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Coutinho PB, Johnson KA, Seritan AL, Galifianakis NB, Coleman R, Wang D, Racine CA, Ostrem JL, Starr PA, de Hemptinne C. Elevated Mood Induced by Subthalamic Nucleus Deep Brain Stimulation: A Video-Recorded Case Report. Tremor Other Hyperkinet Mov (N Y) 2024; 14:37. [PMID: 39005242 PMCID: PMC11243764 DOI: 10.5334/tohm.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Background Deep brain stimulation (DBS) can be an effective therapy to control motor signs in patients with Parkinson's disease (PD). However, subthalamic nucleus (STN) DBS can induce undesirable psychiatric adverse effects, including elevated mood. Case report We reported a video case of a 73-year-old male implanted with bilateral STN DBS who experienced stimulation-induced elevated mood. A correlation between mood changes and enhanced activation of the ventromedial region in the left STN was observed. Discussion This video case report illustrates STN DBS-induced elevated mood and enhances early symptom recognition for patients and diagnostic awareness for professionals.
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Affiliation(s)
- Patricia B. Coutinho
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kara A. Johnson
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Andreea L. Seritan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas B. Galifianakis
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
| | - Robert Coleman
- Department of Neurology, Corewell Health, Grand Rapids, MI, USA
| | - Doris Wang
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline A. Racine
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jill L. Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
| | - Philip A. Starr
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Siddiqi SH, Klingbeil J, Webler R, Kratter IH, Blumberger DM, Fox MD, George MS, Grafman JH, Pascual-Leone A, Pines AR, Richardson RM, Talati P, Vila-Rodriguez F, Downar J, Hershey T, Black KJ. Causal network localization of brain stimulation targets for trait anxiety. RESEARCH SQUARE 2024:rs.3.rs-4221074. [PMID: 38659844 PMCID: PMC11042390 DOI: 10.21203/rs.3.rs-4221074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) can treat some neuropsychiatric disorders, but there is no consensus approach for identifying new targets. We localized causal circuit-based targets for anxiety that converged across multiple natural experiments. Lesions (n=451) and TMS sites (n=111) that modify anxiety mapped to a common normative brain circuit (r=0.68, p=0.01). In an independent dataset (n=300), individualized TMS site connectivity to this circuit predicted anxiety change (p=0.02). Subthalamic DBS sites overlapping the circuit caused more anxiety (n=74, p=0.006), thus demonstrating a network-level effect, as the circuit was derived without any subthalamic sites. The circuit was specific to trait versus state anxiety in datasets that measured both (p=0.003). Broadly, this illustrates a pathway for discovering novel circuit-based targets across neuropsychiatric disorders.
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Affiliation(s)
- Shan H. Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | | | - Ryan Webler
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Hospital
| | - Jordan H. Grafman
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Andrew R. Pines
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital
- Department of Neurosurgery, Harvard Medical School
| | - Pratik Talati
- Department of Neurosurgery, Massachusetts General Hospital
- Department of Neurosurgery, Harvard Medical School
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry and School of Biomedical Engineering, University of British Columbia
| | | | - Tamara Hershey
- Departments of Psychiatry, Radiology, Neurology and Neuroscience, Washington University School of Medicine
| | - Kevin J. Black
- Departments of Psychiatry, Radiology, Neurology and Neuroscience, Washington University School of Medicine
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Muhammad N, Sonkusare S, Ding Q, Wang L, Mandali A, Zhao YJ, Sun B, Li D, Voon V. Time-locked acute alpha-frequency stimulation of subthalamic nuclei during the evaluation of emotional stimuli and its effect on power modulation. Front Hum Neurosci 2023; 17:1181635. [PMID: 37576474 PMCID: PMC10415014 DOI: 10.3389/fnhum.2023.1181635] [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: 03/07/2023] [Accepted: 05/23/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) studies in Parkinson's Disease (PD) targeting the subthalamic nucleus (STN) have characterized its spectral properties across cognitive processes. In emotional evaluation tasks, specific alpha frequency (8-12 Hz) event-related de-synchronization (ERD) (reduced power) has been demonstrated. The time-locked stimulation of STN relative to stimuli onset has shown subjective positive valence shifts with 10 Hz but not with 130 Hz. However, neurophysiological effects of stimulation on power modulation have not been investigated. We aim to investigate effects of acute stimulation of the right STN on concurrent power modulation in the contralateral STN and frontal scalp EEG. From our previous study, we had a strong a priori hypothesis that negative imagery without stimulation would be associated with alpha ERD; negative imagery with 130 Hz stimulation would be also associated with alpha ERD given the lack of its effect on subjective valence ratings; negative imagery with 10 Hz stimulation was to be associated with enhanced alpha power given the shift in behavioral valence ratings. Methods Twenty-four subjects with STN DBS underwent emotional picture-viewing tasks comprising neutral and negative pictures. In a subset of these subjects, the negative images were associated with time-locked acute stimulation at either 10 or 130 Hz. Power of signals was estimated relative to the baseline and subjected to non-parametric statistical testing. Results As hypothesized, in 130 Hz stimulation condition, we show a decrease in alpha power to negative vs. neutral images irrespective of stimulation. In contrast, this alpha power decrease was no longer evident in the negative 10 Hz stimulation condition consistent with a predicted increase in alpha power. Greater beta power in the 10 Hz stimulation condition along with correlations between beta power across the 10 Hz stimulation and unstimulated conditions suggest physiological and cognitive generalization effects. Conclusion Acute alpha-specific frequency stimulation presumably was associated with a loss of this expected decrease or desynchronization in alpha power to negative images suggesting the capacity to facilitate the synchronization of alpha and enhance power. Acute time-locked stimulation has the potential to provide causal insights into the spectral frequencies and temporal dynamics of emotional processing.
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Affiliation(s)
- Naeem Muhammad
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Saurabh Sonkusare
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Qiong Ding
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Alekhya Mandali
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Yi Jie Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- Department of Neurosurgery, Centre for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
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Chang B, Ni C, Mei J, Xiong C, Chen P, Jiang M, Niu C. Nomogram for Predicting Depression Improvement after Deep Brain Stimulation for Parkinson’s Disease. Brain Sci 2022; 12:brainsci12070841. [PMID: 35884652 PMCID: PMC9313072 DOI: 10.3390/brainsci12070841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Parkinson’s disease is a common neurodegenerative disease, with depression being a common non-motor symptom. Bilateral subthalamic nucleus deep brain stimulation is an effective method for the treatment of Parkinson’s disease. Thus, this study aimed to establish a nomogram of the possibility of achieving a better depression improvement rate after subthalamic nucleus deep brain stimulation in patients with Parkinson’s disease. Methods: We retrospectively analyzed 103 patients with Parkinson’s disease who underwent subthalamic nucleus deep brain stimulation and were followed up for the improvement of their Hamilton Depression scale scores 1 year postoperatively. Univariate and multivariate logistic regression analyses were used to select factors affecting the improvement rate of depression. A nomogram was then developed to predict the possibility of achieving better depression improvement. Furthermore, the discrimination and fitting performance was evaluated using a calibration diagram, receiver operating characteristics, and decision curve analysis. Results: The mean and median improvement rates of Hamilton Depression scores were 13.1 and 33.3%, respectively. Among the 103 patients, 70.8% had an improved depression, 23.3% had a worsened depression, and 5.8% remained unchanged. Logistic multivariate regression analysis showed that age, preoperative Parkinson’s Disease Questionnaire, Hamilton Anxiety, and Hamilton Depression scores were independent factors for the possibility of achieving a better depression improvement rate. Based on these results, a nomogram model was developed. The nomogram had a C-index of 0.78 (95% confidence interval: 0.69–0.87) and an area under the receiver operating characteristics of 0.78 (95% confidence interval: 0.69–0.87). The calibration plot and decision curve analysis further demonstrated goodness-of-fit between the nomogram predictions and actual observations. Conclusion: We developed a nomogram to predict the possibility of achieving good depression improvement 1 year after subthalamic nucleus deep brain stimulation in patients with Parkinson’s disease, which showed a certain value in judging the expected depression improvement of these patients.
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Affiliation(s)
- Bowen Chang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
| | - Chen Ni
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
| | - Jiaming Mei
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
| | - Chi Xiong
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
| | - Peng Chen
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
| | - Manli Jiang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (B.C.); (C.N.); (J.M.); (C.X.); (P.C.); (M.J.)
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China
- Correspondence:
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5
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Tseng YT, Zhao B, Chen S, Ye J, Liu J, Liang L, Ding H, Schaefke B, Yang Q, Wang L, Wang F, Wang L. The subthalamic corticotropin-releasing hormone neurons mediate adaptive REM-sleep responses to threat. Neuron 2022; 110:1223-1239.e8. [PMID: 35065715 DOI: 10.1016/j.neuron.2021.12.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 12/23/2021] [Indexed: 01/25/2023]
Abstract
When an animal faces a threatening situation while asleep, rapid arousal is the essential prerequisite for an adequate response. Here, we find that predator stimuli induce immediate arousal from REM sleep compared with NREM sleep. Using in vivo neural activity recording and cell-type-specific manipulations, we identify neurons in the medial subthalamic nucleus (mSTN) expressing corticotropin-releasing hormone (CRH) that mediate arousal and defensive responses to acute predator threats received through multiple sensory modalities across REM sleep and wakefulness. We observe involvement of the same neurons in the normal regulation of REM sleep and the adaptive increase in REM sleep induced by sustained predator stress. Projections to the lateral globus pallidus (LGP) are the effector pathway for the threat-coping responses and REM-sleep expression. Together, our findings suggest adaptive REM-sleep responses could be protective against threats and uncover a critical component of the neural circuitry at their basis.
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Affiliation(s)
- Yu-Ting Tseng
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Binghao Zhao
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Shanping Chen
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jialin Ye
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jingjing Liu
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lisha Liang
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Hui Ding
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Bernhard Schaefke
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Qin Yang
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Lina Wang
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Feng Wang
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Liping Wang
- CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China.
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6
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Scangos KW, Khambhati AN, Daly PM, Makhoul GS, Sugrue LP, Zamanian H, Liu TX, Rao VR, Sellers KK, Dawes HE, Starr PA, Krystal AD, Chang EF. Closed-loop neuromodulation in an individual with treatment-resistant depression. Nat Med 2021; 27:1696-1700. [PMID: 34608328 PMCID: PMC11219029 DOI: 10.1038/s41591-021-01480-w] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
Deep brain stimulation is a promising treatment for neuropsychiatric conditions such as major depression. It could be optimized by identifying neural biomarkers that trigger therapy selectively when symptom severity is elevated. We developed an approach that first used multi-day intracranial electrophysiology and focal electrical stimulation to identify a personalized symptom-specific biomarker and a treatment location where stimulation improved symptoms. We then implanted a chronic deep brain sensing and stimulation device and implemented a biomarker-driven closed-loop therapy in an individual with depression. Closed-loop therapy resulted in a rapid and sustained improvement in depression. Future work is required to determine if the results and approach of this n-of-1 study generalize to a broader population.
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Affiliation(s)
- Katherine W Scangos
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA.
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Ankit N Khambhati
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick M Daly
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Ghassan S Makhoul
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Leo P Sugrue
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Hashem Zamanian
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Tony X Liu
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Vikram R Rao
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kristin K Sellers
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Heather E Dawes
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Philip A Starr
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew D Krystal
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Weill Institute for Neurosciences, University of California, San Francsico, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
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7
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Lin Z, Zhang C, Li D, Sun B. Lateralized effects of deep brain stimulation in Parkinson's disease: evidence and controversies. NPJ Parkinsons Dis 2021; 7:64. [PMID: 34294724 PMCID: PMC8298477 DOI: 10.1038/s41531-021-00209-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
The bilateral effects of deep brain stimulation (DBS) on motor and non-motor symptoms of Parkinson's disease (PD) have been extensively studied and reviewed. However, the unilateral effects-in particular, the potential lateralized effects of left- versus right-sided DBS-have not been adequately recognized or studied. Here we summarized the current evidence and controversies in the literature regarding the lateralized effects of DBS on motor and non-motor outcomes in PD patients. Publications in English language before February 2021 were obtained from the PubMed database and included if they directly compared the effects of unilateral versus contralateral side DBS on motor or non-motor outcomes in PD. The current literature is overall of low-quality and is biased by various confounders. Researchers have investigated mainly PD patients receiving subthalamic nucleus (STN) DBS while the potential lateralized effects of globus pallidus interna (GPi) DBS have not been adequately studied. Evidence suggests potential lateralized effects of STN DBS on axial motor symptoms and deleterious effects of left-sided DBS on language-related functions, in particular, the verbal fluency, in PD. The lateralized DBS effects on appendicular motor symptoms as well as other neurocognitive and neuropsychiatric domains remain inconclusive. Future studies should control for varying methodological approaches as well as clinical and DBS management heterogeneities, including symptom laterality, stimulation parameters, location of active contacts, and lead trajectories. This would contribute to improved treatment strategies such as personalized target selection, surgical planning, and postoperative management that ultimately benefit patients.
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Affiliation(s)
- Zhengyu Lin
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.511008.dShanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Dianyou Li
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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8
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Scangos KW, Makhoul GS, Sugrue LP, Chang EF, Krystal AD. State-dependent responses to intracranial brain stimulation in a patient with depression. Nat Med 2021; 27:229-231. [PMID: 33462446 DOI: 10.1038/s41591-020-01175-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022]
Abstract
Deep brain stimulation is a promising treatment for severe depression, but lack of efficacy in randomized trials raises questions regarding anatomical targeting. We implanted multi-site intracranial electrodes in a severely depressed patient and systematically assessed the acute response to focal electrical neuromodulation. We found an elaborate repertoire of distinctive emotional responses that were rapid in onset, reproducible, and context and state dependent. Results provide proof of concept for personalized, circuit-specific medicine in psychiatry.
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Affiliation(s)
- Katherine W Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Ghassan S Makhoul
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Leo P Sugrue
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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9
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Greene DJ, Marek S, Gordon EM, Siegel JS, Gratton C, Laumann TO, Gilmore AW, Berg JJ, Nguyen AL, Dierker D, Van AN, Ortega M, Newbold DJ, Hampton JM, Nielsen AN, McDermott KB, Roland JL, Norris SA, Nelson SM, Snyder AZ, Schlaggar BL, Petersen SE, Dosenbach NUF. Integrative and Network-Specific Connectivity of the Basal Ganglia and Thalamus Defined in Individuals. Neuron 2020; 105:742-758.e6. [PMID: 31836321 PMCID: PMC7035165 DOI: 10.1016/j.neuron.2019.11.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/28/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
The basal ganglia, thalamus, and cerebral cortex form an interconnected network implicated in many neurological and psychiatric illnesses. A better understanding of cortico-subcortical circuits in individuals will aid in development of personalized treatments. Using precision functional mapping-individual-specific analysis of highly sampled human participants-we investigated individual-specific functional connectivity between subcortical structures and cortical functional networks. This approach revealed distinct subcortical zones of network specificity and multi-network integration. Integration zones were systematic, with convergence of cingulo-opercular control and somatomotor networks in the ventral intermediate thalamus (motor integration zones), dorsal attention and visual networks in the pulvinar, and default mode and multiple control networks in the caudate nucleus. The motor integration zones were present in every individual and correspond to consistently successful sites of deep brain stimulation (DBS; essential tremor). Individually variable subcortical zones correspond to DBS sites with less consistent treatment effects, highlighting the importance of PFM for neurosurgery, neurology, and psychiatry.
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Affiliation(s)
- Deanna J Greene
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Scott Marek
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Evan M Gordon
- VISN17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA; Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Joshua S Siegel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Caterina Gratton
- Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Neurology, Northwestern University, Evanston, IL, USA
| | - Timothy O Laumann
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Adrian W Gilmore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey J Berg
- Department of Psychology, New York University, New York, NY, USA
| | - Annie L Nguyen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dillan J Newbold
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacqueline M Hampton
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley N Nielsen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Kathleen B McDermott
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Psychological and Brain Sciences, Washington University, St. Louis, MO, USA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven M Nelson
- VISN17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA; Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven E Petersen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Nico U F Dosenbach
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA; Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
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10
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Vicheva P, Butler M, Shotbolt P. Deep brain stimulation for obsessive-compulsive disorder: A systematic review of randomised controlled trials. Neurosci Biobehav Rev 2020; 109:129-138. [PMID: 31923474 DOI: 10.1016/j.neubiorev.2020.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/22/2019] [Accepted: 01/06/2020] [Indexed: 12/26/2022]
Abstract
Deep brain stimulation (DBS) is considered a promising intervention for treatment-resistant obsessive-compulsive disorder (trOCD). We conducted a systematic search to investigate the efficacy and safety of DBS for OCD. Primary outcomes included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), adverse events (AE), and quality of life. We assessed affective state, global functioning, cognition, and tolerability as secondary outcomes. Eight studies comprising 80 patients with trOCD were analysed both individually and collectively. We found a pooled mean reduction in Y-BOCS of 38.68 %, indicating DBS could be considered an effective therapy for trOCD. Most AE were mild and transient, however there were five severe surgery-related AE: intracerebral haemorrhage in three patients and infection in two. Mood-related serious AE were one completed suicide, three suicide attempts in two patients, and suicidal thoughts and depression in four. Despite this, affective state improved following stimulation. Despite being limited by significant heterogeneity across studies, our review has shown DBS to be an effective treatment in otherwise trOCD. There is a need to standardise study methodology in future research.
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Affiliation(s)
- Petya Vicheva
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Matthew Butler
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Shotbolt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
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11
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Floden DP, Matias CM, Wathen CA, Ozinga GE, Hogue O, Machado AG. Contact Location and Neuropsychological Outcomes in Subthalamic Deep Brain Stimulation. Neurosurgery 2019; 83:666-674. [PMID: 29048606 DOI: 10.1093/neuros/nyx475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/18/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A host of influences contribute to cognitive and behavioral changes following deep brain stimulation. The location of the active cathode is likely an important variable but it has received little attention. OBJECTIVE To determine whether active contact location relative to the subthalamic nucleus and other neighboring structures is related to nonmotor outcomes. METHODS We identified a retrospective, cross-sectional sample of 46 patients who underwent subthalamic nucleus deep brain stimulation for treatment of idiopathic Parkinson's disease. T-tests or nonparametric equivalents were used to detect baseline differences between unilateral left, unilateral right, and bilateral surgical groups. Correlation and partial correlational analyses identified relationships between contact location variables and alterations in cognitive, mood, quality of life, motor, and disease variables. RESULTS Medial contact locations within the left subthalamic nucleus were correlated with improvements in self-reported mood (r12 = -0.78, P = .001; 95% confidence interval [CI] = -0.43 to -0.93) but worsening semantic fluency (r26 = -0.38, P = .048; 95% CI = -0.01 to -0.66). Phonemic fluency worsened with more posterior left placement (r34 = 0.35, P = .036; 95% CI = 0.03 to 0.61). Memory outcome was related to right hemisphere stimulation voltage (r29 = -0.40, P = .022; 95% CI = -0.05 to -0.66), which is likely a proxy for variable electrode location. CONCLUSION Location of the active contact is related to nonmotor outcomes, even in electrodes that are adequately placed. This is relevant to clinical care as there appears to be a trade-off between mood and fluency abilities that should be considered during surgical planning according to preoperative patient characteristics.
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Affiliation(s)
- Darlene P Floden
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Caio M Matias
- Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Connor A Wathen
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Grace E Ozinga
- Psychology Department, Cleveland State University, Cleveland, Ohio
| | - Olivia Hogue
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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12
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Kinoshita M, Nakataki M, Morigaki R, Sumitani S, Goto S, Kaji R, Ohmori T. Turning on the Left Side Electrode Changed Depressive State to Manic State in a Parkinson's Disease Patient Who Received Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:494-496. [PMID: 30466222 PMCID: PMC6245302 DOI: 10.9758/cpn.2018.16.4.494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/24/2017] [Accepted: 03/20/2017] [Indexed: 11/26/2022]
Abstract
No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of Parkinson’s disease. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.
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Affiliation(s)
- Makoto Kinoshita
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Neurodegenerative Disorders Research, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan
| | - Satsuki Sumitani
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Department of Support for Students with Special Needs, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Satoshi Goto
- Department of Neurodegenerative Disorders Research, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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13
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Milchenko M, Snyder AZ, Campbell MC, Dowling JL, Rich KM, Brier LM, Perlmutter JS, Norris SA. ESM-CT: a precise method for localization of DBS electrodes in CT images. J Neurosci Methods 2018; 308:366-376. [PMID: 30201271 PMCID: PMC6205293 DOI: 10.1016/j.jneumeth.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus produces variable effects in Parkinson disease. Variation may result from different electrode positions relative to target. Thus, precise electrode localization is crucial when investigating DBS effects. NEW METHOD We developed a semi-automated method, Electrode Shaft Modeling in CT images (ESM-CT) to reconstruct DBS lead trajectories and contact locations. We evaluated methodological sensitivity to operator-dependent steps, robustness to image resampling, and test-retest replicability. ESM-CT was applied in 56 patients to study electrode position change (and relation to time between scans, postoperative subdural air volume, and head tilt during acquisition) between images acquired immediately post-implantation (DBS-CT) and months later (DEL-CT). RESULTS Electrode tip localization was robust to image resampling and replicable to within ∼ 0.2 mm on test-retest comparisons. Systematic electrode displacement occurred rostral-ventral-lateral between DBS-CT and DEL-CT scans. Head angle was a major explanatory factor (p < 0.001,Pearson's r = 0.46, both sides) and volume of subdural air weakly predicted electrode displacement (p = 0.02,r = 0.29:p = 0.1,r = 0.25 for left:right). Modeled shaft curvature was slightly greater in DEL-CT. Magnitude of displacement and degree of curvature were independent of elapsed time between scans. COMPARISON WITH EXISTING METHODS Comparison of ESM-CT against two existing methods revealed systematic differences in one coordinate (1 ± 0.3 mm,p < 0.001) for one method and in three coordinates for another method (x:0.1 ± 0.1 mm, y:0.4 ± 0.2 mm, z:0.4 ± 0.2 mm, p < 10-10). Within-method coordinate variability across participants is similar. CONCLUSION We describe a robust and precise method for CT DBS contact localization. Application revealed that acquisition head angle significantly impacts electrode position. DBS localization schemes should account for head angle.
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Affiliation(s)
- Mikhail Milchenko
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Meghan C Campbell
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joshua L Dowling
- Department of Neurosurgical Surgery, Washington University School of Medicine, (CB 8057), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Keith M Rich
- Department of Neurosurgical Surgery, Washington University School of Medicine, (CB 8057), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Lindsey M Brier
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joel S Perlmutter
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurosurgical Surgery, Washington University School of Medicine, (CB 8057), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neuroscience, Washington University School of Medicine, (CB 8108), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Occupational Therapy, CB 8505, 4444 Forest Park Ave, St. Louis, MO 63108, USA; Department of Physical Therapy, CB 8502, 4444 Forest Park Ave, St. Louis, MO, 63108, USA
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
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14
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Gourisankar A, Eisenstein SA, Trapp NT, Koller JM, Campbell MC, Ushe M, Perlmutter JS, Hershey T, Black KJ. Mapping movement, mood, motivation and mentation in the subthalamic nucleus. ROYAL SOCIETY OPEN SCIENCE 2018; 5:171177. [PMID: 30109035 PMCID: PMC6083651 DOI: 10.1098/rsos.171177] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/14/2018] [Indexed: 05/26/2023]
Abstract
The anatomical connections of the subthalamic nucleus (STN) have driven hypotheses about its functional anatomy, including the hypothesis that the precise anatomical location of STN deep brain stimulation (DBS) contributes to the variability of motor and non-motor responses across patients with Parkinson's disease (PD). We previously tested the hypothesis using a three-dimensional (3D) statistical method to interpret the acute effects of unilateral DBS at each patient's clinically optimized DBS settings and active contact. Here, we report a similar analysis from a new study in which DBS parameters were standardized and DBS locations were chosen blind to clinical response. In 74 individuals with PD and STN DBS, STN contacts were selected near the dorsal and ventral borders of the STN contralateral to the more affected side of the body. Participants were tested off PD medications in each of three unilateral DBS conditions (ventral STN DBS, dorsal STN DBS and DBS off) for acute effects on mood, apathy, working memory, response inhibition and motor function. Voltage, frequency and pulse width were standardized, and participants and raters were blind to condition. In a categorical analysis, both dorsal and ventral STN DBS improved mean motor function without affecting cognitive measures. Ventral STN DBS induced greater improvement in rigidity and anxiety than dorsal STN DBS. In the 3D analysis, contact location was significant for body hypokinesia, rigidity and resting tremor, with the greatest improvement occurring with DBS in dorsal STN and zona incerta. The 3D results provide new, direct functional evidence for the anatomically derived model of STN, in which motor function is best represented in dorsal STN. However, our data suggest that functional segregation between motor and non-motor areas of the STN is limited, because locations that induced improvements in motor function and mood overlapped substantially.
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Affiliation(s)
- Amritha Gourisankar
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sarah A. Eisenstein
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nicholas T. Trapp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Meghan C. Campbell
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mwiza Ushe
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joel S. Perlmutter
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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15
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Dandekar MP, Fenoy AJ, Carvalho AF, Soares JC, Quevedo J. Deep brain stimulation for treatment-resistant depression: an integrative review of preclinical and clinical findings and translational implications. Mol Psychiatry 2018; 23:1094-1112. [PMID: 29483673 DOI: 10.1038/mp.2018.2] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
Although deep brain stimulation (DBS) is an established treatment choice for Parkinson's disease (PD), essential tremor and movement disorders, its effectiveness for the management of treatment-resistant depression (TRD) remains unclear. Herein, we conducted an integrative review on major neuroanatomical targets of DBS pursued for the treatment of intractable TRD. The aim of this review article is to provide a critical discussion of possible underlying mechanisms for DBS-generated antidepressant effects identified in preclinical studies and clinical trials, and to determine which brain target(s) elicited the most promising outcomes considering acute and maintenance treatment of TRD. Major electronic databases were searched to identify preclinical and clinical studies that have investigated the effects of DBS on depression-related outcomes. Overall, 92 references met inclusion criteria, and have evaluated six unique DBS targets namely the subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), ventral capsule/ventral striatum or anterior limb of internal capsule (ALIC), medial forebrain bundle (MFB), lateral habenula (LHb) and inferior thalamic peduncle for the treatment of unrelenting TRD. Electrical stimulation of these pertinent brain regions displayed differential effects on mood transition in patients with TRD. In addition, 47 unique references provided preclinical evidence for putative neurobiological mechanisms underlying antidepressant effects of DBS applied to the ventromedial prefrontal cortex, NAc, MFB, LHb and subthalamic nucleus. Preclinical studies suggest that stimulation parameters and neuroanatomical locations could influence DBS-related antidepressant effects, and also pointed that modulatory effects on monoamine neurotransmitters in target regions or interconnected brain networks following DBS could have a role in the antidepressant effects of DBS. Among several neuromodulatory targets that have been investigated, DBS in the neuroanatomical framework of the SCG, ALIC and MFB yielded more consistent antidepressant response rates in samples with TRD. Nevertheless, more well-designed randomized double-blind, controlled trials are warranted to further assess the efficacy, safety and tolerability of these more promising DBS targets for the management of TRD as therapeutic effects have been inconsistent across some controlled studies.
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Affiliation(s)
- M P Dandekar
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - J C Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, Brazil
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16
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Speirs C, Belchev Z, Fernandez A, Korol S, Sears C. Are there age differences in attention to emotional images following a sad mood induction? Evidence from a free-viewing eye-tracking paradigm. AGING NEUROPSYCHOLOGY AND COGNITION 2017; 25:928-957. [PMID: 29083260 DOI: 10.1080/13825585.2017.1391168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Two experiments examined age differences in the effect of a sad mood induction (MI) on attention to emotional images. Younger and older adults viewed sets of four images while their eye gaze was tracked throughout an 8-s presentation. Images were viewed before and after a sad MI to assess the effect of a sad mood on attention to positive and negative scenes. Younger and older adults exhibited positively biased attention after the sad MI, significantly increasing their attention to positive images, with no evidence of an age difference in either experiment. A test of participants' recognition memory for the images indicated that the sad MI reduced memory accuracy for sad images for younger and older adults. The results suggest that heightened attention to positive images following a sad MI reflects an affect regulation strategy related to mood repair. The implications for theories of the positivity effect are discussed.
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Affiliation(s)
| | - Zorry Belchev
- a Department of Psychology , University of Calgary , Canada
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17
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Obeso I, Casabona E, Rodríguez-Rojas R, Bringas ML, Macías R, Pavón N, Obeso JA, Jahanshahi M. Unilateral subthalamotomy in Parkinson's disease: Cognitive, psychiatric and neuroimaging changes. Cortex 2017; 94:39-48. [DOI: 10.1016/j.cortex.2017.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/18/2017] [Accepted: 06/08/2017] [Indexed: 12/28/2022]
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18
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Nummenmaa L, Saarimäki H. Emotions as discrete patterns of systemic activity. Neurosci Lett 2017; 693:3-8. [PMID: 28705730 DOI: 10.1016/j.neulet.2017.07.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 12/24/2022]
Abstract
Emotions organize human and animal behaviour by automatically adjusting their actions at multiple physiological and behavioural scales. Recently, pattern recognition techniques have emerged as an important tool for quantifying the neural, physiological, and phenomenological organization of emotions in humans. Here we review recent advances in our understanding of the human emotion system from the viewpoint of pattern recognition studies, focussing on neuroimaging experiments. These studies suggest, in general, clear and consistent categorical structure of emotions across multiple levels of analysis spanning expressive behaviour, subjective experiences, physiological activity, and neural activation patterns. In particular, the neurophysiological data support the view of multiple discrete emotion systems that are organized in a distributed fashion across the brain, with no clear one-to-one mapping between emotions and brain regions. However, these techniques are inherently limited by the choice of a priori emotion categories used in the studies, and cannot provide direct causal evidence for brain activity-emotion relationships.
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Affiliation(s)
- Lauri Nummenmaa
- Turku PET Centre and Department of Psychology, University of Turku, Finland.
| | - Heini Saarimäki
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Finland
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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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Faggiani E, Benazzouz A. Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: From history to the interaction with the monoaminergic systems. Prog Neurobiol 2017; 151:139-156. [DOI: 10.1016/j.pneurobio.2016.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022]
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Merkl A, Röck E, Schmitz-Hübsch T, Schneider GH, Kühn AA. Effects of subthalamic nucleus deep brain stimulation on emotional working memory capacity and mood in patients with Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:1603-1611. [PMID: 28684915 PMCID: PMC5485890 DOI: 10.2147/ndt.s126397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In Parkinson's disease (PD), cognitive symptoms and mood changes may be even more distressing for the patient than motor symptoms. OBJECTIVE Our aim was to determine the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on working memory (WM) and mood. METHODS Sixteen patients with PD were assessed with STN-DBS switched on (DBS-ON) and with dopaminergic treatment (Med-ON) compared to switched off (DBS-OFF) and without dopaminergic treatment (Med-OFF). The primary outcome measures were a Visual Analog Mood Scale (VAMS) and an emotional 2-back WM task at 12 months after DBS in the optimal DBS-ON/Med-ON setting compared to DBS-OFF/Med-OFF. RESULTS Comparison of DBS-OFF/Med-OFF to DBS-ON/Med-ON revealed a significant increase in alertness (meanoff/off =51.59±24.54; meanon/on =72.75; P=0.016) and contentedness (meanoff/off =38.73±24.41; meanon/on =79.01±17.66; P=0.001, n=16), and a trend for reduction in sedation (P=0.060), which was related to stimulation as shown in a subgroup of seven patients. The N-back task revealed a significant increase in accuracy with DBS-ON/Med-ON compared to DBS-OFF/Med-OFF (82.0% vs 76.0%, respectively) (P=0.044), regardless of stimulus valence. CONCLUSION In line with previous studies, we found that patients rated themselves subjectively as more alert, content, and less sedated during short-term DBS-ON. Accuracy in the WM task increased with the combination of DBS and medication, possibly related to higher alertness of the patients. Our results add to the currently mixed results described for DBS on WM and suggest that there are no deleterious DBS effects on this specific cognitive domain.
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Affiliation(s)
- Angela Merkl
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Benjamin Franklin
| | - Eva Röck
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum
| | - Tanja Schmitz-Hübsch
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,NeuroCure, Charité - University Medicine Berlin
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Campus Virchow Klinikum
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,NeuroCure, Charité - University Medicine Berlin.,Berlin School of Mind and Brain, Charité - University Medicine Berlin, Berlin, Germany
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Lemaire JJ, Pereira B, Derost P, Vassal F, Ulla M, Morand D, Coll G, Gabrillargues J, Marques A, Debilly B, Coste J, Durif F. Subthalamus stimulation in Parkinson disease: Accounting for the bilaterality of contacts. Surg Neurol Int 2016; 7:S837-S847. [PMID: 27990316 PMCID: PMC5134117 DOI: 10.4103/2152-7806.194066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/27/2016] [Indexed: 01/24/2023] Open
Abstract
Background: Deep brain stimulation (DBS) in Parkinson's disease uses bi-hemispheric high-frequency stimulation within the subthalamus, however, the specific impacts of bilaterality of DBS are still not clear. Thus, we aimed to study the individual-level clinical impact of locations of right-left contact pair-up accounting for each subthalamic nucleus (STN) anatomy. Methods: Contact locations and effects at 1 year were studied retrospectively in an unselected series of 53 patients operated between 2004 and 2010. Location of contacts was defined relatively to the main axis of STN used to map longitudinal and transversal positions, and STN membership (out meaning out-of-STN). Contact pairings were described via three methods: (i) Unified contact location (UCL) collapsing DBS into an all-in-one contact; (ii) balance of contact pair-up (BCPU), defined as symmetric or asymmetric regardless of laterality; (iii) hemisphere-wise most frequent contact pair-up (MFCP) regardless of BCPU. Clinical data were: mean levodopa equivalent dose, Unified Parkinson's Disease Rating Scale (UPDRS) motor score III without medication, UPDRS II and III speech sub-scores, UPDRS II freezing sub-score, 1 year versus preoperative values, with and without levodopa. Ad-hoc two-sided tests were used for statistical analysis. Results: Worsening speech, was more frequent for UCL_out patients and when the left MFCP contact was rear and/or superolateral, however, it less frequent for BCPU-asymmetric patients. Worsening freezing was more frequent when the right MFCP contact was rear and superolateral. Conclusions: These results point to strategies for minimizing dysarthria and freezing as adverse effects of DBS.
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Affiliation(s)
- Jean-Jacques Lemaire
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Bruno Pereira
- Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France; Biostatistics, Clinical Research Direction, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Derost
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - François Vassal
- Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Miguel Ulla
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Dominique Morand
- Biostatistics, Clinical Research Direction, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Coll
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Jean Gabrillargues
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Service of Radiology, Neuroradiology Unit, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Ana Marques
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme Coste
- Service of Neurosurgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Image-Guided Clinical Neuroscience and Connectomics, Research Team, Auvergne University, Auvergne, France
| | - Franck Durif
- Service of Neurology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Abstract
OBJECTIVE Apathy has been reported as a possible adverse effect of deep brain stimulation of the subthalamic nucleus (STN-DBS). We investigated the prevalence and severity of apathy in 22 patients with Parkinson's disease (PD) who underwent STN-DBS, as well as the effects of apathy on quality of life (QOL). METHODS All patients were assessed with the Lille Apathy Rating Scale (LARS), the Apathy Scale (AS), and the Parkinson's Disease Questionnaire and were compared to a control group of 38 patients on pharmacotherapy alone. RESULTS There were no significant differences in the prevalence or severity of apathy between patients who had undergone STN-DBS and those on pharmacotherapy alone. Significant correlations were observed between poorer QOL and degree of apathy, as measured by the LARS (p<0.001) and the AS (p=0.021). PD-related disability also correlated with both apathy ratings (p<0.001 and p=0.017, respectively). CONCLUSION Our findings suggest that STN-DBS is not necessarily associated with apathy in the PD population; however, more severe apathy appears to be associated with a higher level of disability due to PD and worse QOL, but no other clinico-demographic characteristics.
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Allert N, Gippert SM, Sajonz BEA, Nelles C, Bewernick B, Schlaepfer TE, Coenen VA. Arachnophobia alleviated by subthalamic nucleus stimulation for Parkinson's disease. J Neural Transm (Vienna) 2016; 123:631-5. [PMID: 27198699 DOI: 10.1007/s00702-016-1546-1] [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: 02/27/2016] [Accepted: 04/01/2016] [Indexed: 11/30/2022]
Abstract
We report on a Parkinson patient with motor fluctuations and dyskinesias in whom deep brain stimulation (DBS) of the subthalamic nucleus (STN) not only improved motor symptoms but also pre-existing arachnophobia. Arachnophobia had been unchanged by the course of Parkinson's disease but rapidly improved with STN-DBS. Both, motor effects and the improvement of arachnophobia were stable during 2 years follow-up. To our knowledge this is the first report on STN stimulation effects on a specific phobia.
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Affiliation(s)
- Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, 53177, Bonn, Germany.
| | - Sabrina M Gippert
- Department of Psychiatry and Psychotherapy, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Bastian E A Sajonz
- Stereotaxy and MR-based OR Techniques/Department of Neurosurgery, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.,Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, 79106, Freiburg im Breisgau, Germany
| | - Christoph Nelles
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, 53177, Bonn, Germany
| | - Bettina Bewernick
- Department of Psychiatry and Psychotherapy, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Thomas E Schlaepfer
- Department of Psychiatry and Psychotherapy, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Volker A Coenen
- Stereotaxy and MR-based OR Techniques/Department of Neurosurgery, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.,Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, 79106, Freiburg im Breisgau, Germany
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Martinez-Fernandez R, Pelissier P, Quesada JL, Klinger H, Lhommée E, Schmitt E, Fraix V, Chabardes S, Mertens P, Castrioto A, Kistner A, Broussolle E, Pollak P, Thobois S, Krack P. Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:311-8. [PMID: 25934016 DOI: 10.1136/jnnp-2014-310189] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/17/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL. METHODS A cohort of 88 patients who underwent STN-DBS was divided into two groups, those who were apathetic at 1 year and those who were not, as measured by the Starkstein scale. HRQoL was assessed using the Parkinson's disease questionnaire 39 (PDQ-39) and was compared between the two groups. We also compared activities of daily living, motor improvement and motor complications (Unified Parkinson's Disease Rating Scale, UPDRS), depression and anxiety, as well as cognition and drug dosages. Baseline characteristics and postoperative complications were recorded. RESULTS One year after surgery, 27.1% of patients suffered from apathy. While motor improvement was significant and equivalent in both the apathy (-40.4% of UPDRS motor score) and non-apathy groups (-48.6%), the PDQ-39 score did not improve in the apathy group (-5.5%; p=0.464), whereas it improved significantly (-36.7%; p≤0.001) in the non-apathy group. Change in apathy scores correlated significantly with change in HRQoL scores (r=0.278, p=0.009). Depression and anxiety scores remained unchanged from baseline in the apathy group (p=0.409, p=0.075), while they improved significantly in patients without apathy (p=0.006, p≤0.001). A significant correlation was found between changes in apathy and depression (r=0.594, p≤0.001). CONCLUSIONS The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.
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Affiliation(s)
- Raul Martinez-Fernandez
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France CINAC-HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
| | - Pierre Pelissier
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Jean-Louis Quesada
- Centre d'Investigation Clinique, CHU de Grenoble, Univesité Joseph Fourier, Grenoble, France Direction de la recherche clinique, Département scientifique, CHU Grenoble, Grenoble, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Valerie Fraix
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Stephan Chabardes
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France Deparment of Neurosurgery, CHU de Grenoble, Grenoble, France
| | - Patrick Mertens
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Pierre Pollak
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
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Shenai MB, Romeo A, Walker HC, Guthrie S, Watts RL, Guthrie BL. Spatial topographies of unilateral subthalamic nucleus deep brain stimulation efficacy for ipsilateral, contralateral, midline, and total Parkinson disease motor symptoms. Neurosurgery 2015; 11 Suppl 2:80-8; discussion 88. [PMID: 25599197 DOI: 10.1227/neu.0000000000000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation is a successful intervention for medically refractory Parkinson disease, although its efficacy depends on optimal electrode placement. Even though the predominant effect is observed contralaterally, modest improvements in ipsilateral and midline symptoms are also observed. OBJECTIVE To elucidate the role of contact location of unilateral deep brain stimulation on contralateral, ipsilateral, and axial subscores of Parkinson disease motor symptoms. METHODS Eighty-six patients receiving first deep brain stimulation STN electrode placements were identified, yielding 73 patients with 3-month follow-up. Total preoperative and postoperative Unified Parkinson Disease Rating Scale Part III scores were obtained and divided into contralateral, ipsilateral, and midline subscores. Contact location was determined on immediate postoperative magnetic resonance imaging. A 3-dimensional ordinary "kriging" algorithm generated spatial interpolations for total, ipsilateral, contralateral, and midline symptom categories. Interpolative reconstructions were performed in the axial planes (z = -0.5, -1.0, -1.5, -3.5, -4.5, -6.0) and a sagittal plane (x = 12.0). Interpolation error and significance were quantified by use of a cross-validation technique and quantile-quantile analysis. RESULTS There was an overall reduction in Unified Parkinson Disease Rating Scale Part III symptoms: total = 37.0 ± 24.11% (P < .05), ipsilateral = 15.9 ± 51.8%, contralateral = 56.2 ± 26.8% (P < .05), and midline = 26.5 ± 34.7%. Kriging interpolation was performed and cross-validated with quantile-quantile analysis with high correlation (R2 > 0.92) and demonstrated regions of efficacy for each symptom category. Contralateral symptoms demonstrated broad regions of efficacy across the peri-STN area. The ipsilateral and midline regions of efficacy were constrained and located along the dorsal STN and caudal zona incerta. CONCLUSION We provide evidence for a unique functional topographic window in which contralateral, ipsilateral, and midline structures may achieve the best efficacy. Although there are overlapping regions, laterality demonstrates distinct topographies. Surgical optimization should target the intersection of optimal regions for these symptom categories.
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Affiliation(s)
- Mahesh B Shenai
- *Department of Neuroscience, Inova Health System, Falls Church, Virginia, ‡Department of Neurosurgery, and §Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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Faggiani E, Delaville C, Benazzouz A. The combined depletion of monoamines alters the effectiveness of subthalamic deep brain stimulation. Neurobiol Dis 2015. [PMID: 26206409 DOI: 10.1016/j.nbd.2015.07.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Non-motor symptoms of Parkinson's disease are under-studied and therefore not well treated. Here, we investigated the role of combined depletions of dopamine, norepinephrine and/or serotonin in the manifestation of motor and non-motor deficits in the rat. Then, we studied the impact of these depletions on the efficacy of deep brain stimulation of the subthalamic nucleus (STN-DBS). We performed selective depletions of dopamine, norepinephrine and serotonin, and the behavioral effects of different combined depletions were investigated using the open field, the elevated plus maze and the forced swim test. Bilateral dopamine depletion alone induced locomotor deficits associated with anxiety and mild "depressive-like" behaviors. Although additional depletions of norepinephrine and/or serotonin did not potentiate locomotor and anxiety disorders, combined depletions of the three monoamines dramatically exacerbated "depressive-like" behavior. STN-DBS markedly reversed locomotor deficits and anxiety behavior in animals with bilateral dopamine depletion alone. However, these improvements were reduced or lost by the additional depletion of norepinephrine and/or serotonin, indicating that the depletion of these monoamines may interfere with the antiparkinsonian efficacy of STN-DBS. Furthermore, our results showed that acute STN-DBS improved "depressive-like" disorder in animals with bilateral depletion of dopamine and also in animals with combined depletions of the three monoamines, which induced severe immobility in the forced swim test. Our data highlight the key role of monoamine depletions in the pathophysiology of anxiety and depressive-like disorders and provide the first evidence of their negative consequences on the efficacy of STN-DBS upon the motor and anxiety disorders in the context of Parkinson's disease.
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Affiliation(s)
- Emilie Faggiani
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33076 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33076 Bordeaux, France
| | - Claire Delaville
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33076 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33076 Bordeaux, France
| | - Abdelhamid Benazzouz
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33076 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33076 Bordeaux, France.
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Gökbayrak NS, Piryatinsky I, Gavett RA, Ahmed OJ. Mixed effects of deep brain stimulation on depressive symptomatology in Parkinson's disease: a review of randomized clinical trials. Front Neurol 2014; 5:154. [PMID: 25157240 PMCID: PMC4127672 DOI: 10.3389/fneur.2014.00154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/28/2014] [Indexed: 11/21/2022] Open
Abstract
Although ~50% of patients with Parkinson’s disease (PD) experience depression, treatment for this important and debilitating comorbidity is relatively understudied. Deep brain stimulation (DBS) has been increasingly utilized for the management of tremors in progressive PD. Several preliminary studies have shown the potential benefit of DBS for non-motor PD symptoms such as depression. Here, we critically evaluate seven recent randomized clinical trials of the effectiveness of DBS in reducing depressive symptomatology among individuals with PD. Findings are mixed for the effectiveness of DBS as a treatment for depression in PD. Our review suggests that this is due, in large part, to the anatomical and methodological variation across the DBS studies. We provide a comprehensive discussion of these variations and highlight the need to conduct larger, more controlled studies aimed specifically at evaluating the treatment of depression in PD patients.
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Affiliation(s)
- N Simay Gökbayrak
- Department of Psychology, University of Rhode Island , Kingston, RI , USA
| | - Irene Piryatinsky
- Memory and Aging Program, Butler Hospital, The Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Rebecca A Gavett
- Memory and Aging Program, Butler Hospital, The Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Omar J Ahmed
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Eisenstein SA, Koller JM, Black KD, Campbell MC, Lugar HM, Ushe M, Tabbal SD, Karimi M, Hershey T, Perlmutter JS, Black KJ. Functional anatomy of subthalamic nucleus stimulation in Parkinson disease. Ann Neurol 2014; 76:279-95. [PMID: 24953991 PMCID: PMC4172323 DOI: 10.1002/ana.24204] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We developed a novel method to map behavioral effects of deep brain stimulation (DBS) across a 3-dimensional brain region and to assign statistical significance after stringent type I error correction. This method was applied to behavioral changes in Parkinson disease (PD) induced by subthalamic nucleus (STN) DBS to determine whether these responses depended on anatomical location of DBS. METHODS Fifty-one PD participants with STN DBS were evaluated off medication, with DBS off and during unilateral STN DBS with clinically optimized settings. Dependent variables included DBS-induced changes in Unified Parkinson Disease Rating Scale (UPDRS) subscores, kinematic measures of bradykinesia and rigidity, working memory, response inhibition, mood, anxiety, and akathisia. Weighted t tests at each voxel produced p images showing where DBS most significantly affected each dependent variable based on outcomes of participants with nearby DBS. Finally, a permutation test computed the probability that this p image indicated significantly different responses based on stimulation site. RESULTS Most motor variables improved with DBS anywhere in the STN region, but several motor, cognitive, and affective responses significantly depended on precise location stimulated, with peak p values in superior STN/zona incerta (quantified bradykinesia), dorsal STN (mood, anxiety), and inferior STN/substantia nigra (UPDRS tremor, working memory). INTERPRETATION Our method identified DBS-induced behavioral changes that depended significantly on DBS site. These results do not support complete functional segregation within STN, because movement improved with DBS throughout, and mood improved with dorsal STN DBS. Rather, findings support functional convergence of motor, cognitive, and limbic information in STN.
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Affiliation(s)
- Sarah A Eisenstein
- Department of Psychiatry, Washington University in St Louis, St Louis, MO
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Dorsal subthalamic nucleus electrical stimulation for drug/treatment-refractory epilepsy may modulate melanocortinergic signaling in astrocytes. Epilepsy Behav 2014; 36:6-8. [PMID: 24835897 DOI: 10.1016/j.yebeh.2014.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/17/2014] [Indexed: 12/17/2022]
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Acute changes in mood induced by subthalamic deep brain stimulation in Parkinson disease are modulated by psychiatric diagnosis. Brain Stimul 2014; 7:701-8. [PMID: 25017671 DOI: 10.1016/j.brs.2014.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/30/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus (STN DBS) reduces Parkinson disease (PD) motor symptoms but has unexplained, variable effects on mood. OBJECTIVE The study tested the hypothesis that pre-existing mood and/or anxiety disorders or increased symptom severity negatively affects mood response to STN DBS. METHODS Thirty-eight PD participants with bilateral STN DBS and on PD medications were interviewed with Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) and completed Beck Depression Inventory (BDI) and Spielberger State Anxiety Inventory (SSAI) self-reports. Subsequently, during OFF and optimal ON (clinical settings) STN DBS conditions and while off PD medications, motor function was assessed with the United Parkinson Disease Rating Scale (UPDRS, part III), and participants rated their mood with Visual Analogue Scales (VAS), and again completed SSAI. VAS mood variables included anxiety, apathy, valence and emotional arousal. RESULTS STN DBS improved UPDRS scores and mood. Unexpectedly, PD participants diagnosed with current anxiety or mood disorders experienced greater STN DBS-induced improvement in mood than those diagnosed with remitted disorders or who were deemed as having never met threshold criteria for diagnosis. BDI and SSAI scores did not modulate mood response to STN DBS, indicating that clinical categorical diagnosis better differentiates mood response to STN DBS than self-rated symptom severity. SCID diagnosis, BDI and SSAI scores did not modulate motor response to STN DBS. CONCLUSIONS PD participants diagnosed with current mood or anxiety disorders are more sensitive to STN DBS-induced effects on mood, possibly indicating altered basal ganglia circuitry in this group.
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Feng L, Liu TT, Ye DW, Qiu Q, Xiang HB, Cheung CW. Stimulation of the dorsal portion of subthalamic nucleus may be a viable therapeutic approach in pharmacoresistant epilepsy: a virally mediated transsynaptic tracing study in transgenic mouse model. Epilepsy Behav 2014; 31:114-6. [PMID: 24394606 DOI: 10.1016/j.yebeh.2013.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 11/27/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Li Feng
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Tao-Tao Liu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Da-Wei Ye
- Cancer Center, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Qiu Qiu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China; Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hong-Bing Xiang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China.
| | - Chi-Wai Cheung
- Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Williams NR, Okun MS. Deep brain stimulation (DBS) at the interface of neurology and psychiatry. J Clin Invest 2013; 123:4546-56. [PMID: 24177464 DOI: 10.1172/jci68341] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) is an emerging interventional therapy for well-screened patients with specific treatment-resistant neuropsychiatric diseases. Some neuropsychiatric conditions, such as Parkinson disease, have available and reasonable guideline and efficacy data, while other conditions, such as major depressive disorder and Tourette syndrome, have more limited, but promising results. This review summarizes both the efficacy and the neuroanatomical targets for DBS in four common neuropsychiatric conditions: Parkinson disease, Tourette syndrome, major depressive disorder, and obsessive-compulsive disorder. Based on emerging new research, we summarize novel approaches to optimization of stimulation for each neuropsychiatric disease and we review the potential positive and negative effects that may be observed following DBS. Finally, we summarize the likely future innovations in the field of electrical neural-network modulation.
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Widge AS, Agarwal P, Giroux M, Farris S, Kimmel RJ, Hebb AO. Psychosis from subthalamic nucleus deep brain stimulator lesion effect. Surg Neurol Int 2013; 4:7. [PMID: 23493632 PMCID: PMC3589868 DOI: 10.4103/2152-7806.106265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/03/2012] [Indexed: 11/08/2022] Open
Abstract
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in particular is highly effective in relieving symptoms of Parkinson's disease (PD). However, it can also have marked psychiatric side effects, including delirium, mania, and psychosis. The etiologies of those effects are not well-understood, and both surgeons and consulting psychiatrists are in need of treatment strategies. Case Description: Two patients with young onset of PD and without significant prior psychiatric problems presented for bilateral STN DBS when medications became ineffective. Both had uneventful operative courses but developed florid psychosis 1-2 weeks later, before stimulator activation. Neither showed signs of delirium, but both required hospitalization, and one required treatment with a first-generation antipsychotic drug. Use of that drug did not worsen PD symptoms, contrary to usual expectations. Conclusion: These cases describe a previously unreported post-DBS syndrome in which local tissue reaction to lead implantation produces psychosis even without electrical stimulation of subcortical circuits. The lesion effect also appears to have anti-Parkinsonian effects that may allow the safe use of otherwise contraindicated medications. These cases have implications for management of PD DBS patients postoperatively, and may also be relevant as DBS is further used in other brain regions to treat behavioral disorders.
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Affiliation(s)
- Alik S Widge
- Department of Psychiatry, University of Washington, Seattle, USA
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Michael Schüpbach W. Impulsivity, impulse control disorders, and subthalamic stimulation in Parkinson’s disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.baga.2012.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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