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Wilhelm E, Derosiere G, Quoilin C, Cakiroglu I, Paço S, Raftopoulos C, Nuttin B, Duque J. Subthalamic DBS does not restore deficits in corticospinal suppression during movement preparation in Parkinson's disease. Clin Neurophysiol 2024; 165:107-116. [PMID: 38996612 DOI: 10.1016/j.clinph.2024.06.002] [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: 10/02/2023] [Revised: 03/27/2024] [Accepted: 06/03/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE Parkinson's disease (PD) patients exhibit changes in mechanisms underlying movement preparation, particularly the suppression of corticospinal excitability - termed "preparatory suppression" - which is thought to facilitate movement execution in healthy individuals. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) being an attractive treatment for advanced PD, we aimed to study the potential contribution of this nucleus to PD-related changes in such corticospinal dynamics. METHODS On two consecutive days, we applied single-pulse transcranial magnetic stimulation to the primary motor cortex of 20 advanced PD patients treated with bilateral STN-DBS (ON vs. OFF), as well as 20 healthy control subjects. Motor-evoked potentials (MEPs) were elicited at rest or during movement preparation in an instructed-delay choice reaction time task including left- or right-hand responses. Preparatory suppression was assessed by expressing MEPs during movement preparation relative to rest. RESULTS PD patients exhibited a deficit in preparatory suppression when it was probed on the responding hand side, particularly when this corresponded to their most-affected hand, regardless of their STN-DBS status. CONCLUSIONS Advanced PD patients displayed a reduction in preparatory suppression which was not restored by STN-DBS. SIGNIFICANCE The current findings confirm that PD patients lack preparatory suppression, as previously reported. Yet, the fact that this deficit was not responsive to STN-DBS calls for future studies on the neural source of this regulatory mechanism during movement preparation.
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Affiliation(s)
- Emmanuelle Wilhelm
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium; Department of Adult Neurology, Saint-Luc University Hospital, 1200 Brussels, Belgium.
| | - Gerard Derosiere
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
| | - Caroline Quoilin
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
| | - Inci Cakiroglu
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
| | - Susana Paço
- NOVA IMS, Universidade Nova de Lisboa, 1070-312 Lisbon, Portugal
| | | | - Bart Nuttin
- Department of Neurosurgery, UZ Leuven, 3000 Leuven, Belgium
| | - Julie Duque
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
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Willett A, Wylie SA, Bowersock JL, Dawant BM, Rodriguez W, Ugiliweneza B, Neimat JS, van Wouwe NC. Focused stimulation of dorsal versus ventral subthalamic nucleus enhances action-outcome learning in patients with Parkinson's disease. Brain Commun 2024; 6:fcae111. [PMID: 38646144 PMCID: PMC11032193 DOI: 10.1093/braincomms/fcae111] [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: 10/03/2023] [Revised: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective treatment for the clinical motor symptoms of Parkinson's disease, but may alter the ability to learn contingencies between stimuli, actions and outcomes. We investigated how stimulation of the functional subregions in the subthalamic nucleus (motor and cognitive regions) modulates stimulus-action-outcome learning in Parkinson's disease patients. Twelve Parkinson's disease patients with deep brain stimulation of the subthalamic nucleus completed a probabilistic stimulus-action-outcome task while undergoing ventral and dorsal subthalamic nucleus stimulation (within subjects, order counterbalanced). The task orthogonalized action choice and outcome valence, which created four action-outcome learning conditions: action-reward, inhibit-reward, action-punishment avoidance and inhibit-punishment avoidance. We compared the effects of deep brain stimulation on learning rates across these conditions as well as on computed Pavlovian learning biases. Dorsal stimulation was associated with higher overall learning proficiency relative to ventral subthalamic nucleus stimulation. Compared to ventral stimulation, stimulating the dorsal subthalamic nucleus led to a particular advantage in learning to inhibit action to produce desired outcomes (gain reward or avoid punishment) as well as better learning proficiency across all conditions providing reward opportunities. The Pavlovian reward bias was reduced with dorsal relative to ventral subthalamic nucleus stimulation, which was reflected by improved inhibit-reward learning. Our results show that focused stimulation in the dorsal compared to the ventral subthalamic nucleus is relatively more favourable for learning action-outcome contingencies and reduces the Pavlovian bias that could lead to reward-driven behaviour. Considering the effects of deep brain stimulation of the subthalamic nucleus on learning and behaviour could be important when optimizing stimulation parameters to avoid side effects like impulsive reward-driven behaviour.
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Affiliation(s)
- Andrew Willett
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Scott A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Jessica L Bowersock
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - William Rodriguez
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Nelleke C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
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Palopoli-Trojani K, Schmidt SL, Baringer KD, Slotkin TA, Peters JJ, Turner DA, Grill WM. Temporally non-regular patterns of deep brain stimulation (DBS) enhance assessment of evoked potentials while maintaining motor symptom management in Parkinson's disease (PD). Brain Stimul 2023; 16:1630-1642. [PMID: 37863388 PMCID: PMC10872419 DOI: 10.1016/j.brs.2023.10.009] [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: 04/14/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Traditional deep brain stimulation (DBS) at fixed regular frequencies (>100 Hz) is effective in treating motor symptoms of Parkinson's disease (PD). Temporally non-regular patterns of DBS are a new parameter space that may help increase efficacy and efficiency. OBJECTIVE To compare the effects of temporally non-regular patterns of DBS to traditional regularly-spaced pulses. METHODS We simultaneously recorded local field potentials (LFP) and monitored motor symptoms (tremor and bradykinesia) in persons with PD during DBS in subthalamic nucleus (STN). We quantified both oscillatory activity and DBS local evoked potentials (DLEPs) from the LFP. RESULTS Temporally non-regular patterns were as effective as traditional pulse patterns in modulating motor symptoms, oscillatory activity, and DLEPs. Moreover, one of our novel patterns enabled recording of longer duration DLEPs during clinically effective stimulation. CONCLUSIONS Stimulation gaps of 50 ms can be used to increase efficiency and to enable regular assessment of long-duration DLEPs while maintaining effective symptom management. This may be a promising paradigm for closed-loop DBS with biomarker assessment during the gaps.
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Affiliation(s)
| | - Stephen L Schmidt
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Karley D Baringer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, USA
| | - Jennifer J Peters
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Dennis A Turner
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurobiology and Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurobiology and Department of Neurosurgery, Duke University, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
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van den Wildenberg WPM, van Wouwe NC, Ridderinkhof KR, Neimat JS, Elias WJ, Bashore TR, Wylie SA. Deep-brain stimulation of the subthalamic nucleus improves overriding motor actions in Parkinson's disease. Behav Brain Res 2021; 402:113124. [PMID: 33422595 DOI: 10.1016/j.bbr.2021.113124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
Findings from previous research using the classic stop-signal task indicate that the subthalamic nucleus (STN) plays an important role in the ability to inhibit motor actions. Here we extend these findings using a stop-change task that requires voluntary action override to stop an ongoing motor response and change to an alternative response. Sixteen patients diagnosed with Parkinson's disease (PD) and 16 healthy control participants (HC) performed the stop-change task. PD patients completed the task when deep-brain stimulation (DBS) of the STN was turned on and when it was turned off. Behavioral results indicated that going, stopping, and changing latencies were shortened significantly among PD patients during STN DBS, the former two reductions replicating findings from previous DBS studies using the classic stop-signal task. The shortened go latencies observed among PD patients fell within the control range. In contrast, stopping latencies among PD patients, although reduced significantly, continued to be significantly longer than those of the HC. Like go latencies, stop-change latencies were reduced sufficiently among PD patients for them to fall within the control range, a novel finding. In conclusion, STN DBS produced a general, but differential, improvement in the ability of PD patients to override motor actions. Going, stopping, and stop-change latencies were all shortened, but only going and stop-change latencies were normalized.
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Affiliation(s)
- Wery P M van den Wildenberg
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, the Netherlands.
| | | | - K Richard Ridderinkhof
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, the Netherlands
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Theodore R Bashore
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA; School of Psychological Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Scott A Wylie
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
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Yu JY, Rajagopal A, Syrkin-Nikolau J, Shin S, Rosenbluth KH, Khosla D, Ross EK, Delp SL. Transcutaneous Afferent Patterned Stimulation Therapy Reduces Hand Tremor for One Hour in Essential Tremor Patients. Front Neurosci 2020; 14:530300. [PMID: 33281539 PMCID: PMC7689107 DOI: 10.3389/fnins.2020.530300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/20/2020] [Indexed: 01/25/2023] Open
Abstract
Essential tremor (ET) patients often experience hand tremor that impairs daily activities. Non-invasive electrical stimulation of median and radial nerves in the wrist using a recently developed therapy called transcutaneous afferent patterned stimulation (TAPS) has been shown to provide symptomatic tremor relief in ET patients and improve patients’ ability to perform functional tasks, but the duration of tremor reduction is unknown. In this single-arm, open-label study, fifteen ET patients performed four hand tremor-specific tasks (postural hold, spiral drawing, finger-to-nose reach, and pouring) from the Fahn-Tolosa-Marin Clinical Rating Scale (FTM-CRS) prior to, during, and 0, 30, and 60 min following TAPS. At each time point, tremor severity was visually rated according to the FTM-CRS and simultaneously measured by wrist-worn accelerometers. The duration of tremor reduction was assessed using (1) improvement in the mean FTM-CRS score across all four tasks relative to baseline, and (2) reduction in accelerometer-measured tremor power relative to baseline for each task. Patients were labeled as having at least 60 min of therapeutic benefit from TAPS with respect to each specified metric if all three (i.e., 0, 30, and 60 min) post-therapy measurements were better than that metric’s baseline value. The mean FTM-CRS scores improved for at least 60 min beyond the end of TAPS for 80% (12 of 15, p = 4.6e–9) of patients. Similarly, for each assessed task, tremor power improved for at least 60 min beyond the end of TAPS for over 70% of patients. The postural hold task had the largest reduction in tremor power (median 5.9-fold peak reduction in tremor power) and had at least 60 min of improvement relative to baseline beyond the end of TAPS therapy for 73% (11 of 15, p = 9.8e–8) of patients. Clinical ratings of tremor severity were correlated to simultaneously recorded accelerometer-measured tremor power (r = 0.33–0.76 across the four tasks), suggesting tremor power is a valid, objective tremor assessment metric that can be used to track tremor symptoms outside the clinic. These results suggest TAPS can provide reductions in upper limb tremor symptoms for at least 1 h post-therapy in some patients, which may improve patients’ ability to perform tasks of daily living.
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Affiliation(s)
- Jai Y Yu
- Cala Health, Inc., Burlingame, CA, United States
| | | | | | - Sooyoon Shin
- Cala Health, Inc., Burlingame, CA, United States
| | | | - Dhira Khosla
- Personal Care Neurology, Oakland, CA, United States
| | - Erika K Ross
- Cala Health, Inc., Burlingame, CA, United States
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, CA, United States
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van Wouwe NC, Neimat JS, van den Wildenberg WPM, Hughes SB, Lopez AM, Phibbs FT, Schall JD, Rodriguez WJ, Bradley EB, Dawant BM, Wylie SA. Subthalamic Nucleus Subregion Stimulation Modulates Inhibitory Control. Cereb Cortex Commun 2020; 1:tgaa083. [PMID: 33381760 PMCID: PMC7750129 DOI: 10.1093/texcom/tgaa083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022] Open
Abstract
Patients with Parkinson's disease (PD) often experience reductions in the proficiency to inhibit actions. The motor symptoms of PD can be effectively treated with deep brain stimulation (DBS) of the subthalamic nucleus (STN), a key structure in the frontal-striatal network that may be directly involved in regulating inhibitory control. However, the precise role of the STN in stopping control is unclear. The STN consists of functional subterritories linked to dissociable cortical networks, although the boundaries of the subregions are still under debate. We investigated whether stimulating the dorsal and ventral subregions of the STN would show dissociable effects on ability to stop. We studied 12 PD patients with STN DBS. Patients with two adjacent contacts positioned within the bounds of the dorsal and ventral STN completed two testing sessions (OFF medication) with low amplitude stimulation (0.4 mA) at either the dorsal or ventral contacts bilaterally, while performing the stop task. Ventral, but not dorsal, DBS improved stopping latencies. Go reactions were similar between dorsal and ventral DBS STN. Stimulation in the ventral, but not dorsal, subregion of the STN improved stopping speed, confirming the involvement of the STN in stopping control and supporting the STN functional subregions.
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Affiliation(s)
- Nelleke C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202 USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202 USA
| | - Wery P M van den Wildenberg
- Department of Psychology, University of Amsterdam, Amsterdam 1018 WS, The Netherlands
- Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam 1001 NK, The Netherlands
| | - Shelby B Hughes
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Alexander M Lopez
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jeffrey D Schall
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - William J Rodriguez
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Elise B Bradley
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Scott A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202 USA
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Schmidt SL, Brocker DT, Swan BD, Turner DA, Grill WM. Evoked potentials reveal neural circuits engaged by human deep brain stimulation. Brain Stimul 2020; 13:1706-1718. [PMID: 33035726 DOI: 10.1016/j.brs.2020.09.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective therapy for reducing the motor symptoms of Parkinson's disease, but the mechanisms of action of DBS and neural correlates of symptoms remain unknown. OBJECTIVE To use the neural response to DBS to reveal connectivity of neural circuits and interactions between groups of neurons as potential mechanisms for DBS. METHODS We recorded activity evoked by DBS of the subthalamic nucleus (STN) in humans with Parkinson's disease. In follow up experiments we also simultaneously recorded activity in the contralateral STN or the ipsilateral globus pallidus from both internal (GPi) and external (GPe) segments. RESULTS DBS local evoked potentials (DLEPs) were stereotyped across subjects, and a biophysical model of reciprocal connections between the STN and the GPe recreated DLEPs. Simultaneous STN and GP recordings during STN DBS demonstrate that DBS evoked potentials were present throughout the basal ganglia and confirmed that DLEPs arose from the reciprocal connections between the STN and GPe. The shape and amplitude of the DLEPs were dependent on the frequency and duration of DBS and were correlated with resting beta band oscillations. In the frequency domain, DLEPs appeared as a 350 Hz high frequency oscillation (HFO) independent of the frequency of DBS. CONCLUSIONS DBS evoked potentials suggest that the intrinsic dynamics of the STN and GP are highly interlinked and may provide a promising new biomarker for adaptive DBS.
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Affiliation(s)
- Stephen L Schmidt
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - David T Brocker
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Brandon D Swan
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Dennis A Turner
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurobiology, Duke University Medical Center, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurobiology, Duke University Medical Center, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
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Wiest C, Tinkhauser G, Pogosyan A, Bange M, Muthuraman M, Groppa S, Baig F, Mostofi A, Pereira EA, Tan H, Brown P, Torrecillos F. Local field potential activity dynamics in response to deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Neurobiol Dis 2020; 143:105019. [PMID: 32681881 PMCID: PMC7115855 DOI: 10.1016/j.nbd.2020.105019] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023] Open
Abstract
Local field potentials (LFPs) may afford insight into the mechanisms of action of deep brain stimulation (DBS) and potential feedback signals for adaptive DBS. In Parkinson's disease (PD) DBS of the subthalamic nucleus (STN) suppresses spontaneous activity in the beta band and drives evoked resonant neural activity (ERNA). Here, we investigate how STN LFP activities change over time following the onset and offset of DBS. To this end we recorded LFPs from the STN in 14 PD patients during long (mean: 181.2 s) and short (14.2 s) blocks of continuous stimulation at 130 Hz. LFP activities were evaluated in the temporal and spectral domains. During long stimulation blocks, the frequency and amplitude of the ERNA decreased before reaching a steady state after ~70 s. Maximal ERNA amplitudes diminished over repeated stimulation blocks. Upon DBS cessation, the ERNA was revealed as an under-damped oscillation, and was more marked and lasted longer after short duration stimulation blocks. In contrast, activity in the beta band suppressed within 0.5 s of continuous DBS onset and drifted less over time. Spontaneous activity was also suppressed in the low gamma band, suggesting that the effects of high frequency stimulation on spontaneous oscillations may not be selective for pathological beta activity. High frequency oscillations were present in only six STN recordings before stimulation onset and their frequency was depressed by stimulation. The different dynamics of the ERNA and beta activity with stimulation imply different DBS mechanisms and may impact how these activities may be used in adaptive feedback.
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Affiliation(s)
- C Wiest
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - G Tinkhauser
- Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - A Pogosyan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - M Bange
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - M Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - S Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - F Baig
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - A Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - E A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - H Tan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - P Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - F Torrecillos
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
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Deep Brain Stimulation of the Subthalamic Nucleus Selectively Modulates Emotion Recognition of Facial Stimuli in Parkinson's Patients. J Clin Med 2019; 8:jcm8091335. [PMID: 31466414 PMCID: PMC6781243 DOI: 10.3390/jcm8091335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 01/05/2023] Open
Abstract
: Background: Diminished emotion recognition is a known symptom in Parkinson (PD) patients and subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to further deteriorate the processing of especially negative emotions. While emotion recognition generally refers to both, implicit and explicit processing, demonstrations of DBS-influences on implicit processing are sparse. In the present study, we assessed the impact of STN-DBS on explicit and implicit processing for emotional stimuli. METHODS Under STN-DBS ON and OFF, fourteen PD patients performed an implicit as well as an explicit emotional processing task. To assess implicit emotional processing, patients were tested with a lexical decision task (LTD) combined with an affective priming paradigm, which provides emotional content through the facial eye region. To assess explicit emotional processing, patients additionally explicitly rated the emotional status of eyes and words used in the implicit task. RESULTS DBS affected explicit emotional processing more than implicit processing with a more pronounced effect on error rates than on reaction speed. STN-DBS generally worsened implicit and explicit processing for disgust stimulus material but improved explicit processing of fear stimuli. CONCLUSIONS This is the first study demonstrating influences of STN-DBS on explicit and implicit emotion processing in PD patients. While STN stimulation impeded the processing of disgust stimuli, it improved explicit discrimination of fear stimuli.
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Smith GS, Mills KA, Pontone GM, Anderson WS, Perepezko KM, Brasic J, Zhou Y, Brandt J, Butson CR, Holt DP, Mathews WB, Dannals RF, Wong DF, Mari Z. Effect of STN DBS on vesicular monoamine transporter 2 and glucose metabolism in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:235-241. [PMID: 31053531 DOI: 10.1016/j.parkreldis.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an established treatment for Parkinson's Disease (PD). Despite the improvement of motor symptoms in most patients by sub-thalamic nucleus (STN) DBS and its widespread use, the neurobiological mechanisms are not completely understood. The objective of the present study was to elucidate the effects of subthalamic nucleus (STN) DBS in PD on the dopamine system and neural circuitry, employing high-resolution positron emission tomography (PET) imaging. The hypotheses tested were that STN DBS would decrease the striatal vesicular monoamine transporter (VMAT2), secondary to an increase in dopamine concentrations, and would decrease striatal cerebral metabolism and increase cortical cerebral metabolism. METHODS PET imaging of the vesicular monoamine transporter (VMAT2) and cerebral glucose metabolism was performed prior to DBS surgery and after 4-6 months of STN stimulation in seven PD patients (mean age 67 ± 7). RESULTS The patients demonstrated significant improvement in motor and neuropsychiatric symptoms after STN DBS. Decreased VMAT2 was observed in the caudate, putamen and associative striatum and in extra-striatal, cortical and limbic regions. Cerebral glucose metabolism was decreased in striatal sub-regions and increased in temporal and parietal cortices and the cerebellum. Decreased striatal VMAT2 was correlated with decreased striatal and increased cortical and limbic metabolism. Improvement of depressive symptoms was correlated with decreased VMAT2 in striatal and extra-striatal regions and with striatal decreases and cortical increases in metabolism. CONCLUSIONS The present results support further investigation of the role of VMAT2, and associated changes in neural circuitry in the improvement of motor and non-motor symptoms with STN DBS in PD.
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Affiliation(s)
- Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Greg M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Stanley Anderson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kate M Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Brasic
- Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yun Zhou
- Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher R Butson
- Scientific Computing & Imaging (SCI) Institute, Departments of Biomedical Engineering, Neurology, Neurosurgery & Psychiatry, University of Utah, USA
| | - Daniel P Holt
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William B Mathews
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert F Dannals
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dean F Wong
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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11
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Mancini C, Modugno N, Santilli M, Pavone L, Grillea G, Morace R, Mirabella G. Unilateral Stimulation of Subthalamic Nucleus Does Not Affect Inhibitory Control. Front Neurol 2019; 9:1149. [PMID: 30666229 PMCID: PMC6330317 DOI: 10.3389/fneur.2018.01149] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/11/2018] [Indexed: 01/06/2023] Open
Abstract
Despite the relevance of inhibitory control in shaping our behavior its neural substrates are still hotly debated. In this regard, it has been suggested that inhibitory control relies upon a right-lateralized network which involves the right subthalamic nucleus (STN). To assess the role of STN, we took advantage of a relatively rare model, i.e., advanced Parkinson's patients who received unilateral deep-brain stimulation (DBS) of the STN either of the left (n = 10) or of the right (n = 10) hemisphere. We gave them a stop-signal reaching task, and we compared patients' performance in two experimental conditions, DBS-ON and DBS-OFF. In addition, we also tested 22 age-matched healthy participants. As expected, we found that inhibitory control is impaired in Parkinson's patients with respect to healthy participants. However, neither reactive nor proactive inhibition is improved when either the right or the left DBS is active. We interpreted these findings in light of the fact that previous studies, exploiting exactly the same task, have shown that only bilateral STN DBS restores a near-normal inhibitory control. Thus, although null results have to be interpreted with caution, our current findings confirm that the right STN does not play a key role in suppressing pending actions. However, on the ground of previous studies, it is very likely that this subcortical structure is part of the brain network subserving inhibition but to implement this executive function both subthalamic nuclei must be simultaneously active. Our findings are of significance to other researchers studying the effects of STN DBS on key executive functions, such as impulsivity and inhibition and they are also of clinical relevance for determining the therapeutic benefits of STN DBS as they suggest that, at least as far as inhibitory control is concerned, it is better to implant DBS bilaterally than unilaterally.
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Affiliation(s)
- Christian Mancini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | | | | | | | | | | | - Giovanni Mirabella
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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12
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van Wouwe NC, Pallavaram S, Phibbs FT, Martinez-Ramirez D, Neimat JS, Dawant BM, D'Haese PF, Kanoff KE, van den Wildenberg WPM, Okun MS, Wylie SA. Focused stimulation of dorsal subthalamic nucleus improves reactive inhibitory control of action impulses. Neuropsychologia 2017; 99:37-47. [PMID: 28237741 PMCID: PMC5493526 DOI: 10.1016/j.neuropsychologia.2017.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/13/2017] [Accepted: 02/22/2017] [Indexed: 01/23/2023]
Abstract
Frontal-basal ganglia circuitry dysfunction caused by Parkinson's disease impairs important executive cognitive processes, such as the ability to inhibit impulsive action tendencies. Subthalamic Nucleus Deep Brain Stimulation in Parkinson's disease improves the reactive inhibition of impulsive actions that interfere with goal-directed behavior. An unresolved question is whether this effect depends on stimulation of a particular Subthalamic Nucleus subregion. The current study aimed to 1) replicate previous findings and additionally investigate the effect of chronic versus acute Subthalamic Nucleus stimulation on inhibitory control in Parkinson's disease patients off dopaminergic medication 2) test whether stimulating Subthalamic Nucleus subregions differentially modulate proactive response control and the proficiency of reactive inhibitory control. In the first experiment, twelve Parkinson's disease patients completed three sessions of the Simon task, Off Deep brain stimulation and medication, on acute Deep Brain Stimulation and on chronic Deep Brain Stimulation. Experiment 2 consisted of 11 Parkinson's disease patients with Subthalamic Nucleus Deep Brain Stimulation (off medication) who completed two testing sessions involving of a Simon task either with stimulation of the dorsal or the ventral contact in the Subthalamic Nucleus. Our findings show that Deep Brain Stimulation improves reactive inhibitory control, regardless of medication and regardless of whether it concerns chronic or acute Subthalamic Nucleus stimulation. More importantly, selective stimulation of dorsal and ventral subregions of the Subthalamic Nucleus indicates that especially the dorsal Subthalamic Nucleus circuitries are crucial for modulating the reactive inhibitory control of motor actions.
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Affiliation(s)
- N C van Wouwe
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S Pallavaram
- Department of Engineering, Vanderbilt University, Nashville, TN, USA
| | - F T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - D Martinez-Ramirez
- Department of Neurology, University of Florida Medical Center, Gainesville, Florida, USA
| | - J S Neimat
- Department of Neurosurgery, University of Louisville Medical Center, Louisville, KY, USA
| | - B M Dawant
- Department of Engineering, Vanderbilt University, Nashville, TN, USA
| | - P F D'Haese
- Department of Engineering, Vanderbilt University, Nashville, TN, USA
| | - K E Kanoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W P M van den Wildenberg
- Cognitive Science Center Amsterdam and Psychology Department, University of Amsterdam, Amsterdam, The Netherlands
| | - M S Okun
- Department of Neurology, University of Florida Medical Center, Gainesville, Florida, USA
| | - S A Wylie
- Department of Neurosurgery, University of Louisville Medical Center, Louisville, KY, USA
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13
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Brocker DT, Swan BD, So RQ, Turner DA, Gross RE, Grill WM. Optimized temporal pattern of brain stimulation designed by computational evolution. Sci Transl Med 2017; 9:eaah3532. [PMID: 28053151 PMCID: PMC5516784 DOI: 10.1126/scitranslmed.aah3532] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 06/15/2016] [Accepted: 11/18/2016] [Indexed: 11/02/2022]
Abstract
Brain stimulation is a promising therapy for several neurological disorders, including Parkinson's disease. Stimulation parameters are selected empirically and are limited to the frequency and intensity of stimulation. We varied the temporal pattern of deep brain stimulation to ameliorate symptoms in a parkinsonian animal model and in humans with Parkinson's disease. We used model-based computational evolution to optimize the stimulation pattern. The optimized pattern produced symptom relief comparable to that from standard high-frequency stimulation (a constant rate of 130 or 185 Hz) and outperformed frequency-matched standard stimulation in a parkinsonian rat model and in patients. Both optimized and standard high-frequency stimulation suppressed abnormal oscillatory activity in the basal ganglia of rats and humans. The results illustrate the utility of model-based computational evolution of temporal patterns to increase the efficiency of brain stimulation in treating Parkinson's disease and thereby reduce the energy required for successful treatment below that of current brain stimulation paradigms.
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Affiliation(s)
- David T Brocker
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Brandon D Swan
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Rosa Q So
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Dennis A Turner
- Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Robert E Gross
- Departments of Neurosurgery and Neurology, Emory University, Atlanta, GA 30322, USA
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
- Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
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14
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Zaehle T, Wagenbreth C, Voges J, Heinze HJ, Galazky I. Effects of deep brain stimulation of the subthalamic nucleus on perceptual decision making. Neuroscience 2016; 343:140-146. [PMID: 27956065 DOI: 10.1016/j.neuroscience.2016.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
Abstract
When faced with difficult decisions, people prefer to stay with the default. This status quo bias often leads to suboptimal choice behavior. Neurophysiological evidence suggests a pivot role of the Subthalamic Nucleus (STN) for overcoming such status quo bias in difficult decisions, but causal evidence is lacking. The present study investigated whether subthalamic deep brain stimulation (DBS) in patients with Parkinson's disease (PD) influences the status quo bias. Eighteen PD patients treated with STN-DBS performed a difficult perceptual decision task incorporating intrinsic status quo option. Patients were tested with (ON) and without (OFF) active STN stimulation. Our results show that DBS of the STN affected perceptual decision making in PD patients depending on the difficulty of decision. STN-DBS improved difficult perceptual decisions due to a selective increase in accuracy (hit rate) that was independent of response bias (no effect on false alarm rate). Furthermore, STN-DBS impacted status quo bias as a function of baseline impulsivity. In impulsive patients, STN-DBS increased the default bias, whereas in less impulsive PD patients, DBS of the STN reduced the status quo bias. In line with our hypothesis, STN-DBS selectively affected the tendency to stick with the default option on difficult decisions, and promoted increased decision accuracy. Moreover, we demonstrate the impact of baseline cognitive abilities on DBS-related performance changes in PD patients.
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Affiliation(s)
- Tino Zaehle
- Department of Neurology and Stereotactic Neurosurgery, University Hospital of Magdeburg, Germany.
| | - Caroline Wagenbreth
- Department of Neurology and Stereotactic Neurosurgery, University Hospital of Magdeburg, Germany
| | - Jürgen Voges
- Department of Neurology and Stereotactic Neurosurgery, University Hospital of Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology and Stereotactic Neurosurgery, University Hospital of Magdeburg, Germany
| | - Imke Galazky
- Department of Neurology and Stereotactic Neurosurgery, University Hospital of Magdeburg, Germany
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15
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So RQ, McConnell GC, Grill WM. Frequency-dependent, transient effects of subthalamic nucleus deep brain stimulation on methamphetamine-induced circling and neuronal activity in the hemiparkinsonian rat. Behav Brain Res 2016; 320:119-127. [PMID: 27939691 DOI: 10.1016/j.bbr.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 02/05/2023]
Abstract
Methamphetamine-induced circling is used to quantify the behavioral effects of subthalamic nucleus (STN) deep brain stimulation (DBS) in hemiparkinsonian rats. We observed a frequency-dependent transient effect of DBS on circling, and quantified this effect to determine its neuronal basis. High frequency STN DBS (75-260Hz) resulted in transient circling contralateral to the lesion at the onset of stimulation, which was not sustained after the first several seconds of stimulation. Following the transient behavioral change, DBS resulted in a frequency-dependent steady-state reduction in pathological ipsilateral circling, but no change in overall movement. Recordings from single neurons in globus pallidus externa (GPe) and substantia nigra pars reticulata (SNr) revealed that high frequency, but not low frequency, STN DBS elicited transient changes in both firing rate and neuronal oscillatory power at the stimulation frequency in a subpopulation of GPe and SNr neurons. These transient changes were not sustained, and most neurons exhibited a different response during the steady-state phase of DBS. During the steady-state, DBS produced elevated neuronal oscillatory power at the stimulus frequency in a majority of GPe and SNr neurons, and the increase was more pronounced during high frequency DBS than during low frequency DBS. Changes in oscillatory power during both transient and steady-state DBS were highly correlated with changes in firing rates. These results suggest that distinct neural mechanisms were responsible for transient and sustained behavioral responses to STN DBS. The transient contralateral turning behavior following the onset of high frequency DBS was paralleled by transient changes in firing rate and oscillatory power in the GPe and SNr, while steady-state suppression of ipsilateral turning was paralleled by sustained increased synchronization of basal ganglia neurons to the stimulus pulses. Our analysis of distinct frequency-dependent transient and steady-state responses to DBS lays the foundation for future mechanistic studies of the immediate and persistent effects of DBS.
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Affiliation(s)
- Rosa Q So
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA; Department of Neurobiology, Duke University, Durham, NC, USA.
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16
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Little S, Beudel M, Zrinzo L, Foltynie T, Limousin P, Hariz M, Neal S, Cheeran B, Cagnan H, Gratwicke J, Aziz TZ, Pogosyan A, Brown P. Bilateral adaptive deep brain stimulation is effective in Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:717-21. [PMID: 26424898 PMCID: PMC4941128 DOI: 10.1136/jnnp-2015-310972] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/17/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION & OBJECTIVES Adaptive deep brain stimulation (aDBS) uses feedback from brain signals to guide stimulation. A recent acute trial of unilateral aDBS showed that aDBS can lead to substantial improvements in contralateral hemibody Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and may be superior to conventional continuous DBS in Parkinson's disease (PD). We test whether potential benefits are retained with bilateral aDBS and in the face of concurrent medication. METHODS We applied bilateral aDBS in 4 patients with PD undergoing DBS of the subthalamic nucleus. aDBS was delivered bilaterally with independent triggering of stimulation according to the amplitude of β activity at the corresponding electrode. Mean stimulation voltage was 3.0±0.1 volts. Motor assessments consisted of double-blinded video-taped motor UPDRS scores that included both limb and axial features. RESULTS UPDRS scores were 43% (p=0.04; Cohen's d=1.62) better with aDBS than without stimulation. Motor improvement with aDBS occurred despite an average time on stimulation (ToS) of only 45%. Levodopa was well tolerated during aDBS and led to further reductions in ToS. CONCLUSION Bilateral aDBS can improve both axial and limb symptoms and can track the need for stimulation across drug states.
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Affiliation(s)
- Simon Little
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Martijn Beudel
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Spencer Neal
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Binith Cheeran
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Hayriye Cagnan
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Gratwicke
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Alex Pogosyan
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK The Medical Research Council Brain Networks Dynamics Unit, University of Oxford, Oxford, UK
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK The Medical Research Council Brain Networks Dynamics Unit, University of Oxford, Oxford, UK
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17
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Arlotti M, Rosa M, Marceglia S, Barbieri S, Priori A. The adaptive deep brain stimulation challenge. Parkinsonism Relat Disord 2016; 28:12-7. [PMID: 27079257 DOI: 10.1016/j.parkreldis.2016.03.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 01/17/2023]
Abstract
Sub-optimal clinical outcomes of conventional deep brain stimulation (cDBS) in treating Parkinson's Disease (PD) have boosted the development of new solutions to improve DBS therapy. Adaptive DBS (aDBS), consisting of closed-loop, real-time changing of stimulation parameters according to the patient's clinical state, promises to achieve this goal and is attracting increasing interest in overcoming all of the challenges posed by its development and adoption. In the design, implementation, and application of aDBS, the choice of the control variable and of the control algorithm represents the core challenge. The proposed approaches, in fact, differ in the choice of the control variable and control policy, in the system design and its technological limits, in the patient's target symptom, and in the surgical procedure needed. Here, we review the current proposals for aDBS systems, focusing on the choice of the control variable and its advantages and drawbacks, thus providing a general overview of the possible pathways for the clinical translation of aDBS with its benefits, limitations and unsolved issues.
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Affiliation(s)
- Mattia Arlotti
- Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Electronics, Computer Science and Systems, University of Bologna, Cesena, Italy
| | - Manuela Rosa
- Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Marceglia
- Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Sergio Barbieri
- Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Unità di Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, University of Milan, Fondazione IRCCS Ca'Granda, Milan, Italy.
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18
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Oswal A, Beudel M, Zrinzo L, Limousin P, Hariz M, Foltynie T, Litvak V, Brown P. Deep brain stimulation modulates synchrony within spatially and spectrally distinct resting state networks in Parkinson's disease. Brain 2016; 139:1482-96. [PMID: 27017189 PMCID: PMC4845255 DOI: 10.1093/brain/aww048] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/25/2016] [Indexed: 11/13/2022] Open
Abstract
Chronic dopamine depletion in Parkinson's disease leads to progressive motor and cognitive impairment, which is associated with the emergence of characteristic patterns of synchronous oscillatory activity within cortico-basal-ganglia circuits. Deep brain stimulation of the subthalamic nucleus is an effective treatment for Parkinson's disease, but its influence on synchronous activity in cortico-basal-ganglia loops remains to be fully characterized. Here, we demonstrate that deep brain stimulation selectively suppresses certain spatially and spectrally segregated resting state subthalamic nucleus-cortical networks. To this end we used a validated and novel approach for performing simultaneous recordings of the subthalamic nucleus and cortex using magnetoencephalography (during concurrent subthalamic nucleus deep brain stimulation). Our results highlight that clinically effective subthalamic nucleus deep brain stimulation suppresses synchrony locally within the subthalamic nucleus in the low beta oscillatory range and furthermore that the degree of this suppression correlates with clinical motor improvement. Moreover, deep brain stimulation relatively selectively suppressed synchronization of activity between the subthalamic nucleus and mesial premotor regions, including the supplementary motor areas. These mesial premotor regions were predominantly coupled to the subthalamic nucleus in the high beta frequency range, but the degree of deep brain stimulation-associated suppression in their coupling to the subthalamic nucleus was not found to correlate with motor improvement. Beta band coupling between the subthalamic nucleus and lateral motor areas was not influenced by deep brain stimulation. Motor cortical coupling with subthalamic nucleus predominantly involved driving of the subthalamic nucleus, with those drives in the higher beta frequency band having much shorter net delays to subthalamic nucleus than those in the lower beta band. These observations raise the possibility that cortical connectivity with the subthalamic nucleus in the high and low beta bands may reflect coupling mediated predominantly by the hyperdirect and indirect pathways to subthalamic nucleus, respectively, and that subthalamic nucleus deep brain stimulation predominantly suppresses the former. Yet only the change in strength of local subthalamic nucleus oscillations correlates with the degree of improvement during deep brain stimulation, compatible with the current view that a strengthened hyperdirect pathway is a prerequisite for locally generated beta activity but that it is the severity of the latter that may determine or index motor impairment.
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Affiliation(s)
- Ashwini Oswal
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK Medical Research Council Brain Network Dynamics Unit, University of Oxford, UK Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London, UK
| | - Martijn Beudel
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK University Medical Centre Groningen, Department of Neurology, University of Groningen, The Netherlands
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Vladimir Litvak
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London, UK
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK Medical Research Council Brain Network Dynamics Unit, University of Oxford, UK
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19
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Akbar U, Raike RS, Hack N, Hess CW, Skinner J, Martinez-Ramirez D, DeJesus S, Okun MS. Randomized, Blinded Pilot Testing of Nonconventional Stimulation Patterns and Shapes in Parkinson's Disease and Essential Tremor: Evidence for Further Evaluating Narrow and Biphasic Pulses. Neuromodulation 2016; 19:343-56. [PMID: 27000764 PMCID: PMC4914444 DOI: 10.1111/ner.12397] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evidence suggests that nonconventional programming may improve deep brain stimulation (DBS) therapy for movement disorders. The primary objective was to assess feasibility of testing the tolerability of several nonconventional settings in Parkinson's disease (PD) and essential tremor (ET) subjects in a single office visit. Secondary objectives were to explore for potential efficacy signals and to assess the energy demand on the implantable pulse-generators (IPGs). MATERIALS AND METHODS A custom firmware (FW) application was developed and acutely uploaded to the IPGs of eight PD and three ET subjects, allowing delivery of several nonconventional DBS settings, including narrow pulse widths, square biphasic pulses, and irregular pulse patterns. Standard clinical rating scales and several objective measures were used to compare motor outcomes with sham, clinically-optimal and nonconventional settings. Blinded and randomized testing was conducted in a traditional office setting. RESULTS Overall, the nonconventional settings were well tolerated. Under these conditions it was also possible to detect clinically-relevant differences in DBS responses using clinical rating scales but not objective measures. Compared to the clinically-optimal settings, some nonconventional settings appeared to offer similar benefit (e.g., narrow pulse widths) and others lesser benefit. Moreover, the results suggest that square biphasic pulses may deliver greater benefit. No unexpected IPG efficiency disadvantages were associated with delivering nonconventional settings. CONCLUSIONS It is feasible to acutely screen nonconventional DBS settings using controlled study designs in traditional office settings. Simple IPG FW upgrades may provide more DBS programming options for optimizing therapy. Potential advantages of narrow and biphasic pulses deserve follow up.
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Affiliation(s)
- Umer Akbar
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.,Department of Neurology, Brown University, Providence, RI, USA
| | - Robert S Raike
- Neuromodulation Global Research, Medtronic Inc., Minneapolis, MN, USA
| | - Nawaz Hack
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.,US Naval Hospital, Okinawa, Japan
| | - Christopher W Hess
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Jared Skinner
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Daniel Martinez-Ramirez
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Sol DeJesus
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Michael S Okun
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.,Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
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20
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Deep brain stimulation of the subthalamic nucleus modulates reward processing and action selection in Parkinson patients. J Neurol 2015; 262:1541-7. [DOI: 10.1007/s00415-015-7749-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/11/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
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21
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Dorval AD, Grill WM. Deep brain stimulation of the subthalamic nucleus reestablishes neuronal information transmission in the 6-OHDA rat model of parkinsonism. J Neurophysiol 2014; 111:1949-59. [PMID: 24554786 DOI: 10.1152/jn.00713.2013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pathophysiological activity of basal ganglia neurons accompanies the motor symptoms of Parkinson's disease. High-frequency (>90 Hz) deep brain stimulation (DBS) reduces parkinsonian symptoms, but the mechanisms remain unclear. We hypothesize that parkinsonism-associated electrophysiological changes constitute an increase in neuronal firing pattern disorder and a concomitant decrease in information transmission through the ventral basal ganglia, and that effective DBS alleviates symptoms by decreasing neuronal disorder while simultaneously increasing information transfer through the same regions. We tested these hypotheses in the freely behaving, 6-hydroxydopamine-lesioned rat model of hemiparkinsonism. Following the onset of parkinsonism, mean neuronal firing rates were unchanged, despite a significant increase in firing pattern disorder (i.e., neuronal entropy), in both the globus pallidus and substantia nigra pars reticulata. This increase in neuronal entropy was reversed by symptom-alleviating DBS. Whereas increases in signal entropy are most commonly indicative of similar increases in information transmission, directed information through both regions was substantially reduced (>70%) following the onset of parkinsonism. Again, this decrease in information transmission was partially reversed by DBS. Together, these results suggest that the parkinsonian basal ganglia are rife with entropic activity and incapable of functional information transmission. Furthermore, they indicate that symptom-alleviating DBS works by lowering the entropic noise floor, enabling more information-rich signal propagation. In this view, the symptoms of parkinsonism may be more a default mode, normally overridden by healthy basal ganglia information. When that information is abolished by parkinsonian pathophysiology, hypokinetic symptoms emerge.
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Affiliation(s)
- Alan D Dorval
- Department of Bioengineering and Brain Institute, University of Utah, Salt Lake City, Utah;
| | - Warren M Grill
- Departments of Biomedical Engineering and Electrical and Computer Engineering, Duke University, Durham, North Carolina; and Departments of Neurobiology and Surgery, Duke University Medical Center, Durham, North Carolina
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Little S, Pogosyan A, Neal S, Zavala B, Zrinzo L, Hariz M, Foltynie T, Limousin P, Ashkan K, FitzGerald J, Green AL, Aziz TZ, Brown P. Adaptive deep brain stimulation in advanced Parkinson disease. Ann Neurol 2013; 74:449-57. [PMID: 23852650 PMCID: PMC3886292 DOI: 10.1002/ana.23951] [Citation(s) in RCA: 760] [Impact Index Per Article: 69.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 05/13/2013] [Accepted: 05/24/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Brain-computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS. METHODS We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale. RESULTS Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation. INTERPRETATION BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD.
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Affiliation(s)
- Simon Little
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
| | - Alex Pogosyan
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
| | - Spencer Neal
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of NeurologyLondon
| | - Baltazar Zavala
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of NeurologyLondon
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of NeurologyLondon
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of NeurologyLondon
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of NeurologyLondon
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College HospitalLondon, United Kingdom
| | - James FitzGerald
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford
- Address correspondence to Dr Brown, Department of Clinical Neurology, University of Oxford, Level 1, West Wing, John Radcliffe Hospital, OX3 9DU, United Kingdom. E-mail:
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Mirabella G, Iaconelli S, Modugno N, Giannini G, Lena F, Cantore G. Stimulation of subthalamic nuclei restores a near normal planning strategy in Parkinson's patients. PLoS One 2013; 8:e62793. [PMID: 23658775 PMCID: PMC3643906 DOI: 10.1371/journal.pone.0062793] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 03/25/2013] [Indexed: 11/18/2022] Open
Abstract
A fundamental function of the motor system is to gather key information from the environment in order to implement behavioral strategies appropriate to the context. Although several lines of evidence indicate that Parkinson's disease affects the ability to modify behavior according to task requirements, it is currently unknown whether deep brain stimulation (DBS) of the subthalamic nucleus (STN) affects context-related planning. To explore this issue, we asked 12 Parkinson's patients with bilateral STN DBS and 13 healthy subjects to execute similar arm reaching movements in two different paradigms: go-only and countermanding tasks. In the former task patients had to perform speeded reaching movements to a peripheral target. In contrast, in the countermanding task participants had to perform the same reaches unless an infrequent and unpredictable stop-signal was shown during the reaction time (RT) indicating that they should withhold the ongoing action. We compared the performance of Parkinson's patients in different DBS conditions. We found that patients with both DBS-ON behaved similarly to healthy subjects, in that RTs of no-stop trial increased while movement times (MTs) decreased with respect to those of go-only-trials. However, when both DBS were off, both RTs and MTs were longer in no-stop trials than in go-only trials. These findings indicate that bilateral DBS of STN can partially restore the appropriate motor strategy according to the given cognitive contexts.
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Affiliation(s)
- Giovanni Mirabella
- Department of Neuroscience, Istituto Neurologico Mediterraneo Neuromed, Pozzilli, IS, Italy.
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A common optimization principle for motor execution in healthy subjects and parkinsonian patients. J Neurosci 2013; 33:665-77. [PMID: 23303945 DOI: 10.1523/jneurosci.1482-12.2013] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Recent research on Parkinson's disease (PD) has emphasized that parkinsonian movement, although bradykinetic, shares many attributes with healthy behavior. This observation led to the suggestion that bradykinesia in PD could be due to a reduction in motor motivation. This hypothesis can be tested in the framework of optimal control theory, which accounts for many characteristics of healthy human movement while providing a link between the motor behavior and a cost/benefit trade-off. This approach offers the opportunity to interpret movement deficits of PD patients in the light of a computational theory of normal motor control. We studied 14 PD patients with bilateral subthalamic nucleus (STN) stimulation and 16 age-matched healthy controls, and tested whether reaching movements were governed by similar rules in these two groups. A single optimal control model accounted for the reaching movements of healthy subjects and PD patients, whatever the condition of STN stimulation (on or off). The choice of movement speed was explained in all subjects by the existence of a preset dynamic range for the motor signals. This range was idiosyncratic and applied to all movements regardless of their amplitude. In PD patients this dynamic range was abnormally narrow and correlated with bradykinesia. STN stimulation reduced bradykinesia and widened this range in all patients, but did not restore it to a normal value. These results, consistent with the motor motivation hypothesis, suggest that constrained optimization of motor effort is the main determinant of movement planning (choice of speed) and movement production, in both healthy and PD subjects.
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Fridley J, Adams G, Sun P, York M, Atassi F, Lai E, Simpson R, Viswanathan A, Yoshor D. Effect of Subthalamic Nucleus or Globus Pallidus Interna Stimulation on Oculomotor Function in Patients with Parkinsons Disease. Stereotact Funct Neurosurg 2013; 91:113-21. [DOI: 10.1159/000343200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/01/2012] [Indexed: 11/19/2022]
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Pinkhardt EH, Jürgens R, Lulé D, Heimrath J, Ludolph AC, Becker W, Kassubek J. Eye movement impairments in Parkinson's disease: possible role of extradopaminergic mechanisms. BMC Neurol 2012; 12:5. [PMID: 22375860 PMCID: PMC3306761 DOI: 10.1186/1471-2377-12-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The basal ganglia (BG) are thought to play an important role in the control of eye movements. Accordingly, the broad variety of subtle oculomotor alterations that has been described in Parkinson's disease (PD) are generally attributed to the dysfunction of the BG dopaminergic system. However, the present study suggest that dopamine substitution is much less effective in improving oculomotor performance than it is in restoring skeletomotor abilities. METHODS We investigated reactive, visually guided saccades (RS), smooth pursuit eye movements (SPEM), and rapidly left-right alternating voluntary gaze shifts (AVGS) by video-oculography in 34 PD patients receiving oral dopaminergic medication (PD-DA), 14 patients with deep brain stimulation of the nucleus subthalamicus (DBS-STN), and 23 control subjects (CTL);In addition, we performed a thorough review of recent literature according therapeuthic effects on oculomotor performance in PD by switching deep brain stimulation off and on in the PD-DBS patients, we achieved swift changes between their therapeutic states without the delays of dopamine withdrawal. In addition, participants underwent neuropsychological testing. RESULTS Patients exhibited the well known deficits such as increased saccade latency, reduced SPEM gain, and reduced frequency and amplitude of AVGS. Across patients none of the investigated oculomotor parameters correlated with UPDRS III whereas there was a negative correlation between SPEM gain and susceptibility to interference (Stroop score). Of the observed deficiencies, DBS-STN slightly improved AVGS frequency but neither AVGS amplitude nor SPEM or RS performance. CONCLUSIONS We conclude that the impairment of SPEM in PD results from a cortical, conceivably non-dopaminergic dysfunction, whereas patients' difficulty to rapidly execute AVGS might be related to their BG dysfunction.
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Affiliation(s)
- Elmar H Pinkhardt
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
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Favilla CG, Ullman D, Wagle Shukla A, Foote KD, Jacobson CE, Okun MS. Worsening essential tremor following deep brain stimulation: disease progression versus tolerance. Brain 2012; 135:1455-62. [PMID: 22344584 DOI: 10.1093/brain/aws026] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A major concern regarding ventralis intermedius nucleus deep brain stimulation for essential tremor has been the loss of surgical efficacy over time in a minority of patients. Some experts have ascribed the worsening tremor to tolerance, while other evidence has suggested that disease progression may play a role. Suboptimal lead placement has also been reported to be a factor in worsening tremor following deep-brain stimulation; however, most authors consider this phenomenon to manifest within a few months of the actual surgery. We aimed to dissect the tolerance versus disease progression issue by analysing preoperative versus long-term post-surgical Fahn-Tolosa-Marin Tremor Rating Scale scores both on and off stimulation among 28 patients who underwent ventralis intermedius nucleus deep brain stimulation and 21 age-matched controls. Of the 28 patients in the treatment arm of the cohort, seven (25%) demonstrated evidence of tremor progression, and had a 34% increase in the tremor score off stimulation at the 36 month follow-up compared with a 32% increase among controls (P = 0.67). In one of the seven patients there was evidence of suboptimal lead placement given the lateral position of the lead, and the motor side effects during threshold testing. This patient demonstrated a loss of stimulation benefit between 24 and 36 months, which may have been more indicative of tolerance. The other six subjects (86%) maintained stimulation benefit throughout the follow-up period, despite worsening tremor off stimulation (at a comparable rate to that of controls), making disease progression the most likely explanation. The data suggest that deep brain stimulation tolerance may be over-reported in the literature, and that a tolerance versus disease progression work-up should include: examining the trend in off stimulation scores, accounting for image based lead locations, and during programming sessions checking for thresholds which may elicit clinical benefits and side effects.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, Centre for Movement Disorders and Neurorestoration, University of Florida College of Medicine, 100 S Newell Drive, Gainesville, FL 32610, USA
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Lulé D, Heimrath J, Pinkhardt EH, Ludolph AC, Uttner I, Kassubek J. Deep Brain Stimulation and Behavioural Changes: Is Comedication the Most Important Factor? NEURODEGENER DIS 2012; 9:18-24. [DOI: 10.1159/000328817] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 04/27/2011] [Indexed: 11/19/2022] Open
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Mirabella G, Iaconelli S, Romanelli P, Modugno N, Lena F, Manfredi M, Cantore G. Deep brain stimulation of subthalamic nuclei affects arm response inhibition in Parkinson's patients. Cereb Cortex 2011; 22:1124-32. [PMID: 21810782 DOI: 10.1093/cercor/bhr187] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The precise localizations of the neural substrates of voluntary inhibition are still debated. It has been hypothesized that, in humans, this executive function relies upon a right-lateralized pathway comprising the inferior frontal gyrus and the presupplementary motor area, which would control the neural processes for movement inhibition acting through the right subthalamic nucleus (STN). We assessed the role of the right STN, via a countermanding reaching task, in 10 Parkinson's patients receiving high-frequency electrical stimulation of the STN of both hemispheres (deep brain stimulation, DBS) and in 13 healthy subjects. We compared the performance of Parkinson's patients in 4 experimental conditions: DBS-ON, DBS-OFF, DBS-OFF right, and DBS-OFF left. We found that 1) inhibitory control is improved only when both DBS are active, that is, the reaction time to the stop signal is significantly shorter in the DBS-ON condition than in all the others, 2) bilateral stimulation of STN restores the inhibitory control to a near-normal level, and 3) DBS does not cause a general improvement in task-related motor function as it does not affect the length of the reaction times of arm movements, that is, in our experimental context, STN seems to play a selective role in response inhibition.
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Affiliation(s)
- G Mirabella
- Istituto di ricovero e cura a carattere scientifico Neuromed, 86077 Pozzilli (IS), Italy.
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Cooper SE, Noecker AM, Abboud H, Vitek JL, McIntyre CC. Return of bradykinesia after subthalamic stimulation ceases: relationship to electrode location. Exp Neurol 2011; 231:207-13. [PMID: 21736878 DOI: 10.1016/j.expneurol.2011.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/26/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
Abstract
In 20 subjects we quantified the rate at which subthalamic nucleus deep brain stimulation effects on Parkinson's bradykinesia "washed-out" after stimulation ceased. We found that wash-out was a two-step process, consisting of an initial fast decrease in stimulation's therapeutic effect, followed by a further, slow decline. Moreover, the relative contribution of the fast and slow components differed between patients. Finally, we found that lateral stimulation caused more of the fast-decaying component, while medial stimulation caused more of the slow-decaying component. This implies the existence of at least two separate mechanisms by which subthalamic nucleus deep brain stimulation improves bradykinesia, associated with activation of spatially separate zones in the vicinity of the subthalamic nucleus.
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Affiliation(s)
- Scott Evan Cooper
- Department of Neurology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
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Waldau B, Clayton DA, Gasperson LB, Turner DA. Analysis of the time course of the effect of subthalamic nucleus stimulation upon hand function in Parkinson's patients. Stereotact Funct Neurosurg 2011; 89:48-55. [PMID: 21252589 DOI: 10.1159/000323340] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 12/02/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) as treatment for Parkinson's disease has been in use for more than a decade, yet the immediate effect of stimulation upon movement parameters is not well characterized. OBJECTIVE The goal of the current study is the identification of the best time point to test hand function after programming DBS devices. METHODS Reaction time, movement time and velocity were measured at multiple time points with a movement-sensitive glove after the deep brain stimulator had been turned on or off, during 'off medication' conditions. RESULTS Velocity, movement time and reaction time worsened significantly in the first 20 min after the deep brain stimulator had been turned off. A 'plateau effect' after 20 min was not observed. Initiation of stimulation led to immediate significant increases in movement time and velocity and to a lesser degree a decrease in reaction time. Patients performed more inconsistently over time after onset of stimulation compared to stimulation withdrawal. Intraoperative testing showed an immediate improvement in velocity after placement of the STN deep brain stimulator. CONCLUSION Movement time and velocity already reach their peak changes within 20 min after the deep brain stimulator has been reprogrammed, and therefore, this time point may be used to test the maximal clinical effect of stimulation.
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Affiliation(s)
- Ben Waldau
- Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
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Wylie SA, Ridderinkhof KR, Elias WJ, Frysinger RC, Bashore TR, Downs KE, van Wouwe NC, van den Wildenberg WPM. Subthalamic nucleus stimulation influences expression and suppression of impulsive behaviour in Parkinson's disease. ACTA ACUST UNITED AC 2010; 133:3611-24. [PMID: 20861152 DOI: 10.1093/brain/awq239] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Past studies show beneficial as well as detrimental effects of subthalamic nucleus deep-brain stimulation on impulsive behaviour. We address this paradox by investigating individuals with Parkinson's disease treated with subthalamic nucleus stimulation (n = 17) and healthy controls without Parkinson's disease (n = 17) on performance in a Simon task. In this reaction time task, conflict between premature response impulses and goal-directed action selection is manipulated. We applied distributional analytic methods to separate the strength of the initial response impulse from the proficiency of inhibitory control engaged subsequently to suppress the impulse. Patients with Parkinson's disease were tested when stimulation was either turned on or off. Mean conflict interference effects did not differ between controls and patients, or within patients when stimulation was on versus off. In contrast, distributional analyses revealed two dissociable effects of subthalamic nucleus stimulation. Fast response errors indicated that stimulation increased impulsive, premature responding in high conflict situations. Later in the reaction process, however, stimulation improved the proficiency with which inhibitory control was engaged to suppress these impulses selectively, thereby facilitating selection of the correct action. This temporal dissociation supports a conceptual framework for resolving past paradoxical findings and further highlights that dynamic aspects of impulse and inhibitory control underlying goal-directed behaviour rely in part on neural circuitry inclusive of the subthalamic nucleus.
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Affiliation(s)
- Scott A Wylie
- Neurology Department, University of Virginia Health Systems, Charlottesville, VA 22908, USA.
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Dorval AD, Kuncel AM, Birdno MJ, Turner DA, Grill WM. Deep brain stimulation alleviates parkinsonian bradykinesia by regularizing pallidal activity. J Neurophysiol 2010; 104:911-21. [PMID: 20505125 DOI: 10.1152/jn.00103.2010] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation (DBS) of the basal ganglia can alleviate the motor symptoms of Parkinson's disease although the therapeutic mechanisms are unclear. We hypothesize that DBS relieves symptoms by minimizing pathologically disordered neuronal activity in the basal ganglia. In human participants with parkinsonism and clinically effective deep brain leads, regular (i.e., periodic) high-frequency stimulation was replaced with irregular (i.e., aperiodic) stimulation at the same mean frequency (130 Hz). Bradykinesia, a symptomatic slowness of movement, was quantified via an objective finger tapping protocol in the absence and presence of regular and irregular DBS. Regular DBS relieved bradykinesia more effectively than irregular DBS. A computational model of the relevant neural structures revealed that output from the globus pallidus internus was more disordered and thalamic neurons made more transmission errors in the parkinsonian condition compared with the healthy condition. Clinically therapeutic, regular DBS reduced firing pattern disorder in the computational basal ganglia and minimized model thalamic transmission errors, consistent with symptom alleviation by clinical DBS. However, nontherapeutic, irregular DBS neither reduced disorder in the computational basal ganglia nor lowered model thalamic transmission errors. Thus we show that clinically useful DBS alleviates motor symptoms by regularizing basal ganglia activity and thereby improving thalamic relay fidelity. This work demonstrates that high-frequency stimulation alone is insufficient to alleviate motor symptoms: DBS must be highly regular. Descriptive models of pathophysiology that ignore the fine temporal resolution of neuronal spiking in favor of average neural activity cannot explain the mechanisms of DBS-induced symptom alleviation.
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Affiliation(s)
- Alan D Dorval
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
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Lempka SF, Johnson MD, Miocinovic S, Vitek JL, McIntyre CC. Current-controlled deep brain stimulation reduces in vivo voltage fluctuations observed during voltage-controlled stimulation. Clin Neurophysiol 2010; 121:2128-33. [PMID: 20493764 DOI: 10.1016/j.clinph.2010.04.026] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 03/01/2010] [Accepted: 04/23/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinical deep brain stimulation (DBS) systems typically utilize voltage-controlled stimulation and thus the voltage distribution generated in the brain can be affected by electrode impedance fluctuations. The goal of this study was to experimentally evaluate the theoretical advantages of using current-controlled pulse generators for DBS applications. METHODS Time-dependent changes in the voltage distribution generated in the brain during voltage-controlled and current-controlled DBS were monitored with in vivo experimental recordings performed in non-human primates implanted with scaled-down clinical DBS electrodes. RESULTS In the days following DBS lead implantation, electrode impedance progressively increased. Application of continuous stimulation through the DBS electrode produced a decrease in the electrode impedance in a time dependent manner, with the largest changes occurring within the first hour of stimulation. Over that time period, voltage-controlled stimuli exhibited an increase in the voltage magnitudes generated in the tissue near the DBS electrode, while current-controlled DBS showed minimal changes. CONCLUSION Large electrode impedance changes occur during DBS. During voltage-controlled stimulation, these impedance changes were significantly correlated with changes in the voltage distribution generated in the brain. However, these effects can be minimized with current-controlled stimulation. SIGNIFICANCE The use of current-controlled DBS may help minimize time-dependent changes in therapeutic efficacy that can complicate patient programming when using voltage-controlled DBS.
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Affiliation(s)
- Scott F Lempka
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH, USA
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Pazo JH, Höcht C, Barceló AC, Fillipini B, Lomastro MJ. Effect of electrical and chemical stimulation of the subthalamic nucleus on the release of striatal dopamine. Synapse 2010; 64:905-15. [DOI: 10.1002/syn.20809] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fimm B, Heber IA, Coenen VA, Fromm C, Noth J, Kronenbuerger M. Deep brain stimulation of the subthalamic nucleus improves intrinsic alertness in Parkinson's disease. Mov Disord 2010; 24:1613-20. [PMID: 19533754 DOI: 10.1002/mds.22580] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a treatment option for patients with Parkinson's disease (PD) in the advanced stage. Besides motor improvement, DBS of the STN may also modulate cognitive and attentional functions of the basal ganglia. In our study, 13 patients with PD and bilateral DBS of the STN were assessed with DBS switched on and off by the use of a wide range of neuropsychological tasks. This included reasoning, cognitive flexibility, phonemic and semantic word fluency, verbal and nonverbal short-term memory, learning, delayed verbal memory recall, and stimulus-response incompatibility. Special emphasis was put on basic attentional functions, in particular intrinsic and phasic alertness as well as visual search. DBS significantly improved intrinsic alertness, whereas phasic alertness and other neuropsychological domains were not affected. Additionally, the effects on intrinsic alertness were independent of motor improvements by DBS. The findings suggest that DBS modulates the fronto-parietal network of alertness.
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Affiliation(s)
- Bruno Fimm
- Department of Neurology, University Hospital RWTH Aachen, Germany.
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Fawcett AP, González EG, Moro E, Steinbach MJ, Lozano AM, Hutchison WD. Subthalamic Nucleus Deep Brain Stimulation Improves Saccades in Parkinson's Disease. Neuromodulation 2009; 13:17-25. [DOI: 10.1111/j.1525-1403.2009.00246.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reese R, Steigerwald F, Pötter M, Herzog J, Deuschl G, Volkmann J, Pinsker MO, Mehdorn HM. High-frequency stimulation of the subthalamic nucleus increases pallidal neuronal firing rate in a patient with Parkinson's disease. Mov Disord 2008; 23:1945-7. [DOI: 10.1002/mds.22225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Agostino R, Dinapoli L, Modugno N, Iezzi E, Gregori B, Esposito V, Romanelli P, Berardelli A. Ipsilateral sequential arm movements after unilateral subthalamic deep-brain stimulation in patients with Parkinson's disease. Mov Disord 2008; 23:1718-24. [DOI: 10.1002/mds.22203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Keresztenyi Z, Valkovic P, Eggert T, Steude U, Hermsdörfer J, Laczko J, Bötzel K. The time course of the return of upper limb bradykinesia after cessation of subthalamic stimulation in Parkinson's disease. Parkinsonism Relat Disord 2007; 13:438-42. [PMID: 17292654 DOI: 10.1016/j.parkreldis.2006.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 11/27/2006] [Accepted: 12/10/2006] [Indexed: 10/23/2022]
Abstract
To investigate the time span within which bradykinesia re-occurs, we registered movement parameters immediately after the termination of deep brain stimulation of the subthalamic nucleus (STN) in nine Parkinson patients with chronically implanted bilateral STN electrodes. Two repetitive movements were investigated: finger-tapping and forearm pronation-supination. When stimulation was switched off, the amplitude and velocity of the investigated movements significantly declined, but the frequency did not. The time course of this decline was modeled by an exponential function that yielded time constants between 15 and 30s. The effect of stimulation had completely disappeared within 1 min. These results suggest that it is necessary to wait at least for 1 min after the end of stimulation before performing further assessments.
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Kelly VE, Samii A, Slimp JC, Price R, Goodkin R, Shumway-Cook A. Gait Changes in Response to Subthalamic Nucleus Stimulation in People with Parkinson Disease. J Neurol Phys Ther 2006; 30:184-94. [PMID: 17233926 DOI: 10.1097/01.npt.0000281255.10174.e2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE For individuals with advanced Parkinson disease (PD), stimulation of the subthalamic nucleus (STN) reduces tremor, rigidity, and bradykinesia, but the effects of stimulation on gait and mobility are not fully understood. The purpose of this paper is to describe the effects of unilateral and bilateral STN stimulation on gait following staged stimulator implantations in a series of individuals with PD. CASE DESCRIPTIONS Participants were 6 individuals with PD who underwent staged stimulator implantation surgeries. The effects of stimulation on gait were assessed in the optimally medicated state using items from the Unified Parkinson's Disease Rating Scale (UPDRS) related to gait and self-reported mobility, time to complete the Timed Up and Go (TUG) test, and quantitative gait analysis. Gait was evaluated with stimulation turned off and with stimulation turned on after unilateral stimulator implantation and again after implantation of the second stimulator. OUTCOMES Variable effects of unilateral and bilateral STN stimulation on gait were observed on UPDRS self-reported mobility, TUG time, and gait velocity, but changes were not detected using the UPDRS gait item. Minimal gait changes, either positive or negative, were detected with unilateral stimulation. With bilateral stimulation, gait improved for 3 individuals but worsened for the other 3 individuals. DISCUSSION The ability to detect changes in gait after STN stimulation using the UPDRS gait item was limited, but variable effects were detected by self-report, TUG time, and gait velocity. For half of the individuals studied, bilateral stimulation improved these measures, but gait worsened for the remaining individuals. Future research is needed to better understand factors that influence the effect of STN stimulation on walking, and assessment of gait changes in people with PD should include self-report and performance-based measures, such as the TUG test or gait velocity.
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Affiliation(s)
- Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E, Ondo W, Pahwa R, Poewe W, Tröster AI, Uitti R, Voon V. Deep brain stimulation: Preoperative issues. Mov Disord 2006; 21 Suppl 14:S171-96. [PMID: 16810718 DOI: 10.1002/mds.20955] [Citation(s) in RCA: 189] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Numerous factors need to be taken into account in deciding whether a patient with Parkinson's disease (PD) is a candidate for deep brain stimulation. Patient-related personal factors including age and the presence of other comorbid disorders need to be considered. Neuropsychological and neuropsychiatric concerns relate both to the presurgical status of the patient and to the potential for surgery to result in new problems postoperatively. A number of factors related to the underlying PD need to be considered, including the specific parkinsonian motor indications (e.g., tremor, bradykinesia, gait dysfunction), previous medical therapies, including benefit from current therapy and adverse effects, and past surgical treatments. Definable causes of Parkinsonism, particularly atypical Parkinsonisms, should be considered. Finally, methods of evaluating outcomes should be defined and formalized. This is a report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society (MDS). The report has been endorsed by the Scientific Issues Committee of the MDS and the American Society of Stereotactic and Functional Neurosurgery. It outlines answers to a series of questions developed to address all aspects of deep brain stimulation preoperative decision-making.
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Affiliation(s)
- Anthony E Lang
- Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada.
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Fogelson N, Kühn AA, Silberstein P, Limousin PD, Hariz M, Trottenberg T, Kupsch A, Brown P. Frequency dependent effects of subthalamic nucleus stimulation in Parkinson's disease. Neurosci Lett 2005; 382:5-9. [PMID: 15911112 DOI: 10.1016/j.neulet.2005.02.050] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 01/21/2005] [Accepted: 02/22/2005] [Indexed: 10/25/2022]
Abstract
Excessive synchronisation of basal ganglia activity at frequencies < 30 Hz is a hallmark of the parkinsonian state, and may contribute to bradykinesia. Accordingly, we electrically stimulated chronically implanted subthalamic macroelectrodes in 10 Parkinson's disease patients, after overnight withdrawal of anti-parkinsonian medication. We compared the effects of stimulation at 0, 5, 10, 15, 20, 25, 30, and ca. 130 Hz by measuring kinesia time (KT) in a tapping task. Although the effects of direct stimulation were small, frequency-response curves demonstrated local peaks at 5-10 Hz and at 20-25 Hz, superimposed upon an overall tendency for KT to reduce with increasing stimulation frequency. This is consistent with the hypothesis that spontaneous activities in these bands might promote bradykinesia.
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Affiliation(s)
- Noa Fogelson
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London WCIN 3BG, UK
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Fawcett AP, Moro E, Lang AE, Lozano AM, Hutchison WD. Pallidal deep brain stimulation influences both reflexive and voluntary saccades in Huntington's disease. Mov Disord 2005; 20:371-7. [PMID: 15580556 DOI: 10.1002/mds.20356] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is being evaluated as a potential new therapy for patients with Huntington's disease (HD). In addition to skeletal movement disorders, HD patients have difficulty initiating voluntary saccades and have difficulty in suppressing rapid saccades toward newly appearing stimuli. We measured several saccade parameters in an HD patient who had marked improvement of clinical symptoms with bilateral GPi DBS to determine whether oculomotor performance improved in parallel with clinical scores. Oculomotor performance was assessed using three testing paradigms: pro-saccades, anti-saccades, and memory-guided saccades. The data from the HD patient was also compared to that of two healthy controls. Pallidal DBS decreased pro-saccade latency, total movement time, and the number of correctly executed trials, as well as increasing saccade gain. Memory-saccade performance was negatively affected with stimulation: saccade gain decreased, latency increased, and the patient's ability to suppress unwanted saccades decreased with stimulation. Our data demonstrate a task-specific improvement of oculomotor deficits in this HD patient with pallidal DBS, supporting a role of GPi in oculomotor control.
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Affiliation(s)
- Adrian P Fawcett
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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