1
|
Sun Y, Lü J, Zhou Y, Liu Y, Chai Y. Suppression of beta oscillations by delayed feedback in a cortex-basal ganglia-thalamus-pedunculopontine nucleus neural loop model. J Biol Phys 2023; 49:463-482. [PMID: 37572243 PMCID: PMC10651615 DOI: 10.1007/s10867-023-09641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023] Open
Abstract
Excessive neural synchronization of neural populations in the beta (β) frequency range (12-35 Hz) is intimately related to the symptoms of hypokinesia in Parkinson's disease (PD). Studies have shown that delayed feedback stimulation strategies can interrupt excessive neural synchronization and effectively alleviate symptoms associated with PD dyskinesia. Work on optimizing delayed feedback algorithms continues to progress, yet it remains challenging to further improve the inhibitory effect with reduced energy expenditure. Therefore, we first established a neural mass model of the cortex-basal ganglia-thalamus-pedunculopontine nucleus (CBGTh-PPN) closed-loop system, which can reflect the internal properties of cortical and basal ganglia neurons and their intrinsic connections with thalamic and pedunculopontine nucleus neurons. Second, the inhibitory effects of three delayed feedback schemes based on the external globus pallidum (GPe) on β oscillations were investigated separately and compared with those based on the subthalamic nucleus (STN) only. Our results show that all four delayed feedback schemes achieve effective suppression of pathological β oscillations when using the linear delayed feedback algorithm. The comparison revealed that the three GPe-based delayed feedback stimulation strategies were able to have a greater range of oscillation suppression with reduced energy consumption, thus improving control performance effectively, suggesting that they may be more effective for the relief of Parkinson's motor symptoms in practical applications.
Collapse
Affiliation(s)
- Yuqin Sun
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, 201306, China
| | - Jiali Lü
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, 201306, China
| | - Ye Zhou
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, 201306, China
| | - Yingpeng Liu
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, 201306, China
| | - Yuan Chai
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, 201306, China.
| |
Collapse
|
2
|
Kromer JA, Bokil H, Tass PA. Synaptic network structure shapes cortically evoked spatio-temporal responses of STN and GPe neurons in a computational model. Front Neuroinform 2023; 17:1217786. [PMID: 37675246 PMCID: PMC10477454 DOI: 10.3389/fninf.2023.1217786] [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: 05/05/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction The basal ganglia (BG) are involved in motor control and play an essential role in movement disorders such as hemiballismus, dystonia, and Parkinson's disease. Neurons in the motor part of the BG respond to passive movement or stimulation of different body parts and to stimulation of corresponding cortical regions. Experimental evidence suggests that the BG are organized somatotopically, i.e., specific areas of the body are associated with specific regions in the BG nuclei. Signals related to the same body part that propagate along different pathways converge onto the same BG neurons, leading to characteristic shapes of cortically evoked responses. This suggests the existence of functional channels that allow for the processing of different motor commands or information related to different body parts in parallel. Neurological disorders such as Parkinson's disease are associated with pathological activity in the BG and impaired synaptic connectivity, together with reorganization of somatotopic maps. One hypothesis is that motor symptoms are, at least partly, caused by an impairment of network structure perturbing the organization of functional channels. Methods We developed a computational model of the STN-GPe circuit, a central part of the BG. By removing individual synaptic connections, we analyzed the contribution of signals propagating along different pathways to cortically evoked responses. We studied how evoked responses are affected by systematic changes in the network structure. To quantify the BG's organization in the form of functional channels, we suggested a two-site stimulation protocol. Results Our model reproduced the cortically evoked responses of STN and GPe neurons and the contributions of different pathways suggested by experimental studies. Cortical stimulation evokes spatio-temporal response patterns that are linked to the underlying synaptic network structure. Our two-site stimulation protocol yielded an approximate functional channel width. Discussion/conclusion The presented results provide insight into the organization of BG synaptic connectivity, which is important for the development of computational models. The synaptic network structure strongly affects the processing of cortical signals and may impact the generation of pathological rhythms. Our work may motivate further experiments to analyze the network structure of BG nuclei and their organization in functional channels.
Collapse
Affiliation(s)
- Justus A. Kromer
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Hemant Bokil
- Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Peter A. Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| |
Collapse
|
3
|
Song J, Lin H, Liu S. Basal ganglia network dynamics and function: Role of direct, indirect and hyper-direct pathways in action selection. NETWORK (BRISTOL, ENGLAND) 2023; 34:84-121. [PMID: 36856435 DOI: 10.1080/0954898x.2023.2173816] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Basal ganglia (BG) are a widely recognized neural basis for action selection, but its decision-making mechanism is still a difficult problem for researchers. Therefore, we constructed a spiking neural network inspired by the BG anatomical data. Simulation experiments were based on the principle of dis-inhibition and our functional hypothesis within the BG: the direct pathway, the indirect pathway, and the hyper-direct pathway of the BG jointly implement the initiation execution and termination of motor programs. Firstly, we studied the dynamic process of action selection with the network, which contained intra-group competition and inter-group competition. Secondly, we focused on the effects of the stimulus intensity and the proportion of excitation and inhibition on the GPi/SNr. The results suggested that inhibition and excitation shape action selection. They also explained why the firing rate of GPi/SNr did not continue to increase in the action-selection experiment. Finally, we discussed the experimental results with the functional hypothesis. Uniquely, this paper summarized the decision-making neural mechanism of action selection based on the direct pathway, the indirect pathway, and the hyper-direct pathway within BG.
Collapse
Affiliation(s)
- Jian Song
- School of Mathematics, South China University of Technology, Guangzhou, China
| | - Hui Lin
- Department of Precision Instruments, Tsinghua University, Beijing, China
| | - Shenquan Liu
- School of Mathematics, South China University of Technology, Guangzhou, China
| |
Collapse
|
4
|
Williams D. Basal ganglia functional connectivity network analysis does not support the 'noisy signal' hypothesis of Parkinson's disease. Brain Commun 2023; 5:fcad123. [PMID: 37124947 PMCID: PMC10139445 DOI: 10.1093/braincomms/fcad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/23/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
The 'noisy signal' hypothesis of basal ganglia dysfunction in Parkinson's disease (PD) suggests that major motor symptoms of the disorder are caused by the development of abnormal basal ganglia activity patterns resulting in the propagation of 'noisy' signals to target systems. While such abnormal activity patterns might be useful biomarkers for the development of therapeutic interventions, correlation between specific changes in activity and PD symptoms has been inconsistently demonstrated, and raises questions concerning the accuracy of the hypothesis. Here, we tested this hypothesis by considering three nodes of the basal ganglia network, the subthalamus, globus pallidus interna, and cortex during self-paced and cued movements in patients with PD. Interactions between these regions were analyzed using measures that assess both linear and non-linear relationships. Marked changes in the network are observed with dopamine state. Specifically, we detected functional disconnection of the basal ganglia from the cortex and higher network variability in untreated PD, but various patterns of directed functional connectivity with lower network variability in treated PD. When we examine the system output, significant correlation is observed between variability in the cortico-basal ganglia network and muscle activity variability but only in the treated state. Rather than supporting a role of the basal ganglia in the transmission of noisy signals in patients with PD, these findings suggest that cortico-basal ganglia network interactions by fault or design, in the treated Parkinsonian state, are actually associated with improved cortical network output variability.
Collapse
Affiliation(s)
- David Williams
- Correspondence to: Dr David Williams. Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Khalifa Bin Zayed Street, Tawam, Next to Tawam Hospital, Al Ain, PO Box 15551, United Arab Emirates. E-mail:
| |
Collapse
|
5
|
Khaledi-Nasab A, Kromer JA, Tass PA. Long-Lasting Desynchronization of Plastic Neuronal Networks by Double-Random Coordinated Reset Stimulation. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:864859. [PMID: 36926109 PMCID: PMC10013062 DOI: 10.3389/fnetp.2022.864859] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022]
Abstract
Hypersynchrony of neuronal activity is associated with several neurological disorders, including essential tremor and Parkinson's disease (PD). Chronic high-frequency deep brain stimulation (HF DBS) is the standard of care for medically refractory PD. Symptoms may effectively be suppressed by HF DBS, but return shortly after cessation of stimulation. Coordinated reset (CR) stimulation is a theory-based stimulation technique that was designed to specifically counteract neuronal synchrony by desynchronization. During CR, phase-shifted stimuli are delivered to multiple neuronal subpopulations. Computational studies on CR stimulation of plastic neuronal networks revealed long-lasting desynchronization effects obtained by down-regulating abnormal synaptic connectivity. This way, networks are moved into attractors of stable desynchronized states such that stimulation-induced desynchronization persists after cessation of stimulation. Preclinical and clinical studies confirmed corresponding long-lasting therapeutic and desynchronizing effects in PD. As PD symptoms are associated with different pathological synchronous rhythms, stimulation-induced long-lasting desynchronization effects should favorably be robust to variations of the stimulation frequency. Recent computational studies suggested that this robustness can be improved by randomizing the timings of stimulus deliveries. We study the long-lasting effects of CR stimulation with randomized stimulus amplitudes and/or randomized stimulus timing in networks of leaky integrate-and-fire (LIF) neurons with spike-timing-dependent plasticity. Performing computer simulations and analytical calculations, we study long-lasting desynchronization effects of CR with and without randomization of stimulus amplitudes alone, randomization of stimulus times alone as well as the combination of both. Varying the CR stimulation frequency (with respect to the frequency of abnormal target rhythm) and the number of separately stimulated neuronal subpopulations, we reveal parameter regions and related mechanisms where the two qualitatively different randomization mechanisms improve the robustness of long-lasting desynchronization effects of CR. In particular, for clinically relevant parameter ranges double-random CR stimulation, i.e., CR stimulation with the specific combination of stimulus amplitude randomization and stimulus time randomization, may outperform regular CR stimulation with respect to long-lasting desynchronization. In addition, our results provide the first evidence that an effective reduction of the overall stimulation current by stimulus amplitude randomization may improve the frequency robustness of long-lasting therapeutic effects of brain stimulation.
Collapse
Affiliation(s)
- Ali Khaledi-Nasab
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Justus A Kromer
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| |
Collapse
|
6
|
Humphries MD, Gurney K. Making decisions in the dark basement of the brain: A look back at the GPR model of action selection and the basal ganglia. BIOLOGICAL CYBERNETICS 2021; 115:323-329. [PMID: 34272969 DOI: 10.1007/s00422-021-00887-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
How does your brain decide what you will do next? Over the past few decades compelling evidence has emerged that the basal ganglia, a collection of nuclei in the fore- and mid-brain of all vertebrates, are vital to action selection. Gurney, Prescott, and Redgrave published an influential computational account of this idea in Biological Cybernetics in 2001. Here we take a look back at this pair of papers, outlining the "GPR" model contained therein, the context of that model's development, and the influence it has had over the past twenty years. Tracing its lineage into models and theories still emerging now, we are encouraged that the GPR model is that rare thing, a computational model of a brain circuit whose advances were directly built on by others.
Collapse
|
7
|
Hu B, Xu M, Wang Z, Jiang D, Wang D, Zhang D. The theoretical mechanism of Parkinson's oscillation frequency bands: a computational model study. Cogn Neurodyn 2020; 15:721-731. [PMID: 34367370 DOI: 10.1007/s11571-020-09651-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 12/27/2022] Open
Abstract
Excessive synchronous oscillation activities appear in the brain is a key pathological feature of Parkinson's disease, the mechanism of which is still unclear. Although some previous studies indicated that β oscillation (13-30 Hz) may directly originate in the network composed of the subthalamic nucleus (STN) and external globus pallidus (GPe) neurons, specific onset mechanisms of which are unclear, especially theoretical evidences in numerical simulation are still little. In this paper, we employ a STN-GPe mean-field model to explore the onset mechanism of Parkinson's oscillation. In addition to β oscillation, we find that some other common oscillation frequency bands can appear in this network, such as the α oscillation band (8-12 Hz), the θ oscillation band (4-7 Hz) and δ oscillation band (1-3 Hz). In addition to the coupling weight between the STN and GPe, the delay is also a critical factor to affect oscillatory activities, which can not be neglected compared to other parameters. Through simulation and analysis, we propose two possible theories may induce the system to transfer from the stable state to the oscillatory state in this model: (1). The oscillation activity can be induced when the firing activation level of the population increases to large enough; (2). In some special cases, the population may stay in the high firing rate stable state and the mean discharge rate of which is too large to induce oscillations, then oscillation activities may be induced as the MD decreases to moderate value. In most situations, the change trends of the MD and oscillation dominant frequency are contrary, which may be an important physiological phenomenon shown in this model. The delays and firing rates were obtained by simulating, which may be verified in the experiment in the future.
Collapse
Affiliation(s)
- Bing Hu
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou, 310023 China.,Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031 China
| | - Minbo Xu
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou, 310023 China
| | - Zhizhi Wang
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou, 310023 China
| | - Danhua Jiang
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou, 310023 China
| | - Dingjiang Wang
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou, 310023 China
| | - Dongmei Zhang
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou, 310023 China
| |
Collapse
|
8
|
González-Redondo Á, Naveros F, Ros E, Garrido JA. A Basal Ganglia Computational Model to Explain the Paradoxical Sensorial Improvement in the Presence of Huntington's Disease. Int J Neural Syst 2020; 30:2050057. [PMID: 32840409 DOI: 10.1142/s0129065720500574] [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: 11/18/2022]
Abstract
The basal ganglia (BG) represent a critical center of the nervous system for sensorial discrimination. Although it is known that Huntington's disease (HD) affects this brain area, it still remains unclear how HD patients achieve paradoxical improvement in sensorial discrimination tasks. This paper presents a computational model of the BG including the main nuclei and the typical firing properties of their neurons. The BG model has been embedded within an auditory signal detection task. We have emulated the effect that the altered levels of dopamine and the degree of HD affectation have in information processing at different layers of the BG, and how these aspects shape transient and steady states differently throughout the selection task. By extracting the independent components of the BG activity at different populations, it is evidenced that early and medium stages of HD affectation may enhance transient activity in the striatum and the substantia nigra pars reticulata. These results represent a possible explanation for the paradoxical improvement that HD patients present in discrimination task performance. Thus, this paper provides a novel understanding on how the fast dynamics of the BG network at different layers interact and enable transient states to emerge throughout the successive neuron populations.
Collapse
Affiliation(s)
| | - Francisco Naveros
- Department of Computer Architecture and Technology, University of Granada, Granada, Spain
| | - Eduardo Ros
- Department of Computer Architecture and Technology, University of Granada, Granada, Spain
| | - Jesús A Garrido
- Department of Computer Architecture and Technology, University of Granada, Granada, Spain
| |
Collapse
|
9
|
The role of coupling connections in a model of the cortico-basal ganglia-thalamocortical neural loop for the generation of beta oscillations. Neural Netw 2020; 123:381-392. [DOI: 10.1016/j.neunet.2019.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/02/2019] [Accepted: 12/22/2019] [Indexed: 11/18/2022]
|
10
|
Koelman LA, Lowery MM. Beta-Band Resonance and Intrinsic Oscillations in a Biophysically Detailed Model of the Subthalamic Nucleus-Globus Pallidus Network. Front Comput Neurosci 2019; 13:77. [PMID: 31749692 PMCID: PMC6848887 DOI: 10.3389/fncom.2019.00077] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022] Open
Abstract
Increased beta-band oscillatory activity in the basal ganglia network is associated with Parkinsonian motor symptoms and is suppressed with medication and deep brain stimulation (DBS). The origins of the beta-band oscillations, however, remains unclear with both intrinsic oscillations arising within the subthalamic nucleus (STN)-external globus pallidus (GPe) network and exogenous beta-activity, originating outside the network, proposed as potential sources of the pathological activity. The aim of this study was to explore the relative contribution of autonomous oscillations and exogenous oscillatory inputs in the generation of pathological oscillatory activity in a biophysically detailed model of the parkinsonian STN-GPe network. The network model accounts for the integration of synaptic currents and their interaction with intrinsic membrane currents in dendritic structures within the STN and GPe. The model was used to investigate the development of beta-band synchrony and bursting within the STN-GPe network by changing the balance of excitation and inhibition in both nuclei, and by adding exogenous oscillatory inputs with varying phase relationships through the hyperdirect cortico-subthalamic and indirect striato-pallidal pathways. The model showed an intrinsic susceptibility to beta-band oscillations that was manifest in weak autonomously generated oscillations within the STN-GPe network and in selective amplification of exogenous beta-band synaptic inputs near the network's endogenous oscillation frequency. The frequency at which this resonance peak occurred was determined by the net level of excitatory drive to the network. Intrinsic or endogenously generated oscillations were too weak to support a pacemaker role for the STN-GPe network, however, they were considerably amplified by sparse cortical beta inputs and were further amplified by striatal beta inputs that promoted anti-phase firing of the cortex and GPe, resulting in maximum transient inhibition of STN neurons. The model elucidates a mechanism of cortical patterning of the STN-GPe network through feedback inhibition whereby intrinsic susceptibility to beta-band oscillations can lead to phase locked spiking under parkinsonian conditions. These results point to resonance of endogenous oscillations with exogenous patterning of the STN-GPe network as a mechanism of pathological synchronization, and a role for the pallido-striatal feedback loop in amplifying beta oscillations.
Collapse
Affiliation(s)
- Lucas A. Koelman
- Neuromuscular Systems Laboratory, School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | | |
Collapse
|
11
|
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0189109.].
Collapse
|
12
|
Kumbhare D, Palys V, Toms J, Wickramasinghe CS, Amarasinghe K, Manic M, Hughes E, Holloway KL. Nucleus Basalis of Meynert Stimulation for Dementia: Theoretical and Technical Considerations. Front Neurosci 2018; 12:614. [PMID: 30233297 PMCID: PMC6130053 DOI: 10.3389/fnins.2018.00614] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/13/2018] [Indexed: 12/17/2022] Open
Abstract
Deep brain stimulation (DBS) of nucleus basalis of Meynert (NBM) is currently being evaluated as a potential therapy to improve memory and overall cognitive function in dementia. Although, the animal literature has demonstrated robust improvement in cognitive functions, phase 1 trial results in humans have not been as clear-cut. We hypothesize that this may reflect differences in electrode location within the NBM, type and timing of stimulation, and the lack of a biomarker for determining the stimulation's effectiveness in real time. In this article, we propose a methodology to address these issues in an effort to effectively interface with this powerful cognitive nucleus for the treatment of dementia. Specifically, we propose the use of diffusion tensor imaging to identify the nucleus and its tracts, quantitative electroencephalography (QEEG) to identify the physiologic response to stimulation during programming, and investigation of stimulation parameters that incorporate the phase locking and cross frequency coupling of gamma and slower oscillations characteristic of the NBM's innate physiology. We propose that modulating the baseline gamma burst stimulation frequency, specifically with a slower rhythm such as theta or delta will pose more effective coupling between NBM and different cortical regions involved in many learning processes.
Collapse
Affiliation(s)
- Deepak Kumbhare
- Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, VA, United States
- McGuire Research Institute, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
| | - Viktoras Palys
- Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, VA, United States
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jamie Toms
- Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, VA, United States
- Southeast PD Research, Education and Clinical Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
| | | | - Kasun Amarasinghe
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, United States
| | - Milos Manic
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, United States
| | - Evan Hughes
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Kathryn L. Holloway
- Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, VA, United States
- Southeast PD Research, Education and Clinical Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
| |
Collapse
|