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Cheyuo C, Germann J, Yamamoto K, Zibly Z, Krishna V, Sarica C, Borges YFF, Vetkas A, Kalia SK, Hodaie M, Fasano A, Schwartz ML, Elias WJ, Lozano AM. Probabilistic Refinement of Focused Ultrasound Thalamotomy Targeting for Parkinson's Disease Tremor. Mov Disord 2024. [PMID: 39120112 DOI: 10.1002/mds.29965] [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: 03/07/2024] [Revised: 07/09/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND There remains high variability in clinical outcomes when the same magnetic resonance image-guided focused ultrasound (MRgFUS) thalamotomy target is used for both essential tremor (ET) and tremor-dominant Parkinson's disease (TDPD). OBJECTIVE Our goal is to refine the MRgFUS thalamotomy target for TDPD versus ET. METHODS We retrospectively performed voxel-wise efficacy and structural connectivity mapping using 3-12-month post-procedure hand tremor scores for a multicenter cohort of 32 TDPD patients and a previously published cohort of 79 ET patients, and 24-hour T1-weighted post-MRgFUS brain images. We validated our findings using Unified Parkinson's Disease Rating Scale part III scores for an independent cohort of nine TDPD patients. RESULTS The post-MRgFUS clinical improvements were 45.9% ± 35.9%, 55.5% ± 36%, and 46.1% ± 18.6% for ET, multicenter TDPD and validation TDPD cohorts, respectively. The TDPD and ET efficacy maps differed significantly (ppermute < 0.05), with peak TDPD improvement (87%) at x = -13.5; y = -15.0; z = 1.5, ~3.5 mm anterior and 3 mm dorsal to the ET target. Discriminative connectivity projections were to the motor and premotor regions in TDPD, and to the motor and somatosensory regions in ET. The disorder-specific voxel-wise efficacy map could be used to estimate outcome in TDPD patients with high accuracy (R = 0.8; R2 = 0.64; P < 0.0001). The model was validated using the independent cohort of nine TDPD patients (R = 0.73; R2 = 0.53; P = 0.025-voxel analysis). CONCLUSION We demonstrated that the most effective MRgFUS thalamotomy target in TDPD is in the ventral intermediate nucleus/ventralis oralis posterior border region. This finding offers new insights into the thalamic regions instrumental in tremor control, with pivotal implications for improving treatment outcomes. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cletus Cheyuo
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Functional Neurosurgery Center, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Zion Zibly
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Center of Neuromodulation, Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vibhor Krishna
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yuri Ferreira Felloni Borges
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
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Chu HY, Smith Y, Lytton WW, Grafton S, Villalba R, Masilamoni G, Wichmann T. Dysfunction of motor cortices in Parkinson's disease. Cereb Cortex 2024; 34:bhae294. [PMID: 39066504 PMCID: PMC11281850 DOI: 10.1093/cercor/bhae294] [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: 02/18/2024] [Revised: 06/26/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
The cerebral cortex has long been thought to be involved in the pathophysiology of motor symptoms of Parkinson's disease. The impaired cortical function is believed to be a direct and immediate effect of pathologically patterned basal ganglia output, mediated to the cerebral cortex by way of the ventral motor thalamus. However, recent studies in humans with Parkinson's disease and in animal models of the disease have provided strong evidence suggesting that the involvement of the cerebral cortex is much broader than merely serving as a passive conduit for subcortical disturbances. In the present review, we discuss Parkinson's disease-related changes in frontal cortical motor regions, focusing on neuropathology, plasticity, changes in neurotransmission, and altered network interactions. We will also examine recent studies exploring the cortical circuits as potential targets for neuromodulation to treat Parkinson's disease.
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Affiliation(s)
- Hong-Yuan Chu
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Pharmacology and Physiology, Georgetown University Medical Center, 3900 Reservoir Rd N.W., Washington D.C. 20007, United States
| | - Yoland Smith
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Neurology, School of Medicine, Emory University, 12 Executive Drive N.E., Atlanta, GA 30329, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
| | - William W Lytton
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Physiology & Pharmacology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
- Department of Neurology, Kings County Hospital, 451 Clarkson Avenue,Brooklyn, NY 11203, United States
| | - Scott Grafton
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Psychological and Brain Sciences, University of California, 551 UCEN Road, Santa Barbara, CA 93106, United States
| | - Rosa Villalba
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
| | - Gunasingh Masilamoni
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
| | - Thomas Wichmann
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Neurology, School of Medicine, Emory University, 12 Executive Drive N.E., Atlanta, GA 30329, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
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Wilken M, Andres DS, Bianchi G, Hallett M, Merello M. Persistence of Basal Ganglia Oscillatory Activity During Tremor Attenuation by Movement in Parkinson's Disease Patients. Mov Disord 2024; 39:768-777. [PMID: 38415321 DOI: 10.1002/mds.29679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND One of the characteristics of parkinsonian tremor is that its amplitude decreases with movement. Current models suggest an interaction between basal ganglia (BG) and cerebello-thalamo-cortical circuits in parkinsonian tremor pathophysiology. OBJECTIVE We aimed to correlate central oscillation in the BG with electromyographic activity during re-emergent tremor in order to detect changes in BG oscillatory activity when tremor is attenuated by movement. METHODS We performed a prospective, observational study on consecutive parkinsonian patients who underwent deep brain stimulation surgery and presented re-emergent tremor. Coherence analysis between subthalamic nucleus/globus pallidus internus (STN/GPi) tremorous activity measured by microrecording (MER) and electromyogram (EMG) from flexor and extensor wrist muscles during rest, posture, and re-emergent tremor pause was performed during surgery. The statistical significance level of the MER-EMG coherence was determined using surrogate data analysis, and the directionality of information transfer between BG and muscle was performed using entropy transfer analysis. RESULTS We analyzed 148 MERs with tremor-like activity from 6 patients which were evaluated against the simultaneous EMGs, resulting in 296 correlations. Of these, 26 presented a significant level of coherence at tremor frequency, throughout rest and posture, with a complete EMG stop in between. During the pause, all recordings showed sustained MER peaks at tremor frequency (±1.5 Hz). Information flows preferentially from BG to muscle during rest and posture, with a loss of directionality during the pause. CONCLUSIONS Our results suggest that oscillatory activity in STN/GPi functionally linked to tremor sustains firing frequency during re-emergent tremor pause, thus suggesting no direct role of the BG circuit on tremor attenuation due to voluntary movements. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Miguel Wilken
- Movement Disorders, Neurology Department, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
- Clinical Neurophysiology, Neurology Department, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Daniela S Andres
- Laboratory of Neuroengineering, Science and Technology School, National University of San Martín (UNSAM), Buenos Aires, Argentina
- Institute of Emergent Technologies and Applied Science, National Council on Scientific and Technical Research, National University of San Martin, Buenos Aires, Argentina
| | - Gianfranco Bianchi
- Laboratory of Neuroengineering, Science and Technology School, National University of San Martín (UNSAM), Buenos Aires, Argentina
- Institute of Emergent Technologies and Applied Science, National Council on Scientific and Technical Research, National University of San Martin, Buenos Aires, Argentina
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Marcelo Merello
- Movement Disorders, Neurology Department, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
- Argentine National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Ding H, Nasseroleslami B, Mirzac D, Isaias IU, Volkmann J, Deuschl G, Groppa S, Muthuraman M. Re-emergent Tremor in Parkinson's Disease: Evidence of Pathologic β and Prokinetic γ Activity. Mov Disord 2024; 39:778-787. [PMID: 38532269 DOI: 10.1002/mds.29771] [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: 09/12/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Re-emergent tremor is characterized as a continuation of resting tremor and is often highly therapy refractory. This study examines variations in brain activity and oscillatory responses between resting and re-emergent tremors in Parkinson's disease. METHODS Forty patients with Parkinson's disease (25 males, mean age, 66.78 ± 5.03 years) and 40 age- and sex-matched healthy controls were included in the study. Electroencephalogram and electromyography signals were simultaneously recorded during resting and re-emergent tremors in levodopa on and off states for patients and mimicked by healthy controls. Brain activity was localized using the beamforming technique, and information flow between sources was estimated using effective connectivity. Cross-frequency coupling was used to assess neuronal oscillations between tremor frequency and canonical frequency oscillations. RESULTS During levodopa on, differences in brain activity were observed in the premotor cortex and cerebellum in both the patient and control groups. However, Parkinson's disease patients also exhibited additional activity in the primary sensorimotor cortex. On withdrawal of levodopa, different source patterns were observed in the supplementary motor area and basal ganglia area. Additionally, levodopa was found to suppress the strength of connectivity (P < 0.001) between the identified sources and influence the tremor frequency-related coupling, leading to a decrease in β (P < 0.001) and an increase in γ frequency coupling (P < 0.001). CONCLUSIONS Distinct variations in cortical-subcortical brain activity are evident in tremor phenotypes. The primary sensorimotor cortex plays a crucial role in the generation of re-emergent tremor. Moreover, oscillatory neuronal responses in pathological β and prokinetic γ activity are specific to tremor phenotypes. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hao Ding
- Department of Neurology, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin, Leinster, Ireland
| | - Bahman Nasseroleslami
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin, Leinster, Ireland
| | - Daniela Mirzac
- Department of Neurology, University Medical Center of the Johannes Gutenberg-UniversityMainz, Mainz, Rheinland-Pfalz, Germany
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Schleswig-Holstein, Germany
| | - Sergiu Groppa
- Department of Neurology, University Medical Center of the Johannes Gutenberg-UniversityMainz, Mainz, Rheinland-Pfalz, Germany
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Pozzi NG, Bolzoni F, Biella GEM, Pezzoli G, Ip CW, Volkmann J, Cavallari P, Asan E, Isaias IU. Brain Noradrenergic Innervation Supports the Development of Parkinson's Tremor: A Study in a Reserpinized Rat Model. Cells 2023; 12:2529. [PMID: 37947607 PMCID: PMC10649099 DOI: 10.3390/cells12212529] [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: 07/31/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
The pathophysiology of tremor in Parkinson's disease (PD) is evolving towards a complex alteration to monoaminergic innervation, and increasing evidence suggests a key role of the locus coeruleus noradrenergic system (LC-NA). However, the difficulties in imaging LC-NA in patients challenge its direct investigation. To this end, we studied the development of tremor in a reserpinized rat model of PD, with or without a selective lesioning of LC-NA innervation with the neurotoxin DSP-4. Eight male rats (Sprague Dawley) received DSP-4 (50 mg/kg) two weeks prior to reserpine injection (10 mg/kg) (DR-group), while seven male animals received only reserpine treatment (R-group). Tremor, rigidity, hypokinesia, postural flexion and postural immobility were scored before and after 20, 40, 60, 80, 120 and 180 min of reserpine injection. Tremor was assessed visually and with accelerometers. The injection of DSP-4 induced a severe reduction in LC-NA terminal axons (DR-group: 0.024 ± 0.01 vs. R-group: 0.27 ± 0.04 axons/um2, p < 0.001) and was associated with significantly less tremor, as compared to the R-group (peak tremor score, DR-group: 0.5 ± 0.8 vs. R-group: 1.6 ± 0.5; p < 0.01). Kinematic measurement confirmed the clinical data (tremor consistency (% of tremor during 180 s recording), DR-group: 37.9 ± 35.8 vs. R-group: 69.3 ± 29.6; p < 0.05). Akinetic-rigid symptoms did not differ between the DR- and R-groups. Our results provide preliminary causal evidence for a critical role of LC-NA innervation in the development of PD tremor and foster the development of targeted therapies for PD patients.
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Affiliation(s)
- Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
| | - Francesco Bolzoni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy;
| | | | - Gianni Pezzoli
- Centro Parkinson e Parkinsonismi, ASST G. Pini-CTO, 20072 Milano, Italy;
| | - Chi Wang Ip
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
| | - Paolo Cavallari
- Department of Pathophysiology and Transplantation, Human Physiology Section, Università degli Studi di Milano, via Mangiagalli 32, 20133 Milano, Italy;
| | - Esther Asan
- Institute of Anatomy and Cell Biology, Julius-Maximilians-Universität Würzburg, Koellikerstr 6, 97070 Würzburg, Germany;
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
- Centro Parkinson e Parkinsonismi, ASST G. Pini-CTO, 20072 Milano, Italy;
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Boon LI, Buijink AWG. Parkinsonian Tremor: Shaking in Synchrony. Mov Disord 2023; 38:1582-1584. [PMID: 37718270 DOI: 10.1002/mds.29568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Lennard I Boon
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Arthur W G Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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Dirkx MF, Shine JM, Helmich RC. Integrative Brain States Facilitate the Expression of Parkinson's Tremor. Mov Disord 2023; 38:1615-1624. [PMID: 37363818 PMCID: PMC10947311 DOI: 10.1002/mds.29506] [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: 02/24/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) rest tremor emerges from pathological activity in the basal ganglia and cerebello-thalamo-cortical circuits. A well-known clinical feature is the waxing and waning of PD tremor amplitude, but the mechanisms that drive this variability are unclear. Previous work has shown that arousal amplifies PD tremor by increasing between-network connectivity. Furthermore, brain states in PD are biased toward integration rather than segregation, a pattern that is also associated with increased arousal. OBJECTIVE The aim was to test the hypothesis that fluctuations in integrative brain states and/or arousal drive spontaneous fluctuations in PD rest tremor. METHODS We compared the temporal relationship between cerebral integration, the ascending arousal system, and tremor, both during cognitive load and in the resting state. In 40 tremor-dominant PD patients, we performed functional magnetic resonance imaging using concurrent tremor recordings and proxy measures of the ascending arousal system (pupil diameter, heart rate). We calculated whole-brain dynamic functional connectivity and used graph theory to determine a scan-by-scan measure of cerebral integration, which we related to the onset of tremor episodes. RESULTS Fluctuations in cerebral integration were time locked to spontaneous changes in tremor amplitude: cerebral integration increased 13 seconds before tremor onset and predicted the amplitude of subsequent increases in tremor amplitude. During but not before tremor episodes, pupil diameter and heart rate increased and correlated with tremor amplitude. CONCLUSIONS Integrative brain states are an important cerebral environment in which tremor-related activity emerges, which is then amplified by the ascending arousal system. New treatments focused on attenuating enhanced cerebral integration in PD may reduce tremor. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michiel F. Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - James M. Shine
- Brain and Mind CenterThe University of SydneySydneyNew South WalesAustralia
| | - Rick C. Helmich
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
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8
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Swinnen BE, de Bie RM, Hallett M, Helmich RC, Buijink AW. Reconstructing Re-emergent Tremor. Mov Disord Clin Pract 2023; 10:1293-1296. [PMID: 37772284 PMCID: PMC10525057 DOI: 10.1002/mdc3.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Bart E.K.S. Swinnen
- Department of Neurology and Clinical NeurophysiologyAmsterdam University Medical Centers, Amsterdam Neuroscience, University of AmsterdamAmsterdamThe Netherlands
| | - Rob M.A. de Bie
- Department of Neurology and Clinical NeurophysiologyAmsterdam University Medical Centers, Amsterdam Neuroscience, University of AmsterdamAmsterdamThe Netherlands
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - Rick C. Helmich
- Department of Neurology, Centre of Expertise for Parkinson and Movement DisordersRadboud University Medical CentreNijmegenThe Netherlands
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Arthur W.G. Buijink
- Department of Neurology and Clinical NeurophysiologyAmsterdam University Medical Centers, Amsterdam Neuroscience, University of AmsterdamAmsterdamThe Netherlands
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Lauro PM, Lee S, Amaya DE, Liu DD, Akbar U, Asaad WF. Concurrent decoding of distinct neurophysiological fingerprints of tremor and bradykinesia in Parkinson's disease. eLife 2023; 12:e84135. [PMID: 37249217 PMCID: PMC10264071 DOI: 10.7554/elife.84135] [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: 10/12/2022] [Accepted: 05/26/2023] [Indexed: 05/31/2023] Open
Abstract
Parkinson's disease (PD) is characterized by distinct motor phenomena that are expressed asynchronously. Understanding the neurophysiological correlates of these motor states could facilitate monitoring of disease progression and allow improved assessments of therapeutic efficacy, as well as enable optimal closed-loop neuromodulation. We examined neural activity in the basal ganglia and cortex of 31 subjects with PD during a quantitative motor task to decode tremor and bradykinesia - two cardinal motor signs of PD - and relatively asymptomatic periods of behavior. Support vector regression analysis of microelectrode and electrocorticography recordings revealed that tremor and bradykinesia had nearly opposite neural signatures, while effective motor control displayed unique, differentiating features. The neurophysiological signatures of these motor states depended on the signal type and location. Cortical decoding generally outperformed subcortical decoding. Within the subthalamic nucleus (STN), tremor and bradykinesia were better decoded from distinct subregions. These results demonstrate how to leverage neurophysiology to more precisely treat PD.
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Affiliation(s)
- Peter M Lauro
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- The Warren Alpert Medical School, Brown UniversityProvidenceUnited States
| | - Shane Lee
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- Norman Prince Neurosciences Institute, Rhode Island HospitalProvidenceUnited States
- Department of Neurosurgery, Rhode Island HospitalProvidenceUnited States
| | - Daniel E Amaya
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
| | - David D Liu
- Department of Neurosurgery, Brigham and Women’s HospitalBostonUnited States
| | - Umer Akbar
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- The Warren Alpert Medical School, Brown UniversityProvidenceUnited States
- Norman Prince Neurosciences Institute, Rhode Island HospitalProvidenceUnited States
- Department of Neurology, Rhode Island HospitalProvidenceUnited States
| | - Wael F Asaad
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- The Warren Alpert Medical School, Brown UniversityProvidenceUnited States
- Norman Prince Neurosciences Institute, Rhode Island HospitalProvidenceUnited States
- Department of Neurosurgery, Rhode Island HospitalProvidenceUnited States
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10
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Morrison S, Reilly N, Schussler E, Kerr G. The effect of standing posture on amplitude and variability of postural tremor in Parkinson’s disease. Neurosci Lett 2023; 805:137220. [PMID: 37019272 DOI: 10.1016/j.neulet.2023.137220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION This study examined whether altering body position (i.e., sitting or standing) affected the dynamics of physiological tremor for healthy older adults and persons with Parkinson's disease (PD). It was also of interest to determine how consistent the tremor was for both groups as determined by examining changes in within-subject variability of tremor amplitude, regularity and frequency. METHODS Ten Parkinsonian participants (65.1±3.2 yrs.) and twelve elderly persons (71.2±2.6 yrs.) participated in this study. Tremor was collected from the index finger and hand segments using lightweight accelerometers during the performance of a bilateral pointing task. Persons performed the pointing task in a standing or sitting position. RESULTS As expected, the tremor for the PD persons was greater in magnitude (mean RMS, peak power), more regular (lower SampEn), and more inconsistent from trial-to-trial (increased intra-individual variability, IIV) than the tremor recorded for the elderly. Further, when assessed during standing, the magnitude of the tremor for all individuals (elderly and PD) was greater, more variable, and less complex compared to the tremor when assessed during the sitting posture. The only measure which did not change within each group was the frequency of the major tremor peak which remained consistent, showing no significant change between limbs or as a function of the posture adopted. CONCLUSION The findings revealed that tremor increased in amplitude and decreased in regularity for all individuals was assessed when standing compared to sitting. It is likely that these increases were task-related, reflecting the increased physical demands of performing the task when standing rather than being driven by specific age- or disease-related changes in the mechanisms underlying tremorgenesis. Further, the tremor for the PD individuals tended to be more variable from trial-by-trial in terms of both amplitude and regularity as compared to the elderly persons. Interestingly, the only tremor metric which showed no change within each group was the frequency of the major tremor peak which was consistent within both groups irrespective of the posture adopted.
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Matthews LG, Puryear CB, Correia SS, Srinivasan S, Belfort GM, Pan MK, Kuo SH. T-type calcium channels as therapeutic targets in essential tremor and Parkinson's disease. Ann Clin Transl Neurol 2023; 10:462-483. [PMID: 36738196 PMCID: PMC10109288 DOI: 10.1002/acn3.51735] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/05/2023] Open
Abstract
Neuronal action potential firing patterns are key components of healthy brain function. Importantly, restoring dysregulated neuronal firing patterns has the potential to be a promising strategy in the development of novel therapeutics for disorders of the central nervous system. Here, we review the pathophysiology of essential tremor and Parkinson's disease, the two most common movement disorders, with a focus on mechanisms underlying the genesis of abnormal firing patterns in the implicated neural circuits. Aberrant burst firing of neurons in the cerebello-thalamo-cortical and basal ganglia-thalamo-cortical circuits contribute to the clinical symptoms of essential tremor and Parkinson's disease, respectively, and T-type calcium channels play a key role in regulating this activity in both the disorders. Accordingly, modulating T-type calcium channel activity has received attention as a potentially promising therapeutic approach to normalize abnormal burst firing in these diseases. In this review, we explore the evidence supporting the theory that T-type calcium channel blockers can ameliorate the pathophysiologic mechanisms underlying essential tremor and Parkinson's disease, furthering the case for clinical investigation of these compounds. We conclude with key considerations for future investigational efforts, providing a critical framework for the development of much needed agents capable of targeting the dysfunctional circuitry underlying movement disorders such as essential tremor, Parkinson's disease, and beyond.
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Affiliation(s)
| | - Corey B Puryear
- Praxis Precision Medicines, Boston, Massachusetts, 02110, USA
| | | | - Sharan Srinivasan
- Praxis Precision Medicines, Boston, Massachusetts, 02110, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | | | - Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10051, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.,Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taiwan
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, 10032, USA.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, New York, 10032, USA
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Chen R, Berardelli A, Bhattacharya A, Bologna M, Chen KHS, Fasano A, Helmich RC, Hutchison WD, Kamble N, Kühn AA, Macerollo A, Neumann WJ, Pal PK, Paparella G, Suppa A, Udupa K. Clinical neurophysiology of Parkinson's disease and parkinsonism. Clin Neurophysiol Pract 2022; 7:201-227. [PMID: 35899019 PMCID: PMC9309229 DOI: 10.1016/j.cnp.2022.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
This review is part of the series on the clinical neurophysiology of movement disorders and focuses on Parkinson’s disease and parkinsonism. The pathophysiology of cardinal parkinsonian motor symptoms and myoclonus are reviewed. The recordings from microelectrode and deep brain stimulation electrodes are reported in detail.
This review is part of the series on the clinical neurophysiology of movement disorders. It focuses on Parkinson’s disease and parkinsonism. The topics covered include the pathophysiology of tremor, rigidity and bradykinesia, balance and gait disturbance and myoclonus in Parkinson’s disease. The use of electroencephalography, electromyography, long latency reflexes, cutaneous silent period, studies of cortical excitability with single and paired transcranial magnetic stimulation, studies of plasticity, intraoperative microelectrode recordings and recording of local field potentials from deep brain stimulation, and electrocorticography are also reviewed. In addition to advancing knowledge of pathophysiology, neurophysiological studies can be useful in refining the diagnosis, localization of surgical targets, and help to develop novel therapies for Parkinson’s disease.
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Affiliation(s)
- Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Antonella Macerollo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.,The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kaviraja Udupa
- Department of Neurophysiology National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Connecting tremors - a circuits perspective. Curr Opin Neurol 2022; 35:518-524. [PMID: 35788547 DOI: 10.1097/wco.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Tremor is one of the most prevalent movement disorders in clinical practice. Here, we review new insights in the pathophysiology of tremor. We focus on the three most common tremor disorders: essential tremor (ET), dystonic tremor syndrome (DTS), and Parkinson's disease (PD) tremor. RECENT FINDINGS Converging evidence suggests that ET, DTS, and PD tremor are all associated with (partly) overlapping cerebral networks involving the basal ganglia and cerebello-thalamo-cortical circuit. Recent studies have assessed the role of these networks in tremor by measuring tremor-related activity and connectivity with electrophysiology and neuroimaging, and by perturbing network components using invasive and noninvasive brain stimulation. The cerebellum plays a more dominant and causal role in action tremors than in rest tremor, as exemplified by recent findings in ET, DTS, and re-emergent tremor in PD. Furthermore, the role of the cerebellum in DTS is related to clinical differences between patients, for example, whether or not the tremor occurs in a dystonic limb, and whether the tremor is jerky or sinusoidal. SUMMARY Insight into the pathophysiological mechanisms of tremor may provide a more direct window into mechanism-based treatment options than either the etiology or the clinical phenotype of a tremor syndrome.
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Sarica C, Nankoo JF, Fomenko A, Grippe TC, Yamamoto K, Samuel N, Milano V, Vetkas A, Darmani G, Cizmeci MN, Lozano AM, Chen R. Human Studies of Transcranial Ultrasound neuromodulation: A systematic review of effectiveness and safety. Brain Stimul 2022; 15:737-746. [DOI: 10.1016/j.brs.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/11/2023] Open
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