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Garg V, Lavu VS, Hey G, Winter B, Firme MS, Hilliard JD, De Hemptinne C, Okun MS, Wong JK. Beyond Pallidal or Subthalamic Deep Brain Stimulation to Treat Dystonia. Tremor Other Hyperkinet Mov (N Y) 2024; 14:45. [PMID: 39308988 PMCID: PMC11414463 DOI: 10.5334/tohm.935] [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: 07/13/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus and globus pallidus internus is approved by the Food and Drug Administration for treating dystonia. Both targets have shown effectiveness in improving symptoms, but post-operative outcomes can vary significantly among patients. This variability has led researchers to explore alternative neuromodulation targets that might offer more consistent results. Emerging research has highlighted several promising new targets for DBS in dystonia. This review examines pre-clinical and clinical data on novel DBS targets for dystonia and explores non-invasive neuromodulation studies that shed light on the disease's underlying pathological circuitry.
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Affiliation(s)
- Vedant Garg
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Venkat Srikar Lavu
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Grace Hey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Brett Winter
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Marcos Santana Firme
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Justin D. Hilliard
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Coralie De Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Wolf D, Ayon-Olivas M, Sendtner M. BDNF-Regulated Modulation of Striatal Circuits and Implications for Parkinson's Disease and Dystonia. Biomedicines 2024; 12:1761. [PMID: 39200225 PMCID: PMC11351984 DOI: 10.3390/biomedicines12081761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
Neurotrophins, particularly brain-derived neurotrophic factor (BDNF), act as key regulators of neuronal development, survival, and plasticity. BDNF is necessary for neuronal and functional maintenance in the striatum and the substantia nigra, both structures involved in the pathogenesis of Parkinson's Disease (PD). Depletion of BDNF leads to striatal degeneration and defects in the dendritic arborization of striatal neurons. Activation of tropomyosin receptor kinase B (TrkB) by BDNF is necessary for the induction of long-term potentiation (LTP), a form of synaptic plasticity, in the hippocampus and striatum. PD is characterized by the degeneration of nigrostriatal neurons and altered striatal plasticity has been implicated in the pathophysiology of PD motor symptoms, leading to imbalances in the basal ganglia motor pathways. Given its essential role in promoting neuronal survival and meditating synaptic plasticity in the motor system, BDNF might have an important impact on the pathophysiology of neurodegenerative diseases, such as PD. In this review, we focus on the role of BDNF in corticostriatal plasticity in movement disorders, including PD and dystonia. We discuss the mechanisms of how dopaminergic input modulates BDNF/TrkB signaling at corticostriatal synapses and the involvement of these mechanisms in neuronal function and synaptic plasticity. Evidence for alterations of BDNF and TrkB in PD patients and animal models are reviewed, and the potential of BDNF to act as a therapeutic agent is highlighted. Advancing our understanding of these mechanisms could pave the way toward innovative therapeutic strategies aiming at restoring neuroplasticity and enhancing motor function in these diseases.
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Affiliation(s)
| | | | - Michael Sendtner
- Institute of Clinical Neurobiology, University Hospital Wuerzburg, 97078 Wuerzburg, Germany (M.A.-O.)
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Nunes GA, Carra RB, Listik C, Machado S, da Silva Simões J, Rocha AC, Menezes JR, Barbosa ER, Cury RG. Effects of Trans-Spinal Magnetic Stimulation on DBS' Induced Freezing of Gait in a Patient with Generalized Dystonia. Mov Disord Clin Pract 2024. [PMID: 38877772 DOI: 10.1002/mdc3.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/02/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024] Open
Affiliation(s)
- Glaucia Aline Nunes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Bernhart Carra
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sheilla Machado
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliana da Silva Simões
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Augusto Coelho Rocha
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Janaína Reis Menezes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Stevens CM, Ragland AR, Nair S, Fort J. Suicide Attempt in a Poststroke Patient After Undergoing Deep Brain Stimulation: A Case Report. Cureus 2024; 16:e53520. [PMID: 38445158 PMCID: PMC10911984 DOI: 10.7759/cureus.53520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Deep brain stimulation (DBS) is a type of therapy involving electrical stimulation of the brain and is primarily used to treat movement disorders. While perhaps beneficial, DBS has also been shown to have some potential major side effects, including increased risk for depression and suicide. In the present article, we report a case of a suicide attempt in a depressed patient two months after undergoing DBS for treatment of acute dystonia the patient had suffered from a prior ischemic stroke. This manuscript serves as a reminder of the negative ramifications that can be associated with DBS and why we should be cautious in providing DBS to patients who are either currently depressed or have a history of depression.
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Affiliation(s)
- Christopher M Stevens
- Interventional Radiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Amanda R Ragland
- Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sachin Nair
- Psychiatry, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Juliana Fort
- Psychiatry, Louisiana State University Health Sciences Center, Shreveport, USA
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Rajmohan R, Baveja S, Nguyen D, Shah E, Sy M, Attaripour S, Swope D. Case report: Approaches to treatment-refractory and super-refractory glutamic acid decarboxylase antibody-spectrum disorders. Front Immunol 2024; 14:1297340. [PMID: 38259445 PMCID: PMC10800536 DOI: 10.3389/fimmu.2023.1297340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background Glutamic acid decarboxylase antibody-spectrum disorders (GAD-SDs) include a group of autoimmune neurological diseases associated with neuronal excitability, most noticeably stiff person syndrome. Immune modulators are the mainstay of treatment, but a significant number of patients remain refractory. Methods We present our single-center experience of eight cases of GAD-SD, two of which were refractory to immune modulatory treatments. Results Of the two cases that were refractory to immunomodulation, one showed significant improvement with bilateral globus pallidus interna deep brain stimulation (GPi DBS) placement, and the other showed significant improvement with autologous hematopoietic stem cell transplant (aHSCT). Discussion To our knowledge, this is the first instance of GPi DBS placement being noted to improve GAD-SD movements.
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Affiliation(s)
- Ravi Rajmohan
- Department of Neurology, University of California, Irvine, CA, United States
| | - Shivali Baveja
- School of Medicine, University of California, Irvine, CA, United States
| | - Dai Nguyen
- Department of Internal Medicine, University of California, Davis, CA, United States
| | - Eshita Shah
- Department of Neurology, University of California, Irvine, CA, United States
| | - Michael Sy
- Department of Neurology, University of California, Irvine, CA, United States
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, United States
| | - David Swope
- Department of Neurology, University of California, Irvine, CA, United States
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Romano M, Bagnato S, Altavista MC, Avanzino L, Belvisi D, Bologna M, Bono F, Carecchio M, Castagna A, Ceravolo R, Conte A, Cosentino G, Eleopra R, Ercoli T, Esposito M, Fabbrini G, Ferrazzano G, Lalli S, Mascia MM, Osio M, Pellicciari R, Petrucci S, Valente EM, Valentino F, Zappia M, Zibetti M, Girlanda P, Tinazzi M, Defazio G, Berardelli A. Diagnostic and therapeutic recommendations in adult dystonia: a joint document by the Italian Society of Neurology, the Italian Academy for the Study of Parkinson’s Disease and Movement Disorders, and the Italian Network on Botulinum Toxin. Neurol Sci 2022; 43:6929-6945. [DOI: 10.1007/s10072-022-06424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
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Silverio AA, Silverio LAA. Developments in Deep Brain Stimulators for Successful Aging Towards Smart Devices—An Overview. FRONTIERS IN AGING 2022; 3:848219. [PMID: 35821845 PMCID: PMC9261350 DOI: 10.3389/fragi.2022.848219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
This work provides an overview of the present state-of-the-art in the development of deep brain Deep Brain Stimulation (DBS) and how such devices alleviate motor and cognitive disorders for a successful aging. This work reviews chronic diseases that are addressable via DBS, reporting also the treatment efficacies. The underlying mechanism for DBS is also reported. A discussion on hardware developments focusing on DBS control paradigms is included specifically the open- and closed-loop “smart” control implementations. Furthermore, developments towards a “smart” DBS, while considering the design challenges, current state of the art, and constraints, are also presented. This work also showcased different methods, using ambient energy scavenging, that offer alternative solutions to prolong the battery life of the DBS device. These are geared towards a low maintenance, semi-autonomous, and less disruptive device to be used by the elderly patient suffering from motor and cognitive disorders.
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Affiliation(s)
- Angelito A. Silverio
- Department of Electronics Engineering, University of Santo Tomas, Manila, Philippines
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
- *Correspondence: Angelito A. Silverio,
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Deep Brain Stimulation (DBS) with Subthalamic Nucleus (STN) as Target for Pediatric Patients with PKAN. World Neurosurg 2022; 163:e317-e322. [PMID: 35367641 DOI: 10.1016/j.wneu.2022.03.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
OBJECT Dystonia in Pantothenate Kinase-Associated Neurodegeneration(PKAN) is progressive despite medication. Deep brain stimulation(DBS) was reported to effectively provide symptom relief. No consensus exists in candidate and target selection for DBS. We aim to demonstrate effectiveness of subthalamic DBS(STN-DBS) placement in pediatric PKAN patients. METHODS We reviewed consecutive series of pediatric patients diagnosed with PKAN and treated with STN-DBS from 2016-2019 in our institution. Each case was described in detail. Preoperative and postoperative Burke-Fahn-Marsden Dystonia Rating Scale(BFMDRS) were assessed to evaluate functional improvement at follow-up. RESULTS Seven pediatric patients were included. Mean age of initial onset was 0.6±0.5 years and presentation to clinics was 6.6±1.3 years. Mean preoperative BFMDRS was 73.3±3.5. Following STN-DBS, for mean follow-up duration of 13.0±10.7 months, mean BFMDRS was 37.3±12.6, translating to score improvement of 36.0±12.9(p<0.001) and percentage improvement of 49.0±18.0%. CONCLUSIONS This case series demonstrated that STN-DBS is an effective symptom-based treatment for pediatric PKAN patients.
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Caccavella VM, Giordano M, Colicchio G, Izzo A, D’Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Montano N. Palliative surgery for drug resistant epilepsy in adult patients. A systematic review of the literature and a pooled analysis of outcomes. World Neurosurg 2022; 163:132-140.e1. [DOI: 10.1016/j.wneu.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
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Krause KJ, Phibbs F, Davis T, Fabbri D. Predicting Motor Responsiveness to Deep Brain Stimulation with Machine Learning. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:651-659. [PMID: 35308984 PMCID: PMC8861668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Deep brain stimulation is a complex movement disorder intervention that requires highly invasive brain surgery. Clinicians struggle to predict how patients will respond to this treatment. To address this problem, we are working toward developing a clinical tool to help neurologists predict deep brain stimulation response. We analyzed a cohort of 105 Parkinson's patients who underwent deep brain stimulation at Vanderbilt University Medical Center. We developed binary and multicategory models for predicting likelihood of motor symptom reduction after undergoing deep brain stimulation. We compared the performances of our best models to predictions made by neurologist experts in movement disorders. The strongest binary classification model achieved a 10-fold cross validation AUC of 0.90, outperforming the best neurologist predictions (0.56). These results are promising for future clinical applications, though more work is necessary to validate these findings in a larger cohort and taking into consideration broader quality of life outcome measures.
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Affiliation(s)
- Kevin J Krause
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Fenna Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Thomas Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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11
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Klink PC, Aubry JF, Ferrera VP, Fox AS, Froudist-Walsh S, Jarraya B, Konofagou EE, Krauzlis RJ, Messinger A, Mitchell AS, Ortiz-Rios M, Oya H, Roberts AC, Roe AW, Rushworth MFS, Sallet J, Schmid MC, Schroeder CE, Tasserie J, Tsao DY, Uhrig L, Vanduffel W, Wilke M, Kagan I, Petkov CI. Combining brain perturbation and neuroimaging in non-human primates. Neuroimage 2021; 235:118017. [PMID: 33794355 PMCID: PMC11178240 DOI: 10.1016/j.neuroimage.2021.118017] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/07/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Brain perturbation studies allow detailed causal inferences of behavioral and neural processes. Because the combination of brain perturbation methods and neural measurement techniques is inherently challenging, research in humans has predominantly focused on non-invasive, indirect brain perturbations, or neurological lesion studies. Non-human primates have been indispensable as a neurobiological system that is highly similar to humans while simultaneously being more experimentally tractable, allowing visualization of the functional and structural impact of systematic brain perturbation. This review considers the state of the art in non-human primate brain perturbation with a focus on approaches that can be combined with neuroimaging. We consider both non-reversible (lesions) and reversible or temporary perturbations such as electrical, pharmacological, optical, optogenetic, chemogenetic, pathway-selective, and ultrasound based interference methods. Method-specific considerations from the research and development community are offered to facilitate research in this field and support further innovations. We conclude by identifying novel avenues for further research and innovation and by highlighting the clinical translational potential of the methods.
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Affiliation(s)
- P Christiaan Klink
- Department of Vision & Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, the Netherlands.
| | - Jean-François Aubry
- Physics for Medicine Paris, Inserm U1273, CNRS UMR 8063, ESPCI Paris, PSL University, Paris, France
| | - Vincent P Ferrera
- Department of Neuroscience & Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, USA
| | - Andrew S Fox
- Department of Psychology & California National Primate Research Center, University of California, Davis, CA, USA
| | | | - Béchir Jarraya
- NeuroSpin, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM), Cognitive Neuroimaging Unit, Université Paris-Saclay, France; Foch Hospital, UVSQ, Suresnes, France
| | - Elisa E Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA
| | - Richard J Krauzlis
- Laboratory of Sensorimotor Research, National Eye Institute, Bethesda, MD, USA
| | - Adam Messinger
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Anna S Mitchell
- Department of Experimental Psychology, Oxford University, Oxford, United Kingdom
| | - Michael Ortiz-Rios
- Newcastle University Medical School, Newcastle upon Tyne NE1 7RU, United Kingdom; German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
| | - Hiroyuki Oya
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa, Iowa city, IA, USA
| | - Angela C Roberts
- Department of Physiology, Development and Neuroscience, Cambridge University, Cambridge, United Kingdom
| | - Anna Wang Roe
- Interdisciplinary Institute of Neuroscience and Technology, School of Medicine, Zhejiang University, Hangzhou 310029, China
| | | | - Jérôme Sallet
- Department of Experimental Psychology, Oxford University, Oxford, United Kingdom; Univ Lyon, Université Lyon 1, Inserm, Stem Cell and Brain Research Institute, U1208 Bron, France; Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Michael Christoph Schmid
- Newcastle University Medical School, Newcastle upon Tyne NE1 7RU, United Kingdom; Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 5, CH-1700 Fribourg, Switzerland
| | - Charles E Schroeder
- Nathan Kline Institute, Orangeburg, NY, USA; Columbia University, New York, NY, USA
| | - Jordy Tasserie
- NeuroSpin, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM), Cognitive Neuroimaging Unit, Université Paris-Saclay, France
| | - Doris Y Tsao
- Division of Biology and Biological Engineering, Tianqiao and Chrissy Chen Institute for Neuroscience; Howard Hughes Medical Institute; Computation and Neural Systems, Caltech, Pasadena, CA, USA
| | - Lynn Uhrig
- NeuroSpin, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM), Cognitive Neuroimaging Unit, Université Paris-Saclay, France
| | - Wim Vanduffel
- Laboratory for Neuro- and Psychophysiology, Neurosciences Department, KU Leuven Medical School, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven Belgium; Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Melanie Wilke
- German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany; Department of Cognitive Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Igor Kagan
- German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany.
| | - Christopher I Petkov
- Newcastle University Medical School, Newcastle upon Tyne NE1 7RU, United Kingdom.
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Tripathi R, Deogaonkar M. Fundamentals of Neuromodulation and Pathophysiology of Neural Networks in Health and Disease. Neurol India 2021; 68:S163-S169. [PMID: 33318346 DOI: 10.4103/0028-3886.302463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuromodulation involves altering neuronal circuitry and subsequent physiological changes with the aim to ameliorate neurological symptoms. Over the years several techniques have been used to obtain neuromodulatory effects for treatment of conditions including Parkinson disease, essential tremor, dystonia or seizures. We provide brief description of the various therapeutics that have been used and mechanisms involved in pathophysiology of these disorders as well as the therapeutic mechanisms of the treatment modalities.
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Affiliation(s)
- Richa Tripathi
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, 33 Medical Center Drive, Morgantown, WV, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, 33 Medical Center Drive, Morgantown, WV, USA
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Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle Tone Physiology and Abnormalities. Toxins (Basel) 2021; 13:toxins13040282. [PMID: 33923397 PMCID: PMC8071570 DOI: 10.3390/toxins13040282] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/10/2023] Open
Abstract
The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal cord, and muscle spindle. Disorders of muscle tone can arise from dysfunction in these pathways and manifest as hypertonia or hypotonia. The loss of supraspinal control mechanisms gives rise to hypertonia, resulting in spasticity or rigidity. On the other hand, dystonia and paratonia also manifest as abnormalities of muscle tone, but arise more due to the network dysfunction between the basal ganglia and the thalamo-cerebello-cortical connections. In this review, we have discussed the normal homeostatic mechanisms maintaining tone and the pathophysiology of spasticity and rigidity with its anatomical correlates. Thereafter, we have also highlighted the phenomenon of network dysfunction, cortical disinhibition, and neuroplastic alterations giving rise to dystonia and paratonia.
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Macerollo A, Sajin V, Bonello M, Barghava D, Alusi SH, Eldridge PR, Osman-Farah J. Deep brain stimulation in dystonia: State of art and future directions. J Neurosci Methods 2020; 340:108750. [DOI: 10.1016/j.jneumeth.2020.108750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/03/2023]
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Deng H, Yue JK, Wang DD. Trends in safety and cost of deep brain stimulation for treatment of movement disorders in the United States: 2002-2014. Br J Neurosurg 2020; 35:57-64. [PMID: 32476485 DOI: 10.1080/02688697.2020.1759776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Deep brain stimulation (DBS) is being increasingly utilized to treat movement disorders including Parkinson's disease (PD), essential tremor (ET), and dystonia. An improved understanding of national trends in safety and cost is necessary. Herein, our objectives are to (1) characterize complication, mortality, and cost profiles of patients undergoing DBS for movement disorders in the United States, (2) identify predictors of morbidity and mortality, and (3) evaluate impact of complications on cost. METHODS DBS surgeries were extracted from the National Inpatient Sample (NIS) 2002-2014 for the clinical indications of PD, ET, and dystonia. Patient characteristics and eight complication categories (hardware malfunction, infection, neurological, other haemorrhagic, thromboembolic, cardiac, pulmonary, and renal/urinary) were reviewed. Outcomes included complications, mortality, hospitalization length, and inflation-adjusted cost. RESULTS There were 44,866 weighted admissions (PD-73.5%, ET-22.7%, dystonia-3.8%). The number of procedures increased 2.22-fold from 2002 to 2014 (N = 2372 in 2002; N = 5260 in 2014). Inpatient cost was $22,802 ± 13,164, remaining stable from 2002 to 2014 ($24,188 ± 15,910, $20,630 ± 11,031, respectively). Four percent experienced complications (dystonia-6.0%, PD-4.4%, ET-3.1%, p < .001). In-hospital mortality was 0.2%. Cost was greater in patients with complications ($36,306 ± 29,263 vs. $22,196 ± 11,560, p < .001). Most common complications were renal/urinary (1.5%), neurological (1.1%), and pulmonary (0.7%). Thromboembolic, pulmonary, and haemorrhagic complications were associated with greatest cost. CONCLUSION Increased DBS utilization for adult movement disorders in the United States from 2002 to 2014 was attributed to rapid adoption by teaching hospitals for PD. DBS remains a safe procedure with low overall complications and stable inpatient costs from 2002 to 2014. Complication risks vary by type of movement disorder, and although rare, multiple complications increase morbidity and cost of care.
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Affiliation(s)
- Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Fagiolini M, Patrizi A, LeBlanc J, Jin LW, Maezawa I, Sinnett S, Gray SJ, Molholm S, Foxe JJ, Johnston MV, Naidu S, Blue M, Hossain A, Kadam S, Zhao X, Chang Q, Zhou Z, Zoghbi H. Intellectual and Developmental Disabilities Research Centers: A Multidisciplinary Approach to Understand the Pathogenesis of Methyl-CpG Binding Protein 2-related Disorders. Neuroscience 2020; 445:190-206. [PMID: 32360592 DOI: 10.1016/j.neuroscience.2020.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
Disruptions in the gene encoding methyl-CpG binding protein 2 (MECP2) underlie complex neurodevelopmental disorders including Rett Syndrome (RTT), MECP2 duplication disorder, intellectual disabilities, and autism. Significant progress has been made on the molecular and cellular basis of MECP2-related disorders providing a new framework for understanding how altered epigenetic landscape can derail the formation and refinement of neuronal circuits in early postnatal life and proper neurological function. This review will summarize selected major findings from the past years and particularly highlight the integrated and multidisciplinary work done at eight NIH-funded Intellectual and Developmental Disabilities Research Centers (IDDRC) across the US. Finally, we will outline a path forward with identification of reliable biomarkers and outcome measures, longitudinal preclinical and clinical studies, reproducibility of results across centers as a synergistic effort to decode and treat the pathogenesis of the complex MeCP2 disorders.
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Affiliation(s)
- Michela Fagiolini
- Children's Hospital Intellectual and Developmental Disabilities Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Annarita Patrizi
- Children's Hospital Intellectual and Developmental Disabilities Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jocelyn LeBlanc
- Children's Hospital Intellectual and Developmental Disabilities Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee-Way Jin
- UC Davis MIND Institute, University of California, Sacramento, CA, USA
| | - Izumi Maezawa
- UC Davis MIND Institute, University of California, Sacramento, CA, USA
| | - Sarah Sinnett
- UNC Intellectual and Developmental Disabilities Research Center, University of North Carolina, Gene Therapy Center and Dept. of Ophthalmology, Chapel Hill, NC, USA; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Steven J Gray
- UNC Intellectual and Developmental Disabilities Research Center, University of North Carolina, Gene Therapy Center and Dept. of Ophthalmology, Chapel Hill, NC, USA; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Departments of Pediatrics, Neuroscience, and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Michael V Johnston
- Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center/Hugo Moser Research Institute at Kennedy Krieger and Johns Hopkins School of Medicine, USA
| | - Sakkubai Naidu
- Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center/Hugo Moser Research Institute at Kennedy Krieger and Johns Hopkins School of Medicine, USA
| | - Mary Blue
- Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center/Hugo Moser Research Institute at Kennedy Krieger and Johns Hopkins School of Medicine, USA
| | - Ahamed Hossain
- Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center/Hugo Moser Research Institute at Kennedy Krieger and Johns Hopkins School of Medicine, USA
| | - Shilpa Kadam
- Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center/Hugo Moser Research Institute at Kennedy Krieger and Johns Hopkins School of Medicine, USA
| | - Xinyu Zhao
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Quiang Chang
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Zhaolan Zhou
- Department of Genetic, Epigenetic Institute, University of Pennsylvania Perelman School of Medicine, Intellectual and Developmental Disabilities Research Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Huda Zoghbi
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA; Howard Hughes Medical Institute, Baylor College of Medicine, Houston, TX, USA
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17
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Okromelidze L, Tsuboi T, Eisinger RS, Burns MR, Charbel M, Rana M, Grewal SS, Lu CQ, Almeida L, Foote KD, Okun MS, Middlebrooks EH. Functional and Structural Connectivity Patterns Associated with Clinical Outcomes in Deep Brain Stimulation of the Globus Pallidus Internus for Generalized Dystonia. AJNR Am J Neuroradiol 2020; 41:508-514. [PMID: 32054614 DOI: 10.3174/ajnr.a6429] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation is a well-established treatment for generalized dystonia, but outcomes remain variable. Establishment of an imaging marker to guide device targeting and programming could possibly impact the efficacy of deep brain stimulation in dystonia, particularly in the absence of acute clinical markers to indicate benefit. We hypothesize that the stimulation-based functional and structural connectivity using resting-state fMRI and DTI can predict therapeutic outcomes in patients with generalized dystonia and deep brain stimulation. MATERIALS AND METHODS We performed a retrospective analysis of 39 patients with inherited or idiopathic-isolated generalized dystonia who underwent bilateral globus pallidus internus deep brain stimulation. After electrode localization, the volumes of tissue activated were modeled and used as seed regions for functional and structural connectivity measures using a normative data base. Resulting connectivity maps were correlated with postoperative improvement in the Unified Dystonia Rating Scale score. RESULTS Structural connectivity between the volumes of tissue activated and the primary sensorimotor cortex was correlated with Unified Dystonia Rating Scale improvement, while more anterior prefrontal connectivity was inversely correlated with Unified Dystonia Rating Scale improvement. Functional connectivity between the volumes of tissue activated and primary sensorimotor regions, motor thalamus, and cerebellum was most correlated with Unified Dystonia Rating Scale improvement; however, an inverse correlation with Unified Dystonia Rating Scale improvement was seen in the supplemental motor area and premotor cortex. CONCLUSIONS Functional and structural connectivity with multiple nodes of the motor network is associated with motor improvement in patients with generalized dystonia undergoing deep brain stimulation. Results from this study may serve as a basis for future development of clinical markers to guide deep brain stimulation targeting and programming in dystonia.
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Affiliation(s)
- L Okromelidze
- From the Departments of Radiology (L.O., C.-Q.L., E.H.M.) and Neurosurgery (S.S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - T Tsuboi
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - R S Eisinger
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - M R Burns
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - M Charbel
- Department of Neurosurgery (K.D.F.), and J. Crayton Pruitt Family Department of Biomedical Engineering (M.C.), University of Florida, Gainesville, Florida
| | - M Rana
- Institute of Medical Psychology and Behavioural Neurobiology (M.R.), University of Tübingen, Tübingen, Germany
| | - S S Grewal
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - C-Q Lu
- From the Departments of Radiology (L.O., C.-Q.L., E.H.M.) and Neurosurgery (S.S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - L Almeida
- Department of Neurosurgery (K.D.F.), and J. Crayton Pruitt Family Department of Biomedical Engineering (M.C.), University of Florida, Gainesville, Florida
| | - K D Foote
- Department of Neurosurgery (K.D.F.), and J. Crayton Pruitt Family Department of Biomedical Engineering (M.C.), University of Florida, Gainesville, Florida
| | - M S Okun
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - E H Middlebrooks
- From the Departments of Radiology (L.O., C.-Q.L., E.H.M.) and Neurosurgery (S.S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida .,Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
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18
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Starnes K, Miller K, Wong-Kisiel L, Lundstrom BN. A Review of Neurostimulation for Epilepsy in Pediatrics. Brain Sci 2019; 9:brainsci9100283. [PMID: 31635298 PMCID: PMC6826633 DOI: 10.3390/brainsci9100283] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
Neurostimulation for epilepsy refers to the application of electricity to affect the central nervous system, with the goal of reducing seizure frequency and severity. We review the available evidence for the use of neurostimulation to treat pediatric epilepsy, including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS), chronic subthreshold cortical stimulation (CSCS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We consider possible mechanisms of action and safety concerns, and we propose a methodology for selecting between available options. In general, we find neurostimulation is safe and effective, although any high quality evidence applying neurostimulation to pediatrics is lacking. Further research is needed to understand neuromodulatory systems, and to identify biomarkers of response in order to establish optimal stimulation paradigms.
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Affiliation(s)
- Keith Starnes
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kai Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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19
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Giorni A, Windels F, Stratton PG, Cook R, Silberstein P, Coyne T, Silburn PA, Sah P. Single-unit activity of the anterior Globus pallidus internus in Tourette patients and posterior Globus pallidus internus in dystonic patients. Clin Neurophysiol 2017; 128:2510-2518. [PMID: 29101846 DOI: 10.1016/j.clinph.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/30/2017] [Accepted: 10/07/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Our goal was to provide a detailed analysis of neurons' electrophysiological activity recorded in sub-territories of Globus pallidus internus (GPi) used as Deep Brain Stimulation (DBS) targets for these clinical conditions to potentially assist electrode targeting. METHODS We used intra-operative microelectrode recording during stereotactic neurosurgery to guide implantation of DBS lead. RESULTS Units in the medial anterior part of GPi of 7 Tourette's syndrome patients under general anesthesia were firing at mean and median rate of 32.1 and 21 Hz respectively (n = 101), with 45% of spikes fired during bursts and 21.3 bursts per minute. In the latero-posterior part of GPi of 7 dystonic patients under local anesthesia the mean and median activity were 46.1 and 30.6 Hz respectively (n = 27), and a mean of 21.7 bursts per minute was observed, with 30% of all spikes occurring during these bursts. CONCLUSION Units activity pattern - slow-regular, fast-irregular or fast-regular were present in different proportions between the two targets. SIGNIFICANCE The electrophysiological characteristics of the medial-anterior part of GPi and its latero-posterior portion can be used to assist DBS electrode targeting and also support the refinement of pathophysiological models of Tourette's syndrome and Dystonia.
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Affiliation(s)
- Andrea Giorni
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia
| | - François Windels
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia.
| | - Peter G Stratton
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia
| | - Raymond Cook
- Royal North Shore and North Shore Private Hospitals, Sydney, New South Wales, Australia
| | - Paul Silberstein
- Royal North Shore and North Shore Private Hospitals, Sydney, New South Wales, Australia
| | - Terrence Coyne
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia; St. Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
| | - Peter A Silburn
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia; St. Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
| | - Pankaj Sah
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, Brisbane, Queensland, Australia
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20
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Local field potential oscillations of the globus pallidus in cervical and tardive dystonia. J Neurol Sci 2016; 366:68-73. [DOI: 10.1016/j.jns.2016.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/16/2016] [Accepted: 04/16/2016] [Indexed: 01/06/2023]
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21
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Trenado C, Elben S, Petri D, Hirschmann J, Groiss SJ, Vesper J, Schnitzler A, Wojtecki L. Combined Invasive Subcortical and Non-invasive Surface Neurophysiological Recordings for the Assessment of Cognitive and Emotional Functions in Humans. J Vis Exp 2016. [PMID: 27286467 DOI: 10.3791/53466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging (fMRI) for extracting crucial information about the mechanism of the human brain, such methods remain insufficient to provide information about physiological processes reflecting cognitive and emotional functions at the subcortical level. In this respect, modern invasive clinical approaches in humans, such as deep brain stimulation (DBS), offer a tremendous possibility to record subcortical brain activity, namely local field potentials (LFPs) representing coherent activity of neural assemblies from localized basal ganglia or thalamic regions. Notwithstanding the fact that invasive approaches in humans are applied only after medical indication and thus recorded data correspond to altered brain circuits, valuable insight can be gained regarding the presence of intact brain functions in relation to brain oscillatory activity and the pathophysiology of disorders in response to experimental cognitive paradigms. In this direction, a growing number of DBS studies in patients with Parkinson's disease (PD) target not only motor functions but also higher level processes such as emotions, decision-making, attention, memory and sensory perception. Recent clinical trials also emphasize the role of DBS as an alternative treatment in neuropsychiatric disorders ranging from obsessive compulsive disorder (OCD) to chronic disorders of consciousness (DOC). Consequently, we focus on the use of combined invasive (LFP) and non-invasive (EEG) human brain recordings in assessing the role of cortical-subcortical structures in cognitive and emotional processing trough experimental paradigms (e.g. speech stimuli with emotional connotation or paradigms of cognitive control such as the Flanker task), for patients undergoing DBS treatment.
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Affiliation(s)
- Carlos Trenado
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University
| | - Saskia Elben
- Department of Neurology, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf
| | - David Petri
- Department of Neurology, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf
| | - Jan Hirschmann
- Department of Neurology, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf
| | - Stefan J Groiss
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University; Department of Neurology, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf
| | - Jan Vesper
- Department of Neurosurgery, Functional Neurosurgery and Stereotaxy, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University; Department of Neurology, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf
| | - Lars Wojtecki
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University; Department of Neurology, Center for Movement Disorders and Neuromodulation, University Clinic Düsseldorf;
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22
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Georgiev D, Mehta D, Zacharia A, Vinke RS, Milabo C, Candelario J, Tripoliti E, Hyam JA, Zrinzo L, Hariz M, O'Riordan S, Foltynie T, Limousin P. Bilateral Deep Brain Stimulation of the Globus Pallidus Pars Interna in a Patient with Variant Ataxia-Telangiectasia. Mov Disord Clin Pract 2016; 3:405-408. [PMID: 30713931 DOI: 10.1002/mdc3.12287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 12/25/2022] Open
Affiliation(s)
- Dejan Georgiev
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Dwij Mehta
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - André Zacharia
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Ruben Saman Vinke
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Catherine Milabo
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom
| | - Joseph Candelario
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom
| | - Elina Tripoliti
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Jonathan A Hyam
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Marwan Hariz
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Seán O'Riordan
- St. Vincent's University Hospital Elm Park Dublin Ireland
| | - Thomas Foltynie
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery National Hospital of Neurology and Neurosurgery London United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders London United Kingdom
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23
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Morigaki R, Mure H, Kaji R, Nagahiro S, Goto S. Therapeutic Perspective on Tardive Syndrome with Special Reference to Deep Brain Stimulation. Front Psychiatry 2016; 7:207. [PMID: 28082923 PMCID: PMC5183634 DOI: 10.3389/fpsyt.2016.00207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/15/2016] [Indexed: 12/28/2022] Open
Abstract
Tardive syndrome (TDS) is a potentially permanent and irreversible hyperkinetic movement disorder caused by exposure to dopamine receptor blocking agents. Guidelines published by the American Academy of Neurology recommend pharmacological first-line treatment for TDS with clonazepam (level B), ginkgo biloba (level B), amantadine (level C), and tetrabenazine (level C). Recently, a class II study provided level C evidence for use of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in patients with TDS. Although the precise pathogenesis of TDS remains to be elucidated, the beneficial effects of GPi-DBS in patients with TDS suggest that the disease may be a basal ganglia disorder. In addition to recent advances in understanding the pathophysiology of TDS, this article introduces the current use of DBS in the treatment of medically intractable TDS.
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Affiliation(s)
- Ryoma Morigaki
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hideo Mure
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryuji Kaji
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Clinical Neuroscience, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Satoshi Goto
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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24
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Hertenstein E, Tang NKY, Bernstein CJ, Nissen C, Underwood MR, Sandhu HK. Sleep in patients with primary dystonia: A systematic review on the state of research and perspectives. Sleep Med Rev 2015; 26:95-107. [PMID: 26164369 DOI: 10.1016/j.smrv.2015.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 12/01/2022]
Abstract
Patients with primary dystonia, the third most prevalent movement disorder, suffer from a markedly reduced quality of life. This might, at least in part, be mediated by non-motor symptoms, including sleep disturbances. Characterising and treating sleep disturbances might provide new inroads to improve relevant patient-centred outcomes. This review evaluates the state of research on sleep in patients with dystonia and outlines an agenda for future research. A literature search was performed in July 2014 using PubMed, Medline via Ovid, PsycInfo, PsycArticles via Proquest and Embase via Ovid. Search results were screened for eligibility by two independent raters. Peer-reviewed publications reporting on sleep in patients with primary dystonia were included. Of 1445 studies identified through the search strategy, 18 met the inclusion criteria. In total, the included studies reported on 708 patients diagnosed with focal dystonia (cervical dystonia or blepharospasm), torsion dystonia, and dopa-responsive dystonia. The results indicate that at least half of the patients with focal cranial dystonia suffer from sleep disturbances, but excessive daytime sleepiness is uncommon. Sleep disturbance is associated with depressive symptoms. The frequency and duration of dystonic movements is markedly reduced during sleep. Reduced sleep quality appears to persist after treatment with botulinum toxin that successfully reduces motor symptoms. The findings are limited by a high clinical and methodological heterogeneity. Future research is needed to i) further characterize subjective and PSG sleep in patients with different types of dystonia, ii) determine the aetiology of sleep disturbances (e.g., abnormal brain function associated with dystonia, side effects of medication, psychological reasons), and iii) test whether targeted sleep interventions improve sleep and quality of life in patients with primary dystonia.
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Affiliation(s)
- Elisabeth Hertenstein
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany.
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Celia J Bernstein
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harbinder K Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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25
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Wei XF, Iyengar N, DeMaria AH. Iterative electrodes increase neural recruitment for deep brain stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:3419-3422. [PMID: 26737027 DOI: 10.1109/embc.2015.7319127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Deep brain stimulators require surgical replacement when primary cell batteries are depleted. We designed novel electrode contact geometries based on the principle of iterative element addition as a method of increasing perimeter. Our hypothesis was that these novel, high-perimeter designs would increase surface current density variation and neuronal activation, thus improving stimulation efficiency by decreasing power requirement. Finite element models of iterative electrodes displayed greater surface current density variations on the electrode surface. Subsequent analysis of their activation efficiency when 100 neurons were randomly positioned either parallel or perpendicular to the electrode yielded higher stimulation efficiencies in response to a monophasic cathodic voltage pulse with a pulse width of 100 μs. Recruitment curves showing the percentage of activated axons as a function of stimulation intensity yielded a ~8% and ~24% reduction in threshold voltage and a ~2% and ~28% reduction in power consumption when nerve fibers were oriented parallel and perpendicular to the electrode, respectively. This heightened efficiency would reduce the frequency of surgical replacements of depleted stimulators, as well as induce fewer side effects associate with high voltage requirement for therapeutic stimulation.
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26
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Neurosurgical treatment for dystonia: Long-term outcome in a case series of 80 patients. Clin Neurol Neurosurg 2014; 123:191-8. [DOI: 10.1016/j.clineuro.2014.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 05/03/2014] [Accepted: 05/18/2014] [Indexed: 11/23/2022]
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