA (R = 0.23, p = 0.308), the VTA outside the GPi (R = 0.12, p = 0.617), or other local structures were found not to be predictive. CONCLUSIONS The results showed that patient-specific functional connectivity seeding from the VTA-GPi intersection could help in GPi DBS outcome prediction. Reproducibility remains to be determined across centers in larger cohorts stratified by PD motor subtype.
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Affiliation(s)
- Yijie Lai
- 1Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naying He
- 2Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjiang Wei
- 3Department of Biomedical Engineering, Institute for Medical Imaging Technology, Shanghai Jiao Tong University, Shanghai, China
| | - Lifu Deng
- 4Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Haiyan Zhou
- 5Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Li
- 6School of Information Science and Technology, Shanghai Technical University, Shanghai, China
| | - Marcus Kaiser
- 7School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; and
| | - Chencheng Zhang
- 1Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 8Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Dianyou Li
- 1Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- 1Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Haber SN, Lehman J, Maffei C, Yendiki A. The rostral zona incerta: a subcortical integrative hub and potential DBS target for OCD. Biol Psychiatry 2023; 93:1010-1022. [PMID: 37055285 DOI: 10.1016/j.biopsych.2023.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND The zona incerta (ZI) is involved in mediating survival behaviors and is connected to a wide range of cortical and subcortical structures, including key basal ganglia nuclei. Based on these connections and their links to behavioral modulation, we propose that the ZI is a connectional hub for mediating between top-down and bottom-up control and a possible target for deep brain stimulation for obsessive-compulsive disorder. METHODS We analyzed the trajectory of cortical fibers to the ZI in nonhuman and human primates based on tracer injections in monkeys and high-resolution diffusion magnetic resonance imaging in humans. The organization of cortical and subcortical connections within the ZI were identified in the nonhuman primate studies. RESULTS Monkey anatomical data and human diffusion magnetic resonance imaging data showed a similar trajectory of fibers/streamlines to the ZI. Prefrontal cortex/anterior cingulate cortex terminals all converged within the rostral ZI, with dorsal and lateral areas being most prominent. Motor areas terminated caudally. Dense subcortical reciprocal connections included the thalamus, medial hypothalamus, substantia nigra/ventral tegmental area, reticular formation, and pedunculopontine nucleus and a dense nonreciprocal projection to the lateral habenula. Additional connections included the amygdala, dorsal raphe nucleus, and periaqueductal gray. CONCLUSIONS Dense connections with dorsal and lateral prefrontal cortex/anterior cingulate cortex cognitive control areas and the lateral habenula and the substantia nigra/ventral tegmental area, coupled with inputs from the amygdala, hypothalamus, and brainstem, suggest that the rostral ZI is a subcortical hub positioned to modulate between top-down and bottom-up control. A deep brain stimulation electrode placed in the rostral ZI would not only involve connections common to other deep brain stimulation sites but also capture several critically distinctive connections.
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Affiliation(s)
- Suzanne N Haber
- Department of Pharmacology & Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
| | - Julia Lehman
- Department of Pharmacology & Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Chiara Maffei
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anastasia Yendiki
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Lowet E, Kondabolu K, Zhou S, Mount RA, Wang Y, Ravasio CR, Han X. Deep brain stimulation creates informational lesion through membrane depolarization in mouse hippocampus. Nat Commun 2022; 13:7709. [PMID: 36513664 PMCID: PMC9748039 DOI: 10.1038/s41467-022-35314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Deep brain stimulation (DBS) is a promising neuromodulation therapy, but the neurophysiological mechanisms of DBS remain unclear. In awake mice, we performed high-speed membrane voltage fluorescence imaging of individual hippocampal CA1 neurons during DBS delivered at 40 Hz or 140 Hz, free of electrical interference. DBS powerfully depolarized somatic membrane potentials without suppressing spike rate, especially at 140 Hz. Further, DBS paced membrane voltage and spike timing at the stimulation frequency and reduced timed spiking output in response to hippocampal network theta-rhythmic (3-12 Hz) activity patterns. To determine whether DBS directly impacts cellular processing of inputs, we optogenetically evoked theta-rhythmic membrane depolarization at the soma. We found that DBS-evoked membrane depolarization was correlated with DBS-mediated suppression of neuronal responses to optogenetic inputs. These results demonstrate that DBS produces powerful membrane depolarization that interferes with the ability of individual neurons to respond to inputs, creating an informational lesion.
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Affiliation(s)
- Eric Lowet
- Boston University, Department of Biomedical Engineering, Boston, MA, 02215, USA.
| | - Krishnakanth Kondabolu
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Samuel Zhou
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Rebecca A. Mount
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Yangyang Wang
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Cara R. Ravasio
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Xue Han
- Boston University, Department of Biomedical Engineering, Boston, MA, 02215, USA.
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Khadka N, Bikson M. Neurocapillary-Modulation. Neuromodulation 2022; 25:1299-1311. [PMID: 33340187 PMCID: PMC8213863 DOI: 10.1111/ner.13338] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We consider two consequences of brain capillary ultrastructure in neuromodulation. First, blood-brain barrier (BBB) polarization as a consequence of current crossing between interstitial space and the blood. Second, interstitial current flow distortion around capillaries impacting neuronal stimulation. MATERIALS AND METHODS We developed computational models of BBB ultrastructure morphologies to first assess electric field amplification at the BBB (principle 1) and neuron polarization amplification by the presence of capillaries (principle 2). We adapt neuron cable theory to develop an analytical solution for maximum BBB polarization sensitivity. RESULTS Electrical current crosses between the brain parenchyma (interstitial space) and capillaries, producing BBB electric fields (EBBB) that are >400x of the average parenchyma electric field (ĒBRAIN), which in turn modulates transport across the BBB. Specifically, for a BBB space constant (λBBB) and wall thickness (dth-BBB), the analytical solution for maximal BBB electric field (EABBB) is given as: (ĒBRAIN × λBBB)/dth-BBB. Electrical current in the brain parenchyma is distorted around brain capillaries, amplifying neuronal polarization. Specifically, capillary ultrastructure produces ∼50% modulation of the ĒBRAIN over the ∼40 μm inter-capillary distance. The divergence of EBRAIN (Activating function) is thus ∼100 kV/m2 per unit ĒBRAIN. CONCLUSIONS BBB stimulation by principle 1 suggests novel therapeutic strategies such as boosting metabolic capacity or interstitial fluid clearance. Whereas the spatial profile of EBRAIN is traditionally assumed to depend only on macroscopic anatomy, principle 2 suggests a central role for local capillary ultrastructure-which impact forms of neuromodulation including deep brain stimulation (DBS), spinal cord stimulation (SCS), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and transcranial electrical stimulation (tES)/transcranial direct current stimulation (tDCS).
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Affiliation(s)
- Niranjan Khadka
- Department of Psychiatry, Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA.
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Ye H, Hendee J, Ruan J, Zhirova A, Ye J, Dima M. Neuron matters: neuromodulation with electromagnetic stimulation must consider neurons as dynamic identities. J Neuroeng Rehabil 2022; 19:116. [PMID: 36329492 PMCID: PMC9632094 DOI: 10.1186/s12984-022-01094-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Neuromodulation with electromagnetic stimulation is widely used for the control of abnormal neural activity, and has been proven to be a valuable alternative to pharmacological tools for the treatment of many neurological diseases. Tremendous efforts have been focused on the design of the stimulation apparatus (i.e., electrodes and magnetic coils) that delivers the electric current to the neural tissue, and the optimization of the stimulation parameters. Less attention has been given to the complicated, dynamic properties of the neurons, and their context-dependent impact on the stimulation effects. This review focuses on the neuronal factors that influence the outcomes of electromagnetic stimulation in neuromodulation. Evidence from multiple levels (tissue, cellular, and single ion channel) are reviewed. Properties of the neural elements and their dynamic changes play a significant role in the outcome of electromagnetic stimulation. This angle of understanding yields a comprehensive perspective of neural activity during electrical neuromodulation, and provides insights in the design and development of novel stimulation technology.
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Affiliation(s)
- Hui Ye
- grid.164971.c0000 0001 1089 6558Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660 USA
| | - Jenna Hendee
- grid.164971.c0000 0001 1089 6558Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660 USA
| | - Joyce Ruan
- grid.164971.c0000 0001 1089 6558Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660 USA
| | - Alena Zhirova
- grid.164971.c0000 0001 1089 6558Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660 USA
| | - Jayden Ye
- grid.164971.c0000 0001 1089 6558Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660 USA
| | - Maria Dima
- grid.164971.c0000 0001 1089 6558Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660 USA
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Bove F, Genovese D, Moro E. Developments in the mechanistic understanding and clinical application of deep brain stimulation for Parkinson's disease. Expert Rev Neurother 2022; 22:789-803. [PMID: 36228575 DOI: 10.1080/14737175.2022.2136030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION. Deep brain stimulation (DBS) is a life-changing treatment for patients with Parkinson's disease (PD) and gives the unique opportunity to directly explore how basal ganglia work. Despite the rapid technological innovation of the last years, the untapped potential of DBS is still high. AREAS COVERED. This review summarizes the developments in the mechanistic understanding of DBS and the potential clinical applications of cutting-edge technological advances. Rather than a univocal local mechanism, DBS exerts its therapeutic effects through several multimodal mechanisms and involving both local and network-wide structures, although crucial questions remain unexplained. Nonetheless, new insights in mechanistic understanding of DBS in PD have provided solid bases for advances in preoperative selection phase, prediction of motor and non-motor outcomes, leads placement and postoperative stimulation programming. EXPERT OPINION. DBS has not only strong evidence of clinical effectiveness in PD treatment, but technological advancements are revamping its role of neuromodulation of brain circuits and key to better understanding PD pathophysiology. In the next few years, the worldwide use of new technologies in clinical practice will provide large data to elucidate their role and to expand their applications for PD patients, providing useful insights to personalize DBS treatment and follow-up.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Genovese
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM, U1216, Grenoble, France
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Steiner LA, Kühn AA, Geiger JR, Alle H, Popovic MR, Kalia SK, Hodaie M, Lozano AM, Hutchison WD, Milosevic L. Persistent synaptic inhibition of the subthalamic nucleus by high frequency stimulation. Brain Stimul 2022; 15:1223-1232. [PMID: 36058524 DOI: 10.1016/j.brs.2022.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/10/2022] [Accepted: 08/25/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) provides symptomatic relief in a growing number of neurological indications, but local synaptic dynamics in response to electrical stimulation that may relate to its mechanism of action have not been fully characterized. OBJECTIVE The objectives of this study were to (1) study local synaptic dynamics during high frequency extracellular stimulation of the subthalamic nucleus (STN), and (2) compare STN synaptic dynamics with those of the neighboring substantia nigra pars reticulata (SNr). METHODS Two microelectrodes were advanced into the STN and SNr of patients undergoing DBS surgery for Parkinson's disease (PD). Neuronal firing and evoked field potentials (fEPs) were recorded with one microelectrode during stimulation from an adjacent microelectrode. RESULTS Inhibitory fEPs could be discerned within the STN and their amplitudes predicted bidirectional effects on neuronal firing (p = .013). There were no differences between STN and SNr inhibitory fEP dynamics at low stimulation frequencies (p > .999). However, inhibitory neuronal responses were sustained over time in STN during high frequency stimulation but not in SNr (p < .001) where depression of inhibitory input was coupled with a return of neuronal firing (p = .003). INTERPRETATION Persistent inhibitory input to the STN suggests a local synaptic mechanism for the suppression of subthalamic firing during high frequency stimulation. Moreover, differences in the resiliency versus vulnerability of inhibitory inputs to the STN and SNr suggest a projection source- and frequency-specificity for this mechanism. The feasibility of targeting electrophysiologically-identified neural structures may provide insight into how DBS achieves frequency-specific modulation of neuronal projections.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Canada; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Berlin Institute of Health (BIH), Germany; Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Jörg Rp Geiger
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Henrik Alle
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Milos R Popovic
- KITE Research Institute, University Health Network, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Canada; KITE Research Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - William D Hutchison
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada; Department of Physiology, University of Toronto, Canada
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Canada; KITE Research Institute, University Health Network, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
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43
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Cellular mechanisms underlying state-dependent neural inhibition with magnetic stimulation. Sci Rep 2022; 12:12131. [PMID: 35840656 PMCID: PMC9287388 DOI: 10.1038/s41598-022-16494-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/11/2022] [Indexed: 12/29/2022] Open
Abstract
Novel stimulation protocols for neuromodulation with magnetic fields are explored in clinical and laboratory settings. Recent evidence suggests that the activation state of the nervous system plays a significant role in the outcome of magnetic stimulation, but the underlying cellular and molecular mechanisms of state-dependency have not been completely investigated. We recently reported that high frequency magnetic stimulation could inhibit neural activity when the neuron was in a low active state. In this paper, we investigate state-dependent neural modulation by applying a magnetic field to single neurons, using the novel micro-coil technology. High frequency magnetic stimulation suppressed single neuron activity in a state-dependent manner. It inhibited neurons in slow-firing states, but spared neurons from fast-firing states, when the same magnetic stimuli were applied. Using a multi-compartment NEURON model, we found that dynamics of voltage-dependent sodium and potassium channels were significantly altered by the magnetic stimulation in the slow-firing neurons, but not in the fast-firing neurons. Variability in neural activity should be monitored and explored to optimize the outcome of magnetic stimulation in basic laboratory research and clinical practice. If selective stimulation can be programmed to match the appropriate neural state, prosthetic implants and brain-machine interfaces can be designed based on these concepts to achieve optimal results.
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44
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Schor JS, Gonzalez Montalvo I, Spratt PWE, Brakaj RJ, Stansil JA, Twedell EL, Bender KJ, Nelson AB. Therapeutic deep brain stimulation disrupts movement-related subthalamic nucleus activity in Parkinsonian mice. eLife 2022; 11:75253. [PMID: 35786442 PMCID: PMC9342952 DOI: 10.7554/elife.75253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation (STN DBS) relieves many motor symptoms of Parkinson’s disease (PD), but its underlying therapeutic mechanisms remain unclear. Since its advent, three major theories have been proposed: (1) DBS inhibits the STN and basal ganglia output; (2) DBS antidromically activates motor cortex; and (3) DBS disrupts firing dynamics within the STN. Previously, stimulation-related electrical artifacts limited mechanistic investigations using electrophysiology. We used electrical artifact-free GCaMP fiber photometry to investigate activity in basal ganglia nuclei during STN DBS in parkinsonian mice. To test whether the observed changes in activity were sufficient to relieve motor symptoms, we then combined electrophysiological recording with targeted optical DBS protocols. Our findings suggest that STN DBS exerts its therapeutic effect through the disruption of movement-related STN activity, rather than inhibition or antidromic activation. These results provide insight into optimizing PD treatments and establish an approach for investigating DBS in other neuropsychiatric conditions.
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Affiliation(s)
- Jonathan S Schor
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | | | - Perry W E Spratt
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | - Rea J Brakaj
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Jasmine A Stansil
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Emily L Twedell
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | - Kevin J Bender
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Alexandra B Nelson
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
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Huang CH, Wang PH, Ju MS, Lin CCK. Using Constrained Square-Root Cubature Kalman Filter for Quantifying the Severity of Epileptic Activities in Mice. Biomedicines 2022; 10:biomedicines10071588. [PMID: 35884892 PMCID: PMC9313404 DOI: 10.3390/biomedicines10071588] [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: 06/03/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Quantification of severity of epileptic activities, especially during electrical stimulation, is an unmet need for seizure control and evaluation of therapeutic efficacy. In this study, a parameter ratio derived from constrained square-root cubature Kalman filter (CSCKF) was formulated to quantify the excitability of local neural network and compared with three commonly used indicators, namely, band power, Teager energy operator, and sample entropy, to objectively determine their effectiveness in quantifying the severity of epileptiform discharges in mice. (2) Methods: A set of one normal and four types of epileptic EEGs was generated by a mathematical model. EEG data of epileptiform discharges during two types of electrical stimulation were recorded in 20 mice. Then, EEG segments of 5 s in length before, during and after the real and sham stimulation were collected. Both simulated and experimental data were used to compare the consistency and differences among the performance indicators. (3) Results: For the experimental data, the results of the four indicators were inconsistent during both types of electrical stimulation, although there was a trend that seizure severity changed with the indicators. For the simulated data, when the simulated EEG segments were used, the results of all four indicators were similar; however, this trend did not match the trend of excitability of the model network. In the model output which retained the DC component, except for the CSCKF parameter ratio, the results of the other three indicators were almost identical to those using the simulated EEG. For CSCKF, the parameter ratio faithfully reflected the excitability of the neural network. (4) Conclusion: For common EEG, CSCKF did not outperform other commonly used performance indicators. However, for EEG with a preserved DC component, CSCKF had the potential to quantify the excitability of the neural network and the associated severity of epileptiform discharges.
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Affiliation(s)
- Chih-Hsu Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Medical Device Innovation Center, National Cheng Kung University, Tainan 70101, Taiwan
| | - Peng-Hsiang Wang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Ming-Shaung Ju
- Department of Mechanical Engineering, National Cheng Kung University, Tainan 70101, Taiwan;
- Correspondence: (M.-S.J.); (C.-C.K.L.); Tel.: +886-6-235-3535 (ext. 2692) (C.-C.K.L.)
| | - Chou-Ching K. Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Medical Device Innovation Center, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (M.-S.J.); (C.-C.K.L.); Tel.: +886-6-235-3535 (ext. 2692) (C.-C.K.L.)
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46
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Ye H. Finding the Location of Axonal Activation by a Miniature Magnetic Coil. Front Comput Neurosci 2022; 16:932615. [PMID: 35847967 PMCID: PMC9276924 DOI: 10.3389/fncom.2022.932615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Magnetic stimulation for neural activation is widely used in clinical and lab research. In comparison to electric stimulation using an implanted electrode, stimulation with a large magnetic coil is associated with poor spatial specificity and incapability to stimulate deep brain structures. Recent developments in micromagnetic stimulation (μMS) technology mitigates some of these shortcomings. The sub-millimeter coils can be covered with soft, biocompatible material, and chronically implanted. They can provide highly specific neural stimulation in the deep neural structure. Although the μMS technology is expected to provide a precise location of neural stimulation, the exact site of neural activation is difficult to determine. Furthermore, factors that could cause the shifting of the activation site during μMS have not been fully investigated. To estimate the location of axon activation in μMS, we first derived an analytical expression of the activating function, which predicts the location of membrane depolarization in an unmyelinated axon. Then, we developed a multi-compartment, Hodgkin-Huxley (H-H) type of NEURON model of an unmyelinated axon to test the impact of several important coil parameters on the location of axonal activation. The location of axonal activation was dependent on both the parameters of the stimulus and the biophysics properties of the targeted axon during μMS. The activating function analysis predicted that the location of membrane depolarization and activation could shift due to the reversal of the coil current and the change in the coil-axon distance. The NEURON modeling confirmed these predictions. Interestingly, the NEURON simulation further revealed that the intensity of stimulation played a significant role in the activation location. Moderate or strong coil currents activated the axon at different locations, mediated by two distinct ion channel mechanisms. This study reports several experimental factors that could cause a potential shift in the location of neural activation during μMS, which is essential for further development of this novel technology.
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Alavi SM, Mirzaei A, Valizadeh A, Ebrahimpour R. Excitatory deep brain stimulation quenches beta oscillations arising in a computational model of the subthalamo-pallidal loop. Sci Rep 2022; 12:7845. [PMID: 35552409 PMCID: PMC9098470 DOI: 10.1038/s41598-022-10084-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinson’s disease (PD) is associated with abnormal \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β band oscillations (13–30 Hz) in the cortico-basal ganglia circuits. Abnormally increased striato-pallidal inhibition and strengthening the synaptic coupling between subthalamic nucleus (STN) and globus pallidus externa (GPe), due to the loss of dopamine, are considered as the potential sources of \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations in the basal ganglia. Deep brain stimulation (DBS) of the basal ganglia subregions is known as a way to reduce the pathological \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations and motor deficits related to PD. Despite the success of the DBS, its underlying mechanism is poorly understood and, there is controversy about the inhibitory or excitatory role of the DBS in the literature. Here, we utilized a computational network model of basal ganglia which consists of STN, GPe, globus pallidus interna, and thalamic neuronal population. This model can reproduce healthy and pathological \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations similar to what has been observed in experimental studies. Using this model, we investigated the effect of DBS to understand whether its effect is excitatory or inhibitory. Our results show that the excitatory DBS is able to quench the pathological synchrony and \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations, while, applying inhibitory DBS failed to quench the PD signs. In light of simulation results, we conclude that the effect of the DBS on its target is excitatory.
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Affiliation(s)
- Seyed Mojtaba Alavi
- Faculty of Computer Engineering, Shahid Rajaee Teacher Training University, Tehran, Iran.,School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | | | - Alireza Valizadeh
- Department of Physics, Institute for Advance Studies in Basic Sciences (IASBS), Zanjan, Iran.,School of Biological Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Reza Ebrahimpour
- Faculty of Computer Engineering, Shahid Rajaee Teacher Training University, Tehran, Iran. .,School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
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Adam EM, Brown EN, Kopell N, McCarthy MM. Deep brain stimulation in the subthalamic nucleus for Parkinson's disease can restore dynamics of striatal networks. Proc Natl Acad Sci U S A 2022; 119:e2120808119. [PMID: 35500112 PMCID: PMC9171607 DOI: 10.1073/pnas.2120808119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective in alleviating movement disability in patients with Parkinson’s disease (PD). However, its therapeutic mechanism of action is unknown. The healthy striatum exhibits rich dynamics resulting from an interaction of beta, gamma, and theta oscillations. These rhythms are essential to selection and execution of motor programs, and their loss or exaggeration due to dopamine (DA) depletion in PD is a major source of behavioral deficits. Restoring the natural rhythms may then be instrumental in the therapeutic action of DBS. We develop a biophysical networked model of a BG pathway to study how abnormal beta oscillations can emerge throughout the BG in PD and how DBS can restore normal beta, gamma, and theta striatal rhythms. Our model incorporates STN projections to the striatum, long known but understudied, found to preferentially target fast-spiking interneurons (FSI). We find that DBS in STN can normalize striatal medium spiny neuron activity by recruiting FSI dynamics and restoring the inhibitory potency of FSIs observed in normal conditions. We also find that DBS allows the reexpression of gamma and theta rhythms, thought to be dependent on high DA levels and thus lost in PD, through cortical noise control. Our study highlights that DBS effects can go beyond regularizing BG output dynamics to restoring normal internal BG dynamics and the ability to regulate them. It also suggests how gamma and theta oscillations can be leveraged to supplement DBS treatment and enhance its effectiveness.
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Affiliation(s)
- Elie M. Adam
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Emery N. Brown
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114
| | - Nancy Kopell
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215
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Germann J, Boutet A, Elias GJ, Gouveia FV, Loh A, Giacobbe P, Bhat V, Kucharczyk W, Lozano AM. Brain Structures and Networks Underlying Treatment Response to Deep Brain Stimulation Targeting the Inferior Thalamic Peduncle in Obsessive-Compulsive Disorder. Stereotact Funct Neurosurg 2022; 100:236-243. [DOI: 10.1159/000523826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
<b><i>Background:</i></b> Obsessive-compulsive disorder (OCD) is a debilitating disease with a lifetime prevalence of 2–3%. Neuromodulatory treatments have been successfully used in severe cases. Deep brain stimulation (DBS) targeting the inferior thalamic peduncle (ITP) has been shown to successfully alleviate symptoms in OCD patients; however, the brain circuits implicated remain unclear. Here, we investigate the efficacious neural substrates following ITP-DBS for OCD. <b><i>Methods:</i></b> High-quality normative structural and functional connectomics and voxel-wise probabilistic mapping techniques were applied to assess the neural substrates of OCD symptom alleviation in a cohort of 5 ITP-DBS patients. <b><i>Results:</i></b> The region of most efficacious stimulation was located in the regions of the ITP and bed nucleus of the stria terminalis. Both functional and structural connectomics analyses demonstrated that successful symptom alleviation involved a brain network encompassing the bilateral amygdala and prefrontal regions. <b><i>Limitations:</i></b> The main limitation is the small size of the ITP-DBS cohort. While the findings are highly consistent and significant, these should be validated in larger studies. <b><i>Conclusions:</i></b> These results identify a tripartite brain network – composed of the bilateral amygdala and prefrontal regions 24 and 46 – whose engagement is associated with greater symptom improvement. They also provide information for optimizing targeting and identifying network components critically involved in ITP-DBS treatment response. Amygdala engagement in particular seems to be a key component for clinical benefits and could constitute a biomarker for treatment optimization.
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50
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Zheng L, Feng Z, Xu Y, Yuan Y, Hu Y. An Anodic Phase Can Facilitate Rather Than Weaken a Cathodic Phase to Activate Neurons in Biphasic-Pulse Axonal Stimulations. Front Neurosci 2022; 16:823423. [PMID: 35368280 PMCID: PMC8968170 DOI: 10.3389/fnins.2022.823423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Electrical pulses have been promisingly utilized in neural stimulations to treat various diseases. Usually, charge-balanced biphasic pulses are applied in the clinic to eliminate the possible side effects caused by charge accumulations. Because of its reversal action to the preceding cathodic phase, the subsequent anodic phase has been commonly considered to lower the activation efficiency of biphasic pulses. However, an anodic pulse itself can also activate axons with its “virtual cathode” effect. Therefore, we hypothesized that the anodic phase of a biphasic pulse could facilitate neuronal activation in some circumstances. To verify the hypothesis, we compared the activation efficiencies of cathodic pulse, biphasic pulse, and anodic pulse applied in both monopolar and bipolar modes in the axonal stimulation of alveus in rat hippocampal CA1 region in vivo. The antidromically evoked population spikes (APS) were recorded and used to evaluate the amount of integrated firing of pyramidal neurons induced by pulse stimulations. We also used a computational model to investigate the pulse effects on axons at various distances from the stimulation electrode. The experimental results showed that, with a small pulse intensity, a cathodic pulse recruited more neurons to fire than a biphasic pulse. However, the situation was reversed with an increased pulse intensity. In addition, setting an inter-phase gap of 100 μs was able to increase the activation efficiency of a biphasic pulse to exceed a cathodic pulse even with a relatively small pulse intensity. Furthermore, the latency of APS evoked by a cathodic pulse was always longer than that of APS evoked by a biphasic pulse, indicating different initial sites of the neuronal firing evoked by the different types of pulses. The computational results of axon modeling showed that the subsequent anodic phase was able to relieve the hyperpolarization block in the flanking regions generated by the preceding cathodic phase, thereby increasing rather than decreasing the activation efficiency of a biphasic pulse with a relatively great intensity. These results of both rat experiments and computational modeling firstly reveal a facilitation rather than an attenuation effect of the anodic phase on biphasic-pulse stimulations, which provides important information for designing electrical stimulations for neural therapies.
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