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Vázquez-Hernández N, Martínez-Torres NI, González-Burgos I. Plastic changes to dendritic spines in the cerebellar and prefrontal cortices underlie the decline in motor coordination and working memory during successful aging. Behav Brain Res 2020; 400:113014. [PMID: 33309738 DOI: 10.1016/j.bbr.2020.113014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
Old age is the last stage of life and by taking a multidimensional view of aging, Neuroscientists have been able to characterize pathological or successful aging. Psychomotor and cognitive performance are recognized as two major domains of successful aging, with a loss of motor coordination and working memory deficits two of the most characteristic features of elderly people. Dendritic spines in both the cerebellar and prefrontal cortices diminish in aging, yet the plastic changes in dendritic spines have not been related to behavioral performance neither the changes in the cerebellar or prefrontal cortices. As such, motor coordination and visuospatial working memory (vsWM) was evaluated here in aged, 22-month-old rats, calculating the density of spines and the proportion of the different types of spines. These animals performed erratically and slowly in a motor coordination-related paradigm, and the vsWM was resolved deficiently. Spine density was reduced in aged animals, and the proportional density of each of the spine types studied diminished in both the brain regions studied. The loss of dendritic spines and particularly, the changes in the proportional density of the different spine types could underlie, at least in part, the behavioral deficits observed during aging. To our knowledge, this is the first study of the plastic changes in different dendritic spine types that might underlie the behavioral alterations in motor and cognitive abilities associated with aging. Further neurochemical and molecular studies will help better understand the functional significance of the plastic changes to dendritic spines in both successful and pathological aging.
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Affiliation(s)
- N Vázquez-Hernández
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, IMSS, Guadalajara, Jal, Mexico
| | - N I Martínez-Torres
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, IMSS, Guadalajara, Jal, Mexico; Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Jal, Mexico
| | - I González-Burgos
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, IMSS, Guadalajara, Jal, Mexico.
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2
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Tóth K, Maglóczky Z. The vulnerability of calretinin-containing hippocampal interneurons to temporal lobe epilepsy. Front Neuroanat 2014; 8:100. [PMID: 25324731 PMCID: PMC4179514 DOI: 10.3389/fnana.2014.00100] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/04/2014] [Indexed: 01/21/2023] Open
Abstract
This review focuses on the vulnerability of a special interneuron type—the calretinin (CR)-containing interneurons—in temporal lobe epilepsy (TLE). CR is a calcium-binding protein expressed mainly by GABAergic interneurons in the hippocampus. Despite their morphological heterogeneity, CR-containing interneurons form a distinct subpopulation of inhibitory cells, innervating other interneurons in rodents and to some extent principal cells in the human. Their dendrites are strongly connected by zona adherentiae and presumably by gap junctions both in rats and humans. CR-containing interneurons are suggested to play a key role in the hippocampal inhibitory network, since they can effectively synchronize dendritic inhibitory interneurons. The sensitivity of CR-expressing interneurons to epilepsy was discussed in several reports, both in animal models and in humans. In the sclerotic hippocampus the density of CR-immunopositive cells is decreased significantly. In the non-sclerotic hippocampus, the CR-containing interneurons are preserved, but their dendritic tree is varicose, segmented, and zona-adherentia-type contacts can be less frequently observed among dendrites. Therefore, the dendritic inhibition of pyramidal cells may be less effective in TLE. This can be partially explained by the impairment of the CR-containing interneuron ensemble in the epileptic hippocampus, which may result in an asynchronous and thus less effective dendritic inhibition of the principal cells. This phenomenon, together with the sprouting of excitatory pathway axons and enhanced innervation of principal cells, may be involved in seizure generation. Preventing the loss of CR-positive cells and preserving the integrity of CR-positive dendrite gap junctions may have antiepileptic effects, maintaining proper inhibitory function and helping to protect principal cells in epilepsy.
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Affiliation(s)
- Kinga Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Budapest, Hungary ; Institute of Experimental Medicine, Hungarian Academy of Sciences Budapest, Hungary
| | - Zsófia Maglóczky
- Institute of Experimental Medicine, Hungarian Academy of Sciences Budapest, Hungary
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3
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Manninen T, Hituri K, Kotaleski JH, Blackwell KT, Linne ML. Postsynaptic signal transduction models for long-term potentiation and depression. Front Comput Neurosci 2010; 4:152. [PMID: 21188161 PMCID: PMC3006457 DOI: 10.3389/fncom.2010.00152] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 11/22/2010] [Indexed: 01/01/2023] Open
Abstract
More than a hundred biochemical species, activated by neurotransmitters binding to transmembrane receptors, are important in long-term potentiation (LTP) and long-term depression (LTD). To investigate which species and interactions are critical for synaptic plasticity, many computational postsynaptic signal transduction models have been developed. The models range from simple models with a single reversible reaction to detailed models with several hundred kinetic reactions. In this study, more than a hundred models are reviewed, and their features are compared and contrasted so that similarities and differences are more readily apparent. The models are classified according to the type of synaptic plasticity that is modeled (LTP or LTD) and whether they include diffusion or electrophysiological phenomena. Other characteristics that discriminate the models include the phase of synaptic plasticity modeled (induction, expression, or maintenance) and the simulation method used (deterministic or stochastic). We find that models are becoming increasingly sophisticated, by including stochastic properties, integrating with electrophysiological properties of entire neurons, or incorporating diffusion of signaling molecules. Simpler models continue to be developed because they are computationally efficient and allow theoretical analysis. The more complex models permit investigation of mechanisms underlying specific properties and experimental verification of model predictions. Nonetheless, it is difficult to fully comprehend the evolution of these models because (1) several models are not described in detail in the publications, (2) only a few models are provided in existing model databases, and (3) comparison to previous models is lacking. We conclude that the value of these models for understanding molecular mechanisms of synaptic plasticity is increasing and will be enhanced further with more complete descriptions and sharing of the published models.
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Affiliation(s)
- Tiina Manninen
- Department of Signal Processing, Tampere University of Technology Tampere, Finland
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Zeng S, Holmes WR. The effect of noise on CaMKII activation in a dendritic spine during LTP induction. J Neurophysiol 2010; 103:1798-808. [PMID: 20107130 DOI: 10.1152/jn.91235.2008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Activation of calcium-calmodulin dependent protein kinase II (CaMKII) during induction of long-term potentiation (LTP) is a series of complicated stochastic processes that are affected by noise. There are two main sources of noise affecting CaMKII activation within a dendritic spine. One is the noise associated with stochastic opening of N-methyl-d-aspartate (NMDA) receptor channels and the other is the noise associated with the stochastic reaction-diffusion kinetics leading to CaMKII activation. Many models have been developed to simulate CaMKII activation, but there is no fully stochastic model that studies the effect of noise on CaMKII activation. Here we construct a fully stochastic model to study these effects. Our results show that noise has important effects on CaMKII activation variability, with the effect from stochastic opening of NMDA receptor channels being 5-10 times more significant than that from stochastic reactions involving CaMKII. In addition, CaMKII activation levels and the variability of activation are greatly affected by small changes in NMDA receptor channel number at the synapse. One reason LTP induction protocols may require tetanic or repeated burst stimulation is that there is a need to overcome inherent variability to provide sufficiently large calcium signals through NMDA receptor channels; with meaningful physiological stimuli, noise may allow the calcium signal to exceed threshold for CaMKII activation when it might not do so otherwise.
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Affiliation(s)
- Shangyou Zeng
- College of Electronic Engineering, Guangxi Normal University, Guangxi, China
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5
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Hasselmo ME, Giocomo LM, Brandon MP, Yoshida M. Cellular dynamical mechanisms for encoding the time and place of events along spatiotemporal trajectories in episodic memory. Behav Brain Res 2009; 215:261-74. [PMID: 20018213 DOI: 10.1016/j.bbr.2009.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 12/05/2009] [Accepted: 12/10/2009] [Indexed: 01/01/2023]
Abstract
Understanding the mechanisms of episodic memory requires linking behavioral data and lesion effects to data on the dynamics of cellular membrane potentials and population interactions within brain regions. Linking behavior to specific membrane channels and neurochemicals has implications for therapeutic applications. Lesions of the hippocampus, entorhinal cortex and subcortical nuclei impair episodic memory function in humans and animals, and unit recording data from these regions in behaving animals indicate episodic memory processes. Intracellular recording in these regions demonstrates specific cellular properties including resonance, membrane potential oscillations and bistable persistent spiking that could underlie the encoding and retrieval of episodic trajectories. A model presented here shows how intrinsic dynamical properties of neurons could mediate the encoding of episodic memories as complex spatiotemporal trajectories. The dynamics of neurons allow encoding and retrieval of unique episodic trajectories in multiple continuous dimensions including temporal intervals, personal location, the spatial coordinates and sensory features of perceived objects and generated actions, and associations between these elements. The model also addresses how cellular dynamics could underlie unit firing data suggesting mechanisms for coding continuous dimensions of space, time, sensation and action.
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Affiliation(s)
- Michael E Hasselmo
- Center for Memory and Brain, Department of Psychology and Program in Neuroscience, Boston University, 2 Cummington Street, Boston, MA 02215, USA.
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6
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A Compartmental Model for Activity-Dependent Dendritic Spine Branching. Bull Math Biol 2009; 71:1048-72. [DOI: 10.1007/s11538-009-9393-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Accepted: 01/07/2009] [Indexed: 11/26/2022]
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7
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Holmes WR, Grover LM. Quantifying the magnitude of changes in synaptic level parameters with long-term potentiation. J Neurophysiol 2006; 96:1478-91. [PMID: 16760350 DOI: 10.1152/jn.00248.2006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Experimental evidence supports a number of mechanisms for the synaptic change that occurs with long-term potentiation (LTP) including insertion of AMPA receptors, an increase in AMPA receptor single channel conductance, unmasking silent synapses, and increases in vesicle release probability. Here we combine experimental and modeling studies to quantify the magnitude of the change needed at the synaptic level to explain LTP with these proposed mechanisms. Whole cell patch recordings were used to measure excitatory postsynaptic potential (EPSP) amplitude in response to near minimal afferent stimulation before and after LTP induction in CA1 pyramidal cells. Detailed neuron and synapse level models were constructed to estimate quantitatively the changes needed to explain the experimental results. For cells in normal artificial cerebrospinal fluid (ACSF), we found a 60% average increase in EPSP amplitude with LTP. This was explained in the models by a 63% increase in the number of activated synapses, a 64% increase in the AMPA receptor single channel conductance, or a 73% increase in the number of AMPA receptors per potentiated synapse. When the percentage LTP was above the average, the required increases through the proposed mechanisms became nonlinear, particularly for increases in the number of receptors. Given constraints from other experimental studies, our quantification suggests that neither unmasking silent synapses nor increasing the numbers of AMPA receptors at synapses is sufficient to explain the magnitude of LTP we observed, but increasing AMPA single channel conductance or vesicle release probability can be sufficient. Our results are most compatible with a combination of mechanisms producing LTP.
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Affiliation(s)
- William R Holmes
- Neuroscience Program, Department of Biological Sciences, Ohio University, Athens, OH 45701, USA.
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8
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Ling DSF, Benardo LS. Nootropic Agents Enhance the Recruitment of Fast GABAA Inhibition in Rat Neocortex. Cereb Cortex 2004; 15:921-8. [PMID: 15459084 DOI: 10.1093/cercor/bhh191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is widely believed that nootropic (cognition-enhancing) agents produce their therapeutic effects by augmenting excitatory synaptic transmission in cortical circuits, primarily through positive modulation of alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionate receptors (AMPARs). However, GABA-mediated inhibition is also critical for cognition, and enhanced GABA function may be likewise therapeutic for cognitive disorders. Could nootropics act through such a mechanism as well? To address this question, we examined the effects of nootropic agents on excitatory and inhibitory postsynaptic currents (EPSCs and IPSCs) recorded from layer V pyramidal cells in acute slices of somatosensory cortex. Aniracetam, a positive modulator of AMPA/kainate receptors, increased the peak amplitude of evoked EPSCs and the amplitude and duration of polysynaptic fast IPSCs, manifested as a greater total charge carried by IPSCs. As a result, the EPSC/IPSC ratio of total charge was decreased, representing a shift in the excitation-inhibition balance that favors inhibition. Aniracetam did not affect the magnitude of either monosynaptic IPSCs (mono-IPSCs) recorded in the presence of excitatory amino acid receptor antagonists, or miniature IPSCs (mIPSCs) recorded in the presence of tetrodotoxin. However, the duration of both mono-IPSCs and mIPSCs was prolonged, suggesting that aniracetam also directly modulates GABAergic transmission. Cyclothiazide, a preferential modulator of AMPAR function, enhanced the magnitude and duration of polysynaptic IPSCs, similar to aniracetam, but did not affect mono-IPSCs. Concanavalin A, a kainate receptor modulator, had little effect on EPSCs or IPSCs, suggesting there was no contribution from kainate receptor activity. These findings indicate that AMPAR modulators strengthen inhibition in neocortical pyramidal cells, most likely by altering the kinetics of AMPARs on synaptically connected interneurons and possibly by modulating GABA(A) receptor responses in pyramidal cells. This suggests that the therapeutic actions of nootropic agents may be partly mediated through enhanced cortical GABAergic inhibition, and not solely through the direct modification of excitation, as previously thought.
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Affiliation(s)
- Douglas S F Ling
- Department of Physiology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, NY 11203,
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Hsu FC, Smith SS. Progesterone withdrawal reduces paired-pulse inhibition in rat hippocampus: dependence on GABA(A) receptor alpha4 subunit upregulation. J Neurophysiol 2003; 89:186-98. [PMID: 12522171 PMCID: PMC2887349 DOI: 10.1152/jn.00195.2002] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Withdrawal from the endogenous steroid progesterone (P) after chronic administration increases anxiety and seizure susceptibility via declining levels of its potent GABA-modulatory metabolite 3alpha-OH-5alpha-pregnan-20-one (3alpha,5alphaTHP). This 3alpha,5alpha-THP withdrawal also results in a decreased decay time constant for GABA-gated current assessed using whole cell patch-clamp techniques on pyramidal cells acutely dissociated from CA1 hippocampus. The purpose of this study was to test the hypothesis that the decreases in total integrated GABA-gated current observed at the level of the isolated pyramidal cell would be manifested as a reduced GABA inhibition at the circuit level following hormone withdrawal. Toward this end, adult, female rats were administered P via subcutaneous capsule for 3 wk using a multiple withdrawal paradigm. We then evaluated paired-pulse inhibition (PPI) of pyramidal neurons in CA1 hippocampus using extracellular recording techniques in hippocampal slices from rats 24 h after removal of the capsule (P withdrawal, P Wd). The population spike (PS) was recorded at the stratum pyramidale following homosynaptic orthodromic stimulation in the nearby stratum radiatum. The threshold for eliciting a response was decreased after P Wd, and the mean PS amplitude was significantly increased compared with control values at this time. Paired pulses with 10-ms inter-pulse intervals were then applied across an intensity range from 2 to 20 times threshold. Evaluation of paired-pulse responses showed a significant 40-50% reduction in PPI for PS recorded in the hippocampal CA1 region after P Wd, suggesting an increase in circuit excitability. At this time, enhancement of PPI by the benzodiazepine lorazepam (LZM; 10 microM) was prevented, while pentobarbital (10 microM) potentiation of PPI was comparable to control levels of response. These data are consistent with upregulation of the alpha4 subunit of the GABA(A) receptor (GABAR) as we have previously shown. Moreover, the reduced PPI caused by P Wd was prevented by suppression of GABAR alpha4-subunit expression following intraventricular administration of specific antisense oligonucleotides (1 microg/h for 72 h). These results demonstrating a reduction in PPI following P Wd suggest that GABAergic-mediated recurrent or feed-forward inhibition occurring at the circuit level were decreased following P Wd in female rats, an effect at least partially attributable to alterations in the GABAR subunit gene expression.
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Affiliation(s)
- Fu-Chun Hsu
- Pediatric Regional Epilepsy Program and Joseph Stokes Research Institute of The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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10
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Cossart R, Dinocourt C, Hirsch JC, Merchan-Perez A, De Felipe J, Ben-Ari Y, Esclapez M, Bernard C. Dendritic but not somatic GABAergic inhibition is decreased in experimental epilepsy. Nat Neurosci 2001; 4:52-62. [PMID: 11135645 DOI: 10.1038/82900] [Citation(s) in RCA: 406] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Impaired inhibition is thought to be important in temporal lobe epilepsy (TLE), the most common form of epilepsy in adult patients. We report that, in experimental TLE, spontaneous GABAergic inhibition was increased in the soma but reduced in the dendrites of pyramidal neurons. The former resulted from the hyperactivity of somatic projecting interneurons, whereas the latter was probably due to the degeneration of a subpopulation of dendritic projecting interneurons. A deficit in dendritic inhibition could reduce seizure threshold, whereas enhanced somatic inhibition would prevent the continuous occurrence of epileptiform activity.
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Affiliation(s)
- R Cossart
- INMED, INSERM Unité 29, Avenue de Luminy, B.P. 13, 13 273 Marseille Cedex 09, France
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11
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Li Y, Holmes WR. Comparison of CaMKinase II activation in a dendritic spine computed with deterministic and stochastic models of the NMDA synaptic conductance. Neurocomputing 2000. [DOI: 10.1016/s0925-2312(00)00137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Vida I, Frotscher M. A hippocampal interneuron associated with the mossy fiber system. Proc Natl Acad Sci U S A 2000; 97:1275-80. [PMID: 10655521 PMCID: PMC15594 DOI: 10.1073/pnas.97.3.1275] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Network properties of the hippocampus emerge from the interaction of principal cells and a heterogeneous population of interneurons expressing gamma-aminobutyric acid (GABA). To understand these interactions, the synaptic connections of different types of interneurons need to be elucidated. Here we describe a type of inhibitory interneuron of the hippocampal CA3 region that has an axon coaligned with the mossy fibers. Whole-cell patch-clamp recordings, in combination with intracellular biocytin filling, were made from nonpyramidal cells of the stratum lucidum under visual control. Mossy fiber-associated (MFA) interneurons generated brief action potentials followed by a prominent after-hyperpolarization. Subsequent visualization revealed an extensive axonal arbor which was preferentially located in the stratum lucidum of CA3 and often invaded the hilus. The dendrites of MFA interneurons were mainly located in the strata radiatum and oriens, suggesting that these cells are primarily activated by associational and commissural fibers. Electron microscopic analysis showed that axon terminals of MFA interneurons established symmetric synaptic contacts predominantly on proximal apical dendritic shafts, and to a lesser degree, on somata of pyramidal cells. Synaptic contacts were also found on GABAergic interneurons of the CA3 region and putative mossy cells of the hilus. Inhibitory postsynaptic currents (IPSCs) elicited by MFA interneurons in simultaneously recorded pyramidal cells had fast kinetics (half duration, 3.6 ms) and were blocked by the GABA(A) receptor antagonist bicuculline. Thus, MFA interneurons are GABAergic cells in a position to selectively suppress the mossy fiber input, an important requirement for the recall of memory traces from the CA3 network.
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Affiliation(s)
- I Vida
- Anatomisches Institut, Albert-Ludwigs-Universität Freiburg, D-79104 Freiburg, Germany
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13
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Active dendrites regulate spatio-temporal synaptic integration in hippocampal dentate granule cells. Neurocomputing 1999. [DOI: 10.1016/s0925-2312(99)00087-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Levy WB, Desmond NL, Zhang DX. Perforant path activation modulates the induction of long-term potentiation of the schaffer collateral--hippocampal CA1 response: theoretical and experimental analyses. Learn Mem 1998; 4:510-8. [PMID: 10701875 DOI: 10.1101/lm.4.6.510] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In one computational model of hippocampal function, the entorhinal cortical input to CA1 is hypothesized to play a key role in the ability of CA1 to decode CA3 recodings. Here, we develop a modification of this CA1 decoder hypothesis that is applicable to several computational theories of hippocampal function, and then we electrophysiologically investigate one assumption of this new hypothesis. First, using biologically realistic estimates, we calculate that CA3-induced CA1 excitation is too high and that inhibition plausibly plays a role in this CA1 decoder model. Thus motivated, we turn to a physiological demonstration to substantiate the plausibility of the proposed mechanism. Using the rat hippocampal slice, we examine an interlaminar interaction between the distal perforant path input to hippocampal CA1 stratum moleculare and the more proximal Schaffer collateral input to stratum radiatum. Perforant path activation provides sufficient inhibition to block homosynaptic long-term potentiation elicited by a suitably strong stratum radiatum input. For this interlaminar interaction to be most effective, perforant path activation must both precede and follow Schaffer collateral activation. Perforant path-evoked inhibition in CA1 can thus serve as a viable mechanism in the learned decoder theory of hippocampal CA1.
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Affiliation(s)
- W B Levy
- Department of Neurological Surgery, University of Virginia, Charlottesville 22908, USA
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