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Ricci A, Rubino E, Serra GP, Wallén-Mackenzie Å. Concerning neuromodulation as treatment of neurological and neuropsychiatric disorder: Insights gained from selective targeting of the subthalamic nucleus, para-subthalamic nucleus and zona incerta in rodents. Neuropharmacology 2024; 256:110003. [PMID: 38789078 DOI: 10.1016/j.neuropharm.2024.110003] [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: 02/06/2024] [Revised: 04/26/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Neuromodulation such as deep brain stimulation (DBS) is advancing as a clinical intervention in several neurological and neuropsychiatric disorders, including Parkinson's disease, dystonia, tremor, and obsessive-compulsive disorder (OCD) for which DBS is already applied to alleviate severely afflicted individuals of symptoms. Tourette syndrome and drug addiction are two additional disorders for which DBS is in trial or proposed as treatment. However, some major remaining obstacles prevent this intervention from reaching its full therapeutic potential. Side-effects have been reported, and not all DBS-treated individuals are relieved of their symptoms. One major target area for DBS electrodes is the subthalamic nucleus (STN) which plays important roles in motor, affective and associative functions, with impact on for example movement, motivation, impulsivity, compulsivity, as well as both reward and aversion. The multifunctionality of the STN is complex. Decoding the anatomical-functional organization of the STN could enhance strategic targeting in human patients. The STN is located in close proximity to zona incerta (ZI) and the para-subthalamic nucleus (pSTN). Together, the STN, pSTN and ZI form a highly heterogeneous and clinically important brain area. Rodent-based experimental studies, including opto- and chemogenetics as well as viral-genetic tract tracings, provide unique insight into complex neuronal circuitries and their impact on behavior with high spatial and temporal precision. This research field has advanced tremendously over the past few years. Here, we provide an inclusive review of current literature in the pre-clinical research fields centered around STN, pSTN and ZI in laboratory mice and rats; the three highly heterogeneous and enigmatic structures brought together in the context of relevance for treatment strategies. Specific emphasis is placed on methods of manipulation and behavioral impact.
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Affiliation(s)
- Alessia Ricci
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Eleonora Rubino
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Gian Pietro Serra
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Åsa Wallén-Mackenzie
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA.
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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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Beck MM, Christiansen L, Madsen MAJ, Jadidi AF, Vinding MC, Thielscher A, Bergmann TO, Siebner HR, Tomasevic L. Transcranial magnetic stimulation of primary motor cortex elicits an immediate transcranial evoked potential. Brain Stimul 2024; 17:802-812. [PMID: 38909748 DOI: 10.1016/j.brs.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Transcranial evoked potentials (TEPs) measured via electroencephalography (EEG) are widely used to study the cortical responses to transcranial magnetic stimulation (TMS). Immediate transcranial evoked potentials (i-TEPs) have been obscured by pulse and muscular artifacts. Thus, the TEP peaks that are commonly reported have latencies that are too long to be caused by direct excitation of cortical neurons. METHODS In 25 healthy individuals, we recorded i-TEPs evoked by a single biphasic TMS pulse targeting the primary motor hand area (M1HAND) or parietal or midline control sites. Sampling EEG at 50 kHz enabled us to reduce the duration of the TMS pulse artifact to a few milliseconds, while minor adjustments of the TMS coil tilt or position enabled us to avoid cranial muscular twitches during the experiment. RESULTS We observed an early positive EEG deflection starting after approx. 2 ms followed by a series of superimposed peaks with an inter-peak interval of ∼1.1-1.4 ms in multiple electrodes surrounding the stimulated sensorimotor region. This multi-peak i-TEP response was only evoked by TMS of the M1HAND region and was modified by changes in stimulation intensity and current direction. DISCUSSION Single-pulse TMS of the M1HAND evokes an immediate local multi-peak response at the cortical site of stimulation. Our results suggest that the observed i-TEP patterns are genuine cortical responses evoked by TMS caused by synchronized excitation of pyramidal neurons in the targeted precentral cortex. This notion needs to be corroborated in future studies, including further investigations into the potential contribution of instrumental or physiological artifacts.
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Affiliation(s)
- Mikkel Malling Beck
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Lasse Christiansen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark; Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Mads Alexander Just Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Armita Faghani Jadidi
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Mikkel Christoffer Vinding
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark; Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Til Ole Bergmann
- Neuroimaging Center (NIC), Johannes Gutenberg University Medical Center, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Leo Tomasevic
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
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Peeters J, Van Bogaert T, Boogers A, Gransier R, Wouters J, De Vloo P, Vandenberghe W, Barbe MT, Visser-Vandewalle V, Nuttin B, Dembek TA, Mc Laughlin M. Electrophysiological sweet spot mapping in deep brain stimulation for Parkinson's disease patients. Brain Stimul 2024; 17:794-801. [PMID: 38821395 DOI: 10.1016/j.brs.2024.05.013] [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: 12/21/2023] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Subthalamic deep brain stimulation (STN-DBS) is a well-established therapy to treat Parkinson's disease (PD). However, the STN-DBS sub-target remains debated. Recently, a white matter tract termed the hyperdirect pathway (HDP), directly connecting the motor cortex to STN, has gained interest as HDP stimulation is hypothesized to drive DBS therapeutic effects. Previously, we have investigated EEG-based evoked potentials (EPs) to better understand the neuroanatomical origins of the DBS clinical effect. We found a 3-ms peak (P3) relating to clinical benefit, and a 10-ms peak (P10) suggesting nigral side effects. Here, we aimed to investigate the neuroanatomical origins of DBS EPs using probabilistic mapping. METHODS EPs were recorded using EEG whilst low-frequency stimulation was delivered at all DBS-contacts individually. Next, EPs were mapped onto the patients' individual space and then transformed to MNI standard space. Using voxel-wise and fiber-wise probabilistic mapping, we determined hotspots/hottracts and coldspots/coldtracts for P3 and P10. Topography analysis was also performed to determine the spatial distribution of the DBS EPs. RESULTS In all 13 patients (18 hemispheres), voxel- and fiber-wise probabilistic mapping resulted in a P3-hotspot/hottract centered on the posterodorsomedial STN border indicative of HDP stimulation, while the P10-hotspot/hottract covered large parts of the substantia nigra. CONCLUSION This study investigated EP-based probabilistic mapping in PD patients during STN-DBS, revealing a P3-hotspot/hottract in line with HDP stimulation and P10-hotspot/hottract related to nigral stimulation. Results from this study provide key evidence for an electrophysiological measure of HDP and nigral stimulation.
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Affiliation(s)
- Jana Peeters
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Belgium
| | - Tine Van Bogaert
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Belgium
| | - Alexandra Boogers
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Belgium; Department of Neurology, UZ Leuven, Belgium
| | - Robin Gransier
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Belgium
| | - Jan Wouters
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Belgium
| | - Philippe De Vloo
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Belgium; Department of Neurosurgery, UZ Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurology, UZ Leuven, Belgium; Laboratory for Parkinson Research, Department of Neurosciences, KU Leuven, Belgium
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine, Department of Stereotactic & Functional Neurosurgery, Cologne, Germany
| | - Bart Nuttin
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Belgium; Department of Neurosurgery, UZ Leuven, Belgium
| | - Till A Dembek
- University of Cologne, Faculty of Medicine, Department of Neurology, Cologne, Germany
| | - Myles Mc Laughlin
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Belgium.
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Borgheai SB, Opri E, Isbaine F, Cole E, Deligani RJ, Laxpati N, Risk BB, Willie JT, Gross RE, Yong NA, McIntyre CC, Miocinovic S. Neural pathway activation in the subthalamic region depends on stimulation polarity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.01.24306044. [PMID: 38746250 PMCID: PMC11092741 DOI: 10.1101/2024.05.01.24306044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD); however, there is limited understanding of which subthalamic pathways are recruited in response to stimulation. Here, by focusing on the polarity of the stimulus waveform (cathodic vs. anodic), our goal was to elucidate biophysical mechanisms that underlie electrical stimulation in the human brain. In clinical studies, cathodic stimulation more easily triggers behavioral responses, but anodic DBS broadens the therapeutic window. This suggests that neural pathways involved respond preferentially depending on stimulus polarity. To experimentally compare the activation of therapeutically relevant pathways during cathodic and anodic subthalamic nucleus (STN) DBS, pathway activation was quantified by measuring evoked potentials resulting from antidromic or orthodromic activation in 15 PD patients undergoing DBS implantation. Cortical evoked potentials (cEP) were recorded using subdural electrocorticography, DBS local evoked potentials (DLEP) were recorded from non-stimulating contacts and EMG activity was recorded from arm and face muscles. We measured: 1) the amplitude of short-latency cEP, previously demonstrated to reflect activation of the cortico-STN hyperdirect pathway, 2) DLEP amplitude thought to reflect activation of STN-globus pallidus (GP) pathway, and 3) amplitudes of very short-latency cEP and motor evoked potentials (mEP) for activation of cortico-spinal/bulbar tract (CSBT). We constructed recruitment and strength-duration curves for each EP/pathway to compare the excitability for different stimulation polarities. We compared experimental data with the most advanced DBS computational models. Our results provide experimental evidence that subcortical cathodic and anodic stimulation activate the same pathways in the STN region and that cathodic stimulation is in general more efficient. However, relative efficiency varies for different pathways so that anodic stimulation is the least efficient in activating CSBT, more efficient in activating the HDP and as efficient as cathodic in activating STN-GP pathway. Our experiments confirm biophysical model predictions regarding neural activations in the central nervous system and provide evidence that stimulus polarity has differential effects on passing axons, terminal synapses, and local neurons. Comparison of experimental results with clinical DBS studies provides further evidence that the hyperdirect pathway may be involved in the therapeutic mechanisms of DBS.
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Beylergil SB, Noecker AM, Kilbane C, McIntyre CC, Shaikh AG. Does Vestibular Motion Perception Correlate with Axonal Pathways Stimulated by Subthalamic Deep Brain Stimulation in Parkinson's Disease? CEREBELLUM (LONDON, ENGLAND) 2024; 23:554-569. [PMID: 37308757 DOI: 10.1007/s12311-023-01576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Perception of our linear motion - heading - is critical for postural control, gait, and locomotion, and it is impaired in Parkinson's disease (PD). Deep brain stimulation (DBS) has variable effects on vestibular heading perception, depending on the location of the electrodes within the subthalamic nucleus (STN). Here, we aimed to find the anatomical correlates of heading perception in PD. Fourteen PD participants with bilateral STN DBS performed a two-alternative forced-choice discrimination task where a motion platform delivered translational forward movements with a heading angle varying between 0 and 30° to the left or to the right with respect to the straight-ahead direction. Using psychometric curves, we derived the heading discrimination threshold angle of each patient from the response data. We created patient-specific DBS models and calculated the percentages of stimulated axonal pathways that are anatomically adjacent to the STN and known to play a major role in vestibular information processing. We performed correlation analyses to investigate the extent of these white matter tracts' involvement in heading perception. Significant positive correlations were identified between improved heading discrimination for rightward heading and the percentage of activated streamlines of the contralateral hyperdirect, pallido-subthalamic, and subthalamo-pallidal pathways. The hyperdirect pathways are thought to provide top-down control over STN connections to the cerebellum. In addition, STN may also antidromically activate collaterals of hyperdirect pathway that projects to the precerebellar pontine nuclei. In select cases, there was strong activation of the cerebello-thalamic projections, but it was not consistently present in all participants. Large volumetric overlap between the volume of tissue activation and the STN in the left hemisphere positively impacted rightward heading perception. Altogether, the results suggest heavy involvement of basal ganglia cerebellar network in STN-induced modulation of vestibular heading perception in PD.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Camilla Kilbane
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA.
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Farokhniaee A, Palmisano C, Del Vecchio Del Vecchio J, Pezzoli G, Volkmann J, Isaias IU. Gait-related beta-gamma phase amplitude coupling in the subthalamic nucleus of parkinsonian patients. Sci Rep 2024; 14:6674. [PMID: 38509158 PMCID: PMC10954750 DOI: 10.1038/s41598-024-57252-2] [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: 06/15/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Analysis of coupling between the phases and amplitudes of neural oscillations has gained increasing attention as an important mechanism for large-scale brain network dynamics. In Parkinson's disease (PD), preliminary evidence indicates abnormal beta-phase coupling to gamma-amplitude in different brain areas, including the subthalamic nucleus (STN). We analyzed bilateral STN local field potentials (LFPs) in eight subjects with PD chronically implanted with deep brain stimulation electrodes during upright quiet standing and unperturbed walking. Phase-amplitude coupling (PAC) was computed using the Kullback-Liebler method, based on the modulation index. Neurophysiological recordings were correlated with clinical and kinematic measurements and individual molecular brain imaging studies ([123I]FP-CIT and single-photon emission computed tomography). We showed a dopamine-related increase in subthalamic beta-gamma PAC from standing to walking. Patients with poor PAC modulation and low PAC during walking spent significantly more time in the stance and double support phase of the gait cycle. Our results provide new insights into the subthalamic contribution to human gait and suggest cross-frequency coupling as a gateway mechanism to convey patient-specific information of motor control for human locomotion.
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Affiliation(s)
- AmirAli Farokhniaee
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy.
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Gianni Pezzoli
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Ioannis U Isaias
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Spooner RK, Hizli BJ, Bahners BH, Schnitzler A, Florin E. Modulation of DBS-induced cortical responses and movement by the directionality and magnitude of current administered. NPJ Parkinsons Dis 2024; 10:53. [PMID: 38459031 PMCID: PMC10923868 DOI: 10.1038/s41531-024-00663-9] [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: 09/11/2023] [Accepted: 02/16/2024] [Indexed: 03/10/2024] Open
Abstract
Subthalamic deep brain stimulation (STN-DBS) is an effective therapy for alleviating motor symptoms in people with Parkinson's disease (PwP), although some may not receive optimal clinical benefits. One potential mechanism of STN-DBS involves antidromic activation of the hyperdirect pathway (HDP), thus suppressing cortical beta synchrony to improve motor function, albeit the precise mechanisms underlying optimal DBS parameters are not well understood. To address this, 18 PwP with STN-DBS completed a 2 Hz monopolar stimulation of the left STN during MEG. MEG data were imaged in the time-frequency domain using minimum norm estimation. Peak vertex time series data were extracted to interrogate the directional specificity and magnitude of DBS current on evoked and induced cortical responses and accelerometer metrics of finger tapping using linear mixed-effects models and mediation analyses. We observed increases in evoked responses (HDP ~ 3-10 ms) and synchronization of beta oscillatory power (14-30 Hz, 10-100 ms) following DBS pulse onset in the primary sensorimotor cortex (SM1), supplementary motor area (SMA) and middle frontal gyrus (MFG) ipsilateral to the site of stimulation. DBS parameters significantly modulated neural and behavioral outcomes, with clinically effective contacts eliciting significant increases in medium-latency evoked responses, reductions in induced SM1 beta power, and better movement profiles compared to suboptimal contacts, often regardless of the magnitude of current applied. Finally, HDP-related improvements in motor function were mediated by the degree of SM1 beta suppression in a setting-dependent manner. Together, these data suggest that DBS-evoked brain-behavior dynamics are influenced by the level of beta power in key hubs of the basal ganglia-cortical loop, and this effect is exacerbated by the clinical efficacy of DBS parameters. Such data provides novel mechanistic and clinical insight, which may prove useful for characterizing DBS programming strategies to optimize motor symptom improvement in the future.
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Affiliation(s)
- Rachel K Spooner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Baccara J Hizli
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
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9
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Bingham CS, McIntyre CC. Coupled Activation of the Hyperdirect and Cerebellothalamic Pathways with Zona Incerta Deep Brain Stimulation. Mov Disord 2024; 39:539-545. [PMID: 38321526 PMCID: PMC10963140 DOI: 10.1002/mds.29717] [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: 03/28/2023] [Revised: 10/18/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or ventral intermediate nucleus (VIM) are established targets for the treatment of Parkinson's disease (PD) or essential tremor (ET), respectively. However, DBS of the zona incerta (ZI) can be effective for both disorders. VIM DBS is assumed to achieve its therapeutic effect via activation of the cerebellothalamic (CBT) pathway, whereas the activation of the hyperdirect (HD) pathway likely plays a role in the mechanisms of STN DBS. Interestingly, HD pathway axons also emit collaterals to the ZI and red nucleus (RN) and the CBT pathway courses nearby to the ZI. OBJECTIVE The aim was to examine the ability of ZI DBS to mutually activate the HD and CBT pathways in a detailed computational model of human DBS. METHODS We extended a previous model of the human HD pathway to incorporate axon collaterals to the ZI and RN. The anatomical framework of the model system also included representations of the CBT pathway and internal capsule (IC) fibers of passage. We then performed detailed biophysical simulations to quantify DBS activation of the HD, CBT, and IC pathways with electrodes located in either the STN or ZI. RESULTS STN DBS and ZI DBS both robustly activated the HD pathway. However, STN DBS was limited by IC activation at higher stimulus amplitudes. Alternatively, ZI DBS avoided IC activation while simultaneously activating the HD and CBT pathways. CONCLUSIONS From both neuroanatomical and biophysical perspectives, ZI DBS represents an advantageous target for coupled activation of the HD and CBT pathways. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Clayton S. Bingham
- Department of Biomedical Engineering, Duke University, Durham, N.C. 27708
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Duke University, Durham, N.C. 27708
- Department of Neurosurgery, Duke University, Durham, N.C. 27708
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Oswal A, Abdi‐Sargezeh B, Sharma A, Özkurt TE, Taulu S, Sarangmat N, Green AL, Litvak V. Spatiotemporal signal space separation for regions of interest: Application for extracting neuromagnetic responses evoked by deep brain stimulation. Hum Brain Mapp 2024; 45:e26602. [PMID: 38339906 PMCID: PMC10826894 DOI: 10.1002/hbm.26602] [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: 07/03/2023] [Revised: 11/18/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
Magnetoencephalography (MEG) recordings are often contaminated by interference that can exceed the amplitude of physiological brain activity by several orders of magnitude. Furthermore, the activity of interference sources may spatially extend (known as source leakage) into the activity of brain signals of interest, resulting in source estimation inaccuracies. This problem is particularly apparent when using MEG to interrogate the effects of brain stimulation on large-scale cortical networks. In this technical report, we develop a novel denoising approach for suppressing the leakage of interference source activity into the activity representing a brain region of interest. This approach leverages spatial and temporal domain projectors for signal arising from prespecified anatomical regions of interest. We apply this denoising approach to reconstruct simulated evoked response topographies to deep brain stimulation (DBS) in a phantom recording. We highlight the advantages of our approach compared to the benchmark-spatiotemporal signal space separation-and show that it can more accurately reveal brain stimulation-evoked response topographies. Finally, we apply our method to MEG recordings from a single patient with Parkinson's disease, to reveal early cortical-evoked responses to DBS of the subthalamic nucleus.
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Affiliation(s)
- Ashwini Oswal
- MRC Brain Network Dynamics UnitUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- The Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
- Department of NeurologyJohn Radcliffe HospitalOxfordUK
| | - Bahman Abdi‐Sargezeh
- MRC Brain Network Dynamics UnitUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Abhinav Sharma
- MRC Brain Network Dynamics UnitUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Tolga Esat Özkurt
- Graduate School of InformaticsMiddle East Technical UniversityAnkaraTurkey
| | - Samu Taulu
- Department of PhysicsUniversity of WashingtonSeattleWashingtonUSA
- Institute for Learning and Brain SciencesUniversity of WashingtonSeattleWashingtonUSA
| | | | - Alexander L. Green
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Vladimir Litvak
- The Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
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11
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Noetscher GM, Tang D, Nummenmaa AR, Bingham CS, McIntyre CC, Makaroff SN. Estimations of Charge Deposition Onto Convoluted Axon Surfaces Within Extracellular Electric Fields. IEEE Trans Biomed Eng 2024; 71:307-317. [PMID: 37535481 PMCID: PMC10837334 DOI: 10.1109/tbme.2023.3299734] [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] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Biophysical models of neural stimulation are a valuable approach to explaining the mechanisms of neuronal recruitment via applied extracellular electric fields. Typically, the applied electric field is estimated via a macroscopic finite element method solution and then applied to cable models as an extracellular voltage source. However, the field resolution is limited by the finite element size (typically 10's-100's of times greater than average neuronal cross-section). As a result, induced charges deposited onto anatomically realistic curved membrane interfaces are not taken into consideration. However, these details may alter estimates of the applied electric field and predictions of neural tissue activation. METHODS To estimate microscopic variations of the electric field, data for intra-axonal space segmented from 3D scanning electron microscopy of the mouse brain genu of corpus callosum were used. The boundary element fast multipole method was applied to accurately compute the extracellular solution. Neuronal recruitment was then estimated via an activating function. RESULTS Taking the physical structure of the arbor into account generally predicts higher values of the activating function. The relative integral 2-norm difference is 90% on average when the entire axonal arbor is present. A large fraction of this difference might be due to the axonal body itself. When an isolated physical axon is considered with all other axons removed, the relative integral 2-norm difference between the single-axon solution and the complete solution is 25% on average. CONCLUSION Our result may provide an explanation as to why Deep Brain Stimulation experiments typically predict lower activation thresholds than commonly used FEM/Cable model approaches to predicting neuronal responses to extracellular electrical stimulation. SIGNIFICANCE These results may change methods for bi-domain neural modeling and neural excitation.
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12
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Conner CR, Forseth KJ, Lozano AM, Ritter R, Fenoy AJ. Thalamo-cortical evoked potentials during stimulation of the dentato-rubro-thalamic tract demonstrate synaptic filtering. Neurotherapeutics 2024; 21:e00295. [PMID: 38237402 PMCID: PMC10903089 DOI: 10.1016/j.neurot.2023.10.005] [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: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 02/16/2024] Open
Abstract
Essential tremor DBS targeting the ventral intermediate nucleus (Vim) of the thalamus and its input, the dentato-rubro-thalamic tract (DRTt), has proven to be an effective treatment strategy. We examined thalamo-cortical evoked potentials (TCEPs) and cortical dynamics during stimulation of the DRTt. We recorded TCEPs in primary motor cortex during clinical and supra-clinical stimulation of the DRTt in ten essential tremor patients. Stimulation was varied over pulse amplitude (2-10 mA) and pulse width (30-250 μs) to allow for strength-duration testing. Testing at clinical levels (3 mA, 60 μs) for stimulation frequencies of 1-160 Hz was performed and phase amplitude coupling (PAC) of beta phase and gamma power was calculated. Primary motor cortex TCEPs displayed two responses: early and all-or-none (<20 ms) or delayed and charge-dependent (>50 ms). Strength-duration curve approximation indicates that the chronaxie of the neural elements related to the TCEPs is <200 μs. At the range of clinical stimulation (amplitude 2-5 mA, pulse width 30-60 μs), TCEPs were not noted over primary motor cortex. Decreased pathophysiological phase-amplitude coupling was seen above 70 Hz stimulation without changes in power spectra and below the threshold of TCEPs. Our findings demonstrate that DRTt stimulation within normal clinical bounds does not excite fibers directly connected with primary motor cortex but that supra-clinical stimulation can excite a direct axonal tract. Both clinical efficacy and phase-amplitude coupling were frequency-dependent, favoring a synaptic filtering model as a possible mechanism of action.
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Affiliation(s)
- Christopher R Conner
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Hartford, CT, USA.
| | - Kiefer J Forseth
- Division of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Ritter
- Department of Neurosurgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Albert J Fenoy
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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13
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Evangelisti S, Boessenkool S, Pflanz CP, Basting R, Betts JF, Jenkinson M, Clare S, Muhammed K, LeHeron C, Armstrong R, Klein JC, Husain M, Nemeth AH, Hu MT, Douaud G. Subthalamic nucleus shows opposite functional connectivity pattern in Huntington's and Parkinson's disease. Brain Commun 2023; 5:fcad282. [PMID: 38075949 PMCID: PMC10699743 DOI: 10.1093/braincomms/fcad282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/26/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
Huntington's and Parkinson's disease are two movement disorders representing mainly opposite states of the basal ganglia inhibitory function. Despite being an integral part of the cortico-subcortico-cortical circuitry, the subthalamic nucleus function has been studied at the level of detail required to isolate its signal only through invasive studies in Huntington's and Parkinson's disease. Here, we tested whether the subthalamic nucleus exhibited opposite functional signatures in early Huntington's and Parkinson's disease. We included both movement disorders in the same whole-brain imaging study, and leveraged ultra-high-field 7T MRI to achieve the very fine resolution needed to investigate the smallest of the basal ganglia nuclei. Eleven of the 12 Huntington's disease carriers were recruited at a premanifest stage, while 16 of the 18 Parkinson's disease patients only exhibited unilateral motor symptoms (15 were at Stage I of Hoehn and Yahr off medication). Our group comparison interaction analyses, including 24 healthy controls, revealed a differential effect of Huntington's and Parkinson's disease on the functional connectivity at rest of the subthalamic nucleus within the sensorimotor network, i.e. an opposite effect compared with their respective age-matched healthy control groups. This differential impact in the subthalamic nucleus included an area precisely corresponding to the deep brain stimulation 'sweet spot'-the area with maximum overall efficacy-in Parkinson's disease. Importantly, the severity of deviation away from controls' resting-state values in the subthalamic nucleus was associated with the severity of motor and cognitive symptoms in both diseases, despite functional connectivity going in opposite directions in each disorder. We also observed an altered, opposite impact of Huntington's and Parkinson's disease on functional connectivity within the sensorimotor cortex, once again with relevant associations with clinical symptoms. The high resolution offered by the 7T scanner has thus made it possible to explore the complex interplay between the disease effects and their contribution on the subthalamic nucleus, and sensorimotor cortex. Taken altogether, these findings reveal for the first time non-invasively in humans a differential, clinically meaningful impact of the pathophysiological process of these two movement disorders on the overall sensorimotor functional connection of the subthalamic nucleus and sensorimotor cortex.
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Affiliation(s)
- Stefania Evangelisti
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy
| | - Sirius Boessenkool
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Chris Patrick Pflanz
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
- Stroke Research Group, Department of Clinical Neuroscience, University of Cambridge, CB2 0QQ Cambridge, UK
| | - Romina Basting
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
- Department of Experimental Psychology, University of Oxford, OX2 6GG Oxford, UK
| | - Jill F Betts
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Mark Jenkinson
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
- School of Computer Science, Faculty of Engineering, University of Adelaide, 5005 Adelaide, Australia
| | - Stuart Clare
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Campbell LeHeron
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
- New Zealand Brain Research Institute, 8011 Christchurch, New Zealand
| | - Richard Armstrong
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Johannes C Klein
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Masud Husain
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
- Department of Experimental Psychology, University of Oxford, OX2 6GG Oxford, UK
| | - Andrea H Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
| | - Gwenaëlle Douaud
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU Oxford, UK
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14
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Neumann WJ, Steiner LA, Milosevic L. Neurophysiological mechanisms of deep brain stimulation across spatiotemporal resolutions. Brain 2023; 146:4456-4468. [PMID: 37450573 PMCID: PMC10629774 DOI: 10.1093/brain/awad239] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/04/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Deep brain stimulation is a neuromodulatory treatment for managing the symptoms of Parkinson's disease and other neurological and psychiatric disorders. Electrodes are chronically implanted in disease-relevant brain regions and pulsatile electrical stimulation delivery is intended to restore neurocircuit function. However, the widespread interest in the application and expansion of this clinical therapy has preceded an overarching understanding of the neurocircuit alterations invoked by deep brain stimulation. Over the years, various forms of neurophysiological evidence have emerged which demonstrate changes to brain activity across spatiotemporal resolutions; from single neuron, to local field potential, to brain-wide cortical network effects. Though fruitful, such studies have often led to debate about a singular putative mechanism. In this Update we aim to produce an integrative account of complementary instead of mutually exclusive neurophysiological effects to derive a generalizable concept of the mechanisms of deep brain stimulation. In particular, we offer a critical review of the most common historical competing theories, an updated discussion on recent literature from animal and human neurophysiological studies, and a synthesis of synaptic and network effects of deep brain stimulation across scales of observation, including micro-, meso- and macroscale circuit alterations.
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Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Leon A Steiner
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
- Department of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto M5T 1M8, Canada
| | - Luka Milosevic
- Department of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto M5T 1M8, Canada
- Institute of Biomedical Engineering, Institute of Medical Sciences, and CRANIA Neuromodulation Institute, University of Toronto, Toronto M5S 3G9, Canada
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15
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Zapata Amaya V, Aman JE, Johnson LA, Wang J, Patriat R, Hill ME, MacKinnon CD, Cooper SE, Darrow D, McGovern R, Harel N, Molnar GF, Park MC, Vitek JL, Escobar Sanabria D. Low-frequency deep brain stimulation reveals resonant beta-band evoked oscillations in the pallidum of Parkinson's Disease patients. Front Hum Neurosci 2023; 17:1178527. [PMID: 37810764 PMCID: PMC10556241 DOI: 10.3389/fnhum.2023.1178527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Evidence suggests that spontaneous beta band (11-35 Hz) oscillations in the basal ganglia thalamocortical (BGTC) circuit are linked to Parkinson's disease (PD) pathophysiology. Previous studies on neural responses in the motor cortex evoked by electrical stimulation in the subthalamic nucleus have suggested that circuit resonance may underlie the generation of spontaneous and stimulation-evoked beta oscillations in PD. Whether these stimulation-evoked, resonant oscillations are present across PD patients in the internal segment of the globus pallidus (GPi), a primary output nucleus in the BGTC circuit, is yet to be determined. Methods We characterized spontaneous and stimulation-evoked local field potentials (LFPs) in the GPi of four PD patients (five hemispheres) using deep brain stimulation (DBS) leads externalized after DBS implantation surgery. Results Our analyses show that low-frequency (2-4 Hz) stimulation in the GPi evoked long-latency (>50 ms) beta-band neural responses in the GPi in 4/5 hemispheres. We demonstrated that neural sources generating both stimulation-evoked and spontaneous beta oscillations were correlated in their frequency content and spatial localization. Discussion Our results support the hypothesis that the same neuronal population and resonance phenomenon in the BGTC circuit generates both spontaneous and evoked pallidal beta oscillations. These data also support the development of closed-loop control systems that modulate the GPi spontaneous oscillations across PD patients using beta band stimulation-evoked responses.
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Affiliation(s)
| | - Joshua E Aman
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Luke A Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Remi Patriat
- Department of Radiology, University of Minnesota, Minneapolis, MN, United States
| | - Meghan E Hill
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Scott E Cooper
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Robert McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Noam Harel
- Department of Radiology, University of Minnesota, Minneapolis, MN, United States
| | - Gregory F Molnar
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
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16
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Barbosa DAN, Gattas S, Salgado JS, Kuijper FM, Wang AR, Huang Y, Kakusa B, Leuze C, Luczak A, Rapp P, Malenka RC, Hermes D, Miller KJ, Heifets BD, Bohon C, McNab JA, Halpern CH. An orexigenic subnetwork within the human hippocampus. Nature 2023; 621:381-388. [PMID: 37648849 PMCID: PMC10499606 DOI: 10.1038/s41586-023-06459-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Abstract
Only recently have more specific circuit-probing techniques become available to inform previous reports implicating the rodent hippocampus in orexigenic appetitive processing1-4. This function has been reported to be mediated at least in part by lateral hypothalamic inputs, including those involving orexigenic lateral hypothalamic neuropeptides, such as melanin-concentrating hormone5,6. This circuit, however, remains elusive in humans. Here we combine tractography, intracranial electrophysiology, cortico-subcortical evoked potentials, and brain-clearing 3D histology to identify an orexigenic circuit involving the lateral hypothalamus and converging in a hippocampal subregion. We found that low-frequency power is modulated by sweet-fat food cues, and this modulation was specific to the dorsolateral hippocampus. Structural and functional analyses of this circuit in a human cohort exhibiting dysregulated eating behaviour revealed connectivity that was inversely related to body mass index. Collectively, this multimodal approach describes an orexigenic subnetwork within the human hippocampus implicated in obesity and related eating disorders.
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Affiliation(s)
- Daniel A N Barbosa
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Gattas
- Department of Electrical Engineering and Computer Science, University of California, Irvine, Irvine, CA, USA
| | - Juliana S Salgado
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Fiene Marie Kuijper
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
- Université Paris Cité, Paris, France
- Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Allan R Wang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuhao Huang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Bina Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Christoph Leuze
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Artur Luczak
- Canadian Centre for Behavioral Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Paul Rapp
- Department of Military & Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Robert C Malenka
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Dora Hermes
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A McNab
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
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17
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Campbell BA, Favi Bocca L, Tiefenbach J, Hogue O, Nagel SJ, Rammo R, Escobar Sanabria D, Machado AG, Baker KB. Myogenic and cortical evoked potentials vary as a function of stimulus pulse geometry delivered in the subthalamic nucleus of Parkinson's disease patients. Front Neurol 2023; 14:1216916. [PMID: 37693765 PMCID: PMC10484227 DOI: 10.3389/fneur.2023.1216916] [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: 05/04/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction The therapeutic efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) may be limited for some patients by the presence of stimulation-related side effects. Such effects are most often attributed to electrical current spread beyond the target region. Prior computational modeling studies have suggested that changing the degree of asymmetry of the individual phases of the biphasic, stimulus pulse may allow for more selective activation of neural elements in the target region. To the extent that different neural elements contribute to the therapeutic vs. side-effect inducing effects of DBS, such improved selectivity may provide a new parameter for optimizing DBS to increase the therapeutic window. Methods We investigated the effect of six different pulse geometries on cortical and myogenic evoked potentials in eight patients with PD whose leads were temporarily externalized following STN DBS implant surgery. DBS-cortical evoked potentials were quantified using peak to peak measurements and wavelets and myogenic potentials were quantified using RMS. Results We found that the slope of the recruitment curves differed significantly as a function of pulse geometry for both the cortical- and myogenic responses. Notably, this effect was observed most frequently when stimulation was delivered using a monopolar, as opposed to a bipolar, configuration. Discussion Manipulating pulse geometry results in differential physiological effects at both the cortical and neuromuscular level. Exploiting these differences may help to expand DBS' therapeutic window and support the potential for incorporating pulse geometry as an additional parameter for optimizing therapeutic benefit.
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Affiliation(s)
- Brett A. Campbell
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
| | - Leonardo Favi Bocca
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
| | - Jakov Tiefenbach
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia Hogue
- Center for Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Sean J. Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Richard Rammo
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - David Escobar Sanabria
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G. Machado
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Kenneth B. Baker
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States
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18
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Pellegrini F, Delorme A, Nikulin V, Haufe S. Identifying good practices for detecting inter-regional linear functional connectivity from EEG. Neuroimage 2023; 277:120218. [PMID: 37307866 PMCID: PMC10374983 DOI: 10.1016/j.neuroimage.2023.120218] [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: 03/14/2023] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Aggregating voxel-level statistical dependencies between multivariate time series is an important intermediate step when characterising functional connectivity (FC) between larger brain regions. However, there are numerous ways in which voxel-level data can be aggregated into inter-regional FC, and the advantages of each of these approaches are currently unclear. In this study we generate ground-truth data and compare the performances of various pipelines that estimate directed and undirected linear phase-to-phase FC between regions. We test the ability of several existing and novel FC analysis pipelines to identify the true regions within which connectivity was simulated. We test various inverse modelling algorithms, strategies to aggregate time series within regions, and connectivity metrics. Furthermore, we investigate the influence of the number of interactions, the signal-to-noise ratio, the noise mix, the interaction time delay, and the number of active sources per region on the ability of detecting phase-to-phase FC. Throughout all simulated scenarios, lowest performance is obtained with pipelines involving the absolute value of coherency. Further, the combination of dynamic imaging of coherent sources (DICS) beamforming with directed FC metrics that aggregate information across multiple frequencies leads to unsatisfactory results. Pipelines that show promising results with our simulated pseudo-EEG data involve the following steps: (1) Source projection using the linearly-constrained minimum variance (LCMV) beamformer. (2) Principal component analysis (PCA) using the same fixed number of components within every region. (3) Calculation of the multivariate interaction measure (MIM) for every region pair to assess undirected phase-to-phase FC, or calculation of time-reversed Granger Causality (TRGC) to assess directed phase-to-phase FC. We formulate recommendations based on these results that may increase the validity of future experimental connectivity studies. We further introduce the free ROIconnect plugin for the EEGLAB toolbox that includes the recommended methods and pipelines that are presented here. We show an exemplary application of the best performing pipeline to the analysis of EEG data recorded during motor imagery.
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Affiliation(s)
- Franziska Pellegrini
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany; Bernstein Center for Computational Neuroscience, Philippstraße 13, Berlin, 10117, Germany.
| | - Arnaud Delorme
- Swartz Center for Computational Neuroscience, 9500 Gilman Dr., La Jolla, California, 92903-0559, United States
| | - Vadim Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Stephanstraße 1a, Leipzig, 04103, Germany
| | - Stefan Haufe
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany; Bernstein Center for Computational Neuroscience, Philippstraße 13, Berlin, 10117, Germany; Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623, Germany; Physikalisch-Technische Bundesanstalt Braunschweig und Berlin, Abbestraße 2-12, Berlin, 10587, Germany
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19
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Rangel BO, Novembre G, Wessel JR. Measuring the nonselective effects of motor inhibition using isometric force recordings. Behav Res Methods 2023:10.3758/s13428-023-02197-z. [PMID: 37550468 DOI: 10.3758/s13428-023-02197-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
Inhibition is a key cognitive control mechanism humans use to enable goal-directed behavior. When rapidly exerted, inhibitory control has broad, nonselective motor effects, typically demonstrated using corticospinal excitability measurements (CSE) elicited by transcranial magnetic stimulation (TMS). For example, during rapid action-stopping, CSE is suppressed at both stopped and task-unrelated muscles. While such TMS-based CSE measurements have provided crucial insights into the fronto-basal ganglia circuitry underlying inhibitory control, they have several downsides. TMS is contraindicated in many populations (e.g., epilepsy or deep-brain stimulation patients), has limited temporal resolution, produces distracting auditory and haptic stimulation, is difficult to combine with other imaging methods, and necessitates expensive, immobile equipment. Here, we attempted to measure the nonselective motor effects of inhibitory control using a method unaffected by these shortcomings. Thirty male and female human participants exerted isometric force on a high-precision handheld force transducer while performing a foot-response stop-signal task. Indeed, when foot movements were successfully stopped, force output at the task-irrelevant hand was suppressed as well. Moreover, this nonselective reduction of isometric force was highly correlated with stop-signal performance and showed frequency dynamics similar to established inhibitory signatures typically found in neural and muscle recordings. Together, these findings demonstrate that isometric force recordings can reliably capture the nonselective effects of motor inhibition, opening the door to many applications that are hard or impossible to realize with TMS.
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Affiliation(s)
- Benjamin O Rangel
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA, 52245, USA.
- Cognitive Control Collaborative, University of Iowa, Iowa City, IA, 52245, USA.
- University of Iowa, 444 Medical Research Center, Iowa City, IA, 52242, USA.
| | - Giacomo Novembre
- Neuroscience of Perception & Action Laboratory, Italian Institute of Technology, Rome, Italy
| | - Jan R Wessel
- Cognitive Control Collaborative, University of Iowa, Iowa City, IA, 52245, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52245, USA
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
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20
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Makaroff SN, Nummenmaa AR, Noetscher GM, Qi Z, McIntyre CC, Bingham CS. Influence of charges deposited on membranes of human hyperdirect pathway axons on depolarization during subthalamic deep brain stimulation. J Neural Eng 2023; 20:10.1088/1741-2552/ace5de. [PMID: 37429285 PMCID: PMC10542971 DOI: 10.1088/1741-2552/ace5de] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/10/2023] [Indexed: 07/12/2023]
Abstract
Objective.The motor hyperdirect pathway (HDP) is a key target in the treatment of Parkinson's disease with deep brain stimulation (DBS). Biophysical models of HDP DBS have been used to explore the mechanisms of stimulation. Built upon finite element method volume conductor solutions, such models are limited by a resolution mismatch, where the volume conductor is modeled at the macro scale, while the neural elements are at the micro scale. New techniques are needed to better integrate volume conductor models with neuron models.Approach.We simulated subthalamic DBS of the human HDP using finely meshed axon models to calculate surface charge deposition on insulting membranes of nonmyelinated axons. We converted the corresponding double layer extracellular problem to a single layer problem and applied the well-conditioned charge-based boundary element fast multipole method (BEM-FMM) with unconstrained numerical spatial resolution. Commonly used simplified estimations of membrane depolarization were compared with more realistic solutions.Main result.Neither centerline potential nor estimates of axon recruitment were impacted by the estimation method used except at axon bifurcations and hemispherical terminations. Local estimates of axon polarization were often much higher at bifurcations and terminations than at any other place along the axon and terminal arbor. Local average estimates of terminal electric field are higher by 10%-20%.Significance. Biophysical models of action potential initiation in the HDP suggest that axon terminations are often the lowest threshold elements for activation. The results of this study reinforce that hypothesis and suggest that this phenomenon is even more pronounced than previously realized.
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Affiliation(s)
- Sergey N Makaroff
- Electrical and Computer Engineering Department, Worcester Polytechnic Institution, Worcester, MA 01609, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Aapo R Nummenmaa
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Gregory M Noetscher
- Electrical and Computer Engineering Department, Worcester Polytechnic Institution, Worcester, MA 01609, United States of America
- ARMY DEVCOM-SC, General Greene Ave, Natick, MA 01760, United States of America
| | - Zhen Qi
- Electrical and Computer Engineering Department, Worcester Polytechnic Institution, Worcester, MA 01609, United States of America
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
- Department of Neurosurgery, Duke University, Durham, NC 27710, United States of America
| | - Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
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21
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Cassar IR, Grill WM. The Therapeutic Frequency Profile of Subthalamic Nucleus Deep Brain Stimulation in Rats Is Shaped by Antidromic Spike Failure. J Neurosci 2023; 43:5114-5127. [PMID: 37328290 PMCID: PMC10324992 DOI: 10.1523/jneurosci.1798-22.2023] [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: 09/20/2022] [Revised: 05/22/2023] [Accepted: 06/10/2023] [Indexed: 06/18/2023] Open
Abstract
The therapeutic mechanisms of subthalamic nucleus (STN) deep brain stimulation (DBS) may depend on antidromic activation of cortex via the hyperdirect pathway. However, hyperdirect pathway neurons cannot reliably follow high-stimulation frequencies, and the spike failure rate appears to correlate with symptom relief as a function of stimulation frequency. We hypothesized that antidromic spike failure contributes to the cortical desynchronization caused by DBS. We measured in vivo evoked cortical activity in female Sprague Dawley rats and developed a computational model of cortical activation from STN DBS. We modeled stochastic antidromic spike failure to determine how spike failure affected the desynchronization of pathophysiological oscillatory activity in cortex. We found that high-frequency STN DBS desynchronized pathologic oscillations via the masking of intrinsic spiking through a combination of spike collision, refractoriness, and synaptic depletion. Antidromic spike failure shaped the parabolic relationship between DBS frequency and cortical desynchronization, with maximum desynchronization at ∼130 Hz. These findings reveal that antidromic spike failure plays a critical role in mediating the dependency of symptom relief on stimulation frequency.SIGNIFICANCE STATEMENT Deep brain stimulation (DBS) is a highly effective neuromodulation therapy, yet it remains uncertain why conventionally used stimulation frequencies (e.g., ∼130 Hz) are optimal. In this study, we demonstrate a potential explanation for the stimulation frequency dependency of DBS through a combination of in vivo experimental measurements and computational modeling. We show that high-frequency stimulation can desynchronize pathologic firing patterns in populations of neurons by inducing an informational lesion. However, sporadic spike failure at these high frequencies limits the efficacy of the informational lesion, yielding a parabolic profile with optimal effects at ∼130 Hz. This work provides a potential explanation for the therapeutic mechanism of DBS, and highlights the importance of considering spike failure in mechanistic models of DBS.
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Affiliation(s)
- Isaac R Cassar
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708
- Departments of Electrical and Computer Engineering, Neurobiology, and Neurosurgery, Duke University, Durham, North Carolina 27708
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22
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Neumann WJ, Horn A, Kühn AA. Insights and opportunities for deep brain stimulation as a brain circuit intervention. Trends Neurosci 2023; 46:472-487. [PMID: 37105806 DOI: 10.1016/j.tins.2023.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
Deep brain stimulation (DBS) is an effective treatment and has provided unique insights into the dynamic circuit architecture of brain disorders. This Review illustrates our current understanding of the pathophysiology of movement disorders and their underlying brain circuits that are modulated with DBS. It proposes principles of pathological network synchronization patterns like beta activity (13-35 Hz) in Parkinson's disease. We describe alterations from microscale including local synaptic activity via modulation of mesoscale hypersynchronization to changes in whole-brain macroscale connectivity. Finally, an outlook on advances for clinical innovations in next-generation neurotechnology is provided: from preoperative connectomic targeting to feedback controlled closed-loop adaptive DBS as individualized network-specific brain circuit interventions.
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Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt Universität zu Berlin, Berlin, Germany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt Universität zu Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; MGH Neurosurgery & Center for Neurotechnology and Neurorecovery at MGH Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt Universität zu Berlin, Berlin, Germany; NeuroCure Clinical Research Centre, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; DZNE, German Center for Degenerative Diseases, Berlin, Germany.
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23
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Agharazi H, Hardin EC, Flannery K, Beylergil SB, Noecker A, Kilbane C, Factor SA, McIntyre C, Shaikh AG. Physiological measures and anatomical correlates of subthalamic deep brain stimulation effect on gait in Parkinson's disease. J Neurol Sci 2023; 449:120647. [PMID: 37100017 DOI: 10.1016/j.jns.2023.120647] [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: 12/03/2022] [Revised: 03/25/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
We examined whether conflicting visual and non-visual information leads to gait abnormalities and how the subthalamic deep brain stimulation (STN DBS) influences gait dysfunction in Parkinson's disease (PD). We used a motion capture system to measure the kinematics of the lower limbs during treadmill walking in immersive virtual reality. The visual information provided in the virtual reality paradigm was modulated to create a mismatch between the optic-flow velocity of the visual scene and the walking speed on the treadmill. In each mismatched condition, we calculated the step duration, step length, step phase, step height, and asymmetries. The key finding of our study was that mismatch between treadmill walking speed and the optic-flow velocity did not consistently alter gait parameters in PD. We also found that STN DBS improved the PD gait pattern by changing the stride length and step height. The effects on phase and left/right asymmetry were not statistically significant. The DBS parameters and location also determined its effects on gait. Statistical effects on stride length and step height were noted when the DBS volume of activated tissue (VTA) was in the dorsal aspect of the subthalamus. The statistically significant effects of STN DBS was present when VTA significantly overlapped with MR tractogrphically measured motor and pre-motor hyperdirect pathways. In summary, our results provide novel insight into ways for controlling walking behavior in PD using STN DBS.
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Affiliation(s)
- Hanieh Agharazi
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Elizabeth C Hardin
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
| | - Katherine Flannery
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | | | - Angela Noecker
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Camilla Kilbane
- Neurological Institute, University Hospitals, Cleveland, OH, United States of America; Department of Neurology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States of America
| | - Cameron McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Aasef G Shaikh
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America; Neurological Institute, University Hospitals, Cleveland, OH, United States of America; Department of Neurology, Case Western Reserve University, Cleveland, OH, United States of America; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.
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24
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DBS-evoked cortical responses index optimal contact orientations and motor outcomes in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:37. [PMID: 36906723 PMCID: PMC10008535 DOI: 10.1038/s41531-023-00474-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/13/2023] [Indexed: 03/13/2023] Open
Abstract
Although subthalamic deep brain stimulation (DBS) is a highly-effective treatment for alleviating motor dysfunction in patients with Parkinson's disease (PD), clinicians currently lack reliable neurophysiological correlates of clinical outcomes for optimizing DBS parameter settings, which may contribute to treatment inefficacies. One parameter that could aid DBS efficacy is the orientation of current administered, albeit the precise mechanisms underlying optimal contact orientations and associated clinical benefits are not well understood. Herein, 24 PD patients received monopolar stimulation of the left STN during magnetoencephalography and standardized movement protocols to interrogate the directional specificity of STN-DBS current administration on accelerometer metrics of fine hand movements. Our findings demonstrate that optimal contact orientations elicit larger DBS-evoked cortical responses in the ipsilateral sensorimotor cortex, and importantly, are differentially predictive of smoother movement profiles in a contact-dependent manner. Moreover, we summarize traditional evaluations of clinical efficacy (e.g., therapeutic windows, side effects) for a comprehensive review of optimal/non-optimal STN-DBS contact settings. Together, these data suggest that DBS-evoked cortical responses and quantitative movement outcomes may provide clinical insight for characterizing the optimal DBS parameters necessary for alleviating motor symptoms in patients with PD in the future.
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25
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Bahners BH, Spooner RK, Hartmann CJ, Schnitzler A, Florin E. Subthalamic stimulation evoked cortical responses relate to motor performance in Parkinson's disease. Brain Stimul 2023; 16:561-563. [PMID: 36878426 DOI: 10.1016/j.brs.2023.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/04/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Rachel K Spooner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Christian J Hartmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany; Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany; Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany.
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26
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Bingham CS, Petersen MV, Parent M, McIntyre CC. Evolving characterization of the human hyperdirect pathway. Brain Struct Funct 2023; 228:353-365. [PMID: 36708394 PMCID: PMC10716731 DOI: 10.1007/s00429-023-02610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
The hyperdirect pathway (HDP) represents the main glutamatergic input to the subthalamic nucleus (STN), through which the motor and prefrontal cerebral cortex can modulate basal ganglia activity. Further, direct activation of the motor HDP is thought to be an important component of therapeutic deep brain stimulation (DBS), mediating the disruption of pathological oscillations. Alternatively, unintended recruitment of the prefrontal HDP may partly explain some cognitive side effects of DBS therapy. Previous work describing the HDP has focused on non-human primate (NHP) histological pathway tracings, diffusion-weighted MRI analysis of human white matter, and electrophysiology studies involving paired cortical recordings with DBS. However, none of these approaches alone yields a complete understanding of the complexities of the HDP. As such, we propose that generative modeling methods hold promise to bridge anatomy and physiology results, from both NHPs and humans, into a more detailed representation of the human HDP. Nonetheless, numerous features of the HDP remain to be experimentally described before model-based methods can simulate corticosubthalamic activity with a high degree of scientific detail. Therefore, the goals of this review are to examine the experimental evidence for HDP projections from across the primate neocortex and discuss new data which are required to improve the utility of anatomical and biophysical models of the human corticosubthalamic system.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Martin Parent
- Department of Psychiatry and Neuroscience, Laval University, Quebec, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Neurosurgery, Duke University, Durham, NC, USA.
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27
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Schultz KE, Mantell B, Berkman ET, Swann NC. Prepared and reactive inhibition in smokers and non-smokers. Behav Brain Res 2023; 437:114120. [PMID: 36181947 PMCID: PMC9926641 DOI: 10.1016/j.bbr.2022.114120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Models of addiction have identified deficits in inhibitory control, or the ability to inhibit inappropriate or unwanted behaviors, as one factor in the development and maintenance of addictive behaviors. Current literature supports disruption of the prefrontal circuits that mediate reactive inhibitory control processes (i.e., inhibition in response to sudden, unplanned changes in environmental demands) in substance use disorders. However, the relationship between disorders of addiction, such as nicotine dependence, and planned inhibitory processes (i.e., inhibition that occurs after advance warning) is unclear. The goal of the present study was to examine the extent to which reactive and planned inhibitory processes are differentially disrupted in nicotine dependent individuals. METHOD We employed an internet-based novel stop signal task wherein participants were instructed to stop a continuous movement at either a predictable or unpredictable time. This task explicitly separated planned and reactive inhibitory processes and assessed group differences in task performance between smokers (N = 281) and non-smokers (N = 164). The smoker group was defined as any participant that identified as a smoker and reported an average daily nicotine consumption of at least 2 mg. The non-smoker group was defined as any participant that identified as a non-smoker and had not been a former smoker that quit within the last year. The smoker group also completed a questionnaire regarding smoking behaviors which included the Fägerstrom Test of Nicotine Dependence (FTND). We used these data to assess the continuous relation between planned stopping, unplanned stopping, and smoking behaviors. RESULTS We found significant differences in stop times for both reactive and planned stopping between groups as well as within the smoker group. Additionally, in the smoker group, dependence as measured by the FTND was associated with longer stop times on planned stop trials. Surprisingly, greater daily average consumption of nicotine was related to faster stopping for both trial types. CONCLUSION These results indicate the relevance of measuring both reactive and planned inhibitory processes for elucidating the relationship between nicotine addiction and mechanisms of inhibitory control.
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Affiliation(s)
- Kelsey E. Schultz
- Department of Biology, University of Oregon, USA,Department of Human Physiology, University of Oregon, USA,Institute of Neuroscience, University of Oregon, USA,Corresponding author at: Department of Biology, University of Oregon, USA. (K.E. Schultz)
| | | | - Elliot T. Berkman
- Department of Psychology, University of Oregon, USA,Center for Translational Neuroscience, University of Oregon, USA
| | - Nicole C. Swann
- Department of Human Physiology, University of Oregon, USA,Center for Translational Neuroscience, University of Oregon, USA,Institute of Neuroscience, University of Oregon, USA
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28
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Peeters J, Boogers A, Van Bogaert T, Davidoff H, Gransier R, Wouters J, Nuttin B, Mc Laughlin M. Electrophysiologic Evidence That Directional Deep Brain Stimulation Activates Distinct Neural Circuits in Patients With Parkinson Disease. Neuromodulation 2023; 26:403-413. [PMID: 35088733 DOI: 10.1016/j.neurom.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) delivered via multicontact leads implanted in the basal ganglia is an established therapy to treat Parkinson disease (PD). However, the different neural circuits that can be modulated through stimulation on different DBS contacts are poorly understood. Evidence shows that electrically stimulating the subthalamic nucleus (STN) causes a therapeutic effect through antidromic activation of the hyperdirect pathway-a monosynaptic connection from the cortex to the STN. Recent studies suggest that stimulating the substantia nigra pars reticulata (SNr) may improve gait. The advent of directional DBS leads now provides a spatially precise means to probe these neural circuits and better understand how DBS affects distinct neural networks. MATERIALS AND METHODS We measured cortical evoked potentials (EPs) using electroencephalography (EEG) in response to low-frequency DBS using the different directional DBS contacts in eight patients with PD. RESULTS A short-latency EP at 3 milliseconds originating from the primary motor cortex appeared largest in amplitude when stimulating DBS contacts closest to the dorsolateral STN (p < 0.001). A long-latency EP at 10 milliseconds originating from the premotor cortex appeared strongest for DBS contacts closest to the SNr (p < 0.0001). CONCLUSIONS Our results show that at the individual patient level, electrical stimulation of different nuclei produces distinct EP signatures. Our approach could be used to identify the functional location of each DBS contact and thus help patient-specific DBS programming. CLINICAL TRIAL REGISTRATION The ClinicalTrials.gov registration number for the study is NCT04658641.
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Affiliation(s)
- Jana Peeters
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| | - Alexandra Boogers
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Neurology, UZ Leuven, Leuven, Belgium
| | - Tine Van Bogaert
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hannah Davidoff
- Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Robin Gransier
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Bart Nuttin
- Division of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Neurosurgery, UZ Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Wong JK, Mayberg HS, Wang DD, Richardson RM, Halpern CH, Krinke L, Arlotti M, Rossi L, Priori A, Marceglia S, Gilron R, Cavanagh JF, Judy JW, Miocinovic S, Devergnas AD, Sillitoe RV, Cernera S, Oehrn CR, Gunduz A, Goodman WK, Petersen EA, Bronte-Stewart H, Raike RS, Malekmohammadi M, Greene D, Heiden P, Tan H, Volkmann J, Voon V, Li L, Sah P, Coyne T, Silburn PA, Kubu CS, Wexler A, Chandler J, Provenza NR, Heilbronner SR, Luciano MS, Rozell CJ, Fox MD, de Hemptinne C, Henderson JM, Sheth SA, Okun MS. Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation. Front Hum Neurosci 2023; 16:1084782. [PMID: 36819295 PMCID: PMC9933515 DOI: 10.3389/fnhum.2022.1084782] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023] Open
Abstract
The deep brain stimulation (DBS) Think Tank X was held on August 17-19, 2022 in Orlando FL. The session organizers and moderators were all women with the theme women in neuromodulation. Dr. Helen Mayberg from Mt. Sinai, NY was the keynote speaker. She discussed milestones and her experiences in developing depression DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging DBS technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank X speakers was that DBS has continued to expand in scope however several indications have reached the "trough of disillusionment." DBS for depression was considered as "re-emerging" and approaching a slope of enlightenment. DBS for depression will soon re-enter clinical trials. The group estimated that globally more than 244,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia, and Australia; cutting-edge technologies, closed loop DBS, DBS tele-health, neuroethics, lesion therapy, interventional psychiatry, and adaptive DBS.
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Affiliation(s)
- Joshua K. Wong
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Doris D. Wang
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Casey H. Halpern
- Richards Medical Research Laboratories, Department of Neurosurgery, Perelman School of Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, United States
| | - Lothar Krinke
- Newronika, Goose Creek, SC, United States
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | | | | | | | | | | | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Jack W. Judy
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Svjetlana Miocinovic
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Annaelle D. Devergnas
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Roy V. Sillitoe
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Stephanie Cernera
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Carina R. Oehrn
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Erika A. Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Petra Heiden
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jens Volkmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Pankaj Sah
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Peter A. Silburn
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Cynthia S. Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Chandler
- Centre for Health Law, Policy, and Ethics, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sarah R. Heilbronner
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Marta San Luciano
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher J. Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Coralie de Hemptinne
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jaimie M. Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Michael S. Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Peeters J, Boogers A, Van Bogaert T, Dembek TA, Gransier R, Wouters J, Vandenberghe W, De Vloo P, Nuttin B, Mc Laughlin M. Towards biomarker-based optimization of deep brain stimulation in Parkinson's disease patients. Front Neurosci 2023; 16:1091781. [PMID: 36711127 PMCID: PMC9875598 DOI: 10.3389/fnins.2022.1091781] [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: 11/07/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Background Subthalamic deep brain stimulation (DBS) is an established therapy to treat Parkinson's disease (PD). To maximize therapeutic outcome, optimal DBS settings must be carefully selected for each patient. Unfortunately, this is not always achieved because of: (1) increased technological complexity of DBS devices, (2) time restraints, or lack of expertise, and (3) delayed therapeutic response of some symptoms. Biomarkers to accurately predict the most effective stimulation settings for each patient could streamline this process and improve DBS outcomes. Objective To investigate the use of evoked potentials (EPs) to predict clinical outcomes in PD patients with DBS. Methods In ten patients (12 hemispheres), a monopolar review was performed by systematically stimulating on each DBS contact and measuring the therapeutic window. Standard imaging data were collected. EEG-based EPs were then recorded in response to stimulation at 10 Hz for 50 s on each DBS-contact. Linear mixed models were used to assess how well both EPs and image-derived information predicted the clinical data. Results Evoked potential peaks at 3 ms (P3) and at 10 ms (P10) were observed in nine and eleven hemispheres, respectively. Clinical data were well predicted using either P3 or P10. A separate model showed that the image-derived information also predicted clinical data with similar accuracy. Combining both EPs and image-derived information in one model yielded the highest predictive value. Conclusion Evoked potentials can accurately predict clinical DBS responses. Combining EPs with imaging data further improves this prediction. Future refinement of this approach may streamline DBS programming, thereby improving therapeutic outcomes. Clinical trial registration ClinicalTrials.gov, identifier NCT04658641.
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Affiliation(s)
- Jana Peeters
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Alexandra Boogers
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Tine Van Bogaert
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Robin Gransier
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium,Laboratory for Parkinson Research, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Philippe De Vloo
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Nuttin
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium,*Correspondence: Myles Mc Laughlin,
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Kähkölä J, Lahtinen M, Keinänen T, Katisko J. Stimulation of the Presupplementary Motor Area Cluster of the Subthalamic Nucleus Predicts More Consistent Clinical Outcomes. Neurosurgery 2022; 92:1058-1065. [PMID: 36700693 DOI: 10.1227/neu.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The development of diffusion tensor imaging and tractography has raised increasing interest in the functional targeting of deep brain stimulation of the subthalamic nucleus (STN) in Parkinson disease. OBJECTIVE To study, using deterministic tractography, the functional subdivisions of the STN and hyperdirect white matter connections located between the STN and the medial frontal cortex, especially the presupplementary motor area (preSMA), SMA, primary motor area (M1), and dorsolateral premotor cortex, and to study retrospectively whether this information correlates with clinical outcome. METHODS Twenty-two patients with Parkinson disease who underwent STN deep brain stimulation were analyzed. Using 3 T MR images, the medial frontal cortex was manually segmented into preSMA, SMA, M1, and dorsolateral premotor cortex, which were then used to determine the functional subdivisions of the lateral border of the STN. The intersectional quantities of the volume of activated tissue (VAT) and the hyperdirect white matter connections were calculated. The results were combined with clinical data including unilateral 12-month postoperative motor outcome and levodopa equivalent daily dose. RESULTS Stimulated clusters of the STN were connected mostly to the cortical SMA and preSMA regions. Patients with primarily preSMA cluster stimulation (presmaVAT% ≥ 50%) had good responses to the treatment with unilateral motor improvement over 40% and levodopa equivalent daily dose reduction over 60%. Larger VAT was not found to correlate with better patient outcomes. CONCLUSION Our study is the first to suggest that stimulating, predominantly, the STN cluster where preSMA hyperdirect pathways are located, could be predictive of more consistent treatment results.
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Affiliation(s)
- Johannes Kähkölä
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Maija Lahtinen
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Oulu University Hospital, Oulu, Finland
| | - Tuija Keinänen
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Oulu University Hospital, Oulu, Finland
| | - Jani Katisko
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Oulu University Hospital, Oulu, Finland
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Campbell BA, Favi Bocca L, Escobar Sanabria D, Almeida J, Rammo R, Nagel SJ, Machado AG, Baker KB. The impact of pulse timing on cortical and subthalamic nucleus deep brain stimulation evoked potentials. Front Hum Neurosci 2022; 16:1009223. [PMID: 36204716 PMCID: PMC9532054 DOI: 10.3389/fnhum.2022.1009223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
The impact of pulse timing is an important factor in our understanding of how to effectively modulate the basal ganglia thalamocortical (BGTC) circuit. Single pulse low-frequency DBS-evoked potentials generated through electrical stimulation of the subthalamic nucleus (STN) provide insight into circuit activation, but how the long-latency components change as a function of pulse timing is not well-understood. We investigated how timing between stimulation pulses delivered in the STN region influence the neural activity in the STN and cortex. DBS leads implanted in the STN of five patients with Parkinson's disease were temporarily externalized, allowing for the delivery of paired pulses with inter-pulse intervals (IPIs) ranging from 0.2 to 10 ms. Neural activation was measured through local field potential (LFP) recordings from the DBS lead and scalp EEG. DBS-evoked potentials were computed using contacts positioned in dorsolateral STN as determined through co-registered post-operative imaging. We quantified the degree to which distinct IPIs influenced the amplitude of evoked responses across frequencies and time using the wavelet transform and power spectral density curves. The beta frequency content of the DBS evoked responses in the STN and scalp EEG increased as a function of pulse-interval timing. Pulse intervals <1.0 ms apart were associated with minimal to no change in the evoked response. IPIs from 1.5 to 3.0 ms yielded a significant increase in the evoked response, while those >4 ms produced modest, but non-significant growth. Beta frequency activity in the scalp EEG and STN LFP response was maximal when IPIs were between 1.5 and 4.0 ms. These results demonstrate that long-latency components of DBS-evoked responses are pre-dominantly in the beta frequency range and that pulse interval timing impacts the level of BGTC circuit activation.
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Affiliation(s)
- Brett A. Campbell
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Leonardo Favi Bocca
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - David Escobar Sanabria
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Julio Almeida
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Richard Rammo
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sean J. Nagel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G. Machado
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kenneth B. Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Kenneth B. Baker
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Chen PL, Chen YC, Tu PH, Liu TC, Chen MC, Wu HT, Yeap MC, Yeh CH, Lu CS, Chen CC. Subthalamic high-beta oscillation informs the outcome of deep brain stimulation in patients with Parkinson's disease. Front Hum Neurosci 2022; 16:958521. [PMID: 36158623 PMCID: PMC9493001 DOI: 10.3389/fnhum.2022.958521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe therapeutic effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) is related to the modulation of pathological neural activities, particularly the synchronization in the β band (13–35 Hz). However, whether the local β activity in the STN region can directly predict the stimulation outcome remains unclear.ObjectiveWe tested the hypothesis that low-β (13–20 Hz) and/or high-β (20–35 Hz) band activities recorded from the STN region can predict DBS efficacy.MethodsLocal field potentials (LFPs) were recorded in 26 patients undergoing deep brain stimulation surgery in the subthalamic nucleus area. Recordings were made after the implantation of the DBS electrode prior to its connection to a stimulator. The maximum normalized powers in the theta (4–7 Hz), alpha (7–13 Hz), low-β (13–20 Hz), high-β (20–35 Hz), and low-γ (40–55 Hz) subbands in the postoperatively recorded LFP were correlated with the stimulation-induced improvement in contralateral tremor or bradykinesia–rigidity. The distance between the contact selected for stimulation and the contact with the maximum subband power was correlated with the stimulation efficacy. Following the identification of the potential predictors by the significant correlations, a multiple regression analysis was performed to evaluate their effect on the outcome.ResultsThe maximum high-β power was positively correlated with bradykinesia–rigidity improvement (rs = 0.549, p < 0.0001). The distance to the contact with maximum high-β power was negatively correlated with bradykinesia–rigidity improvement (rs = −0.452, p < 0.001). No significant correlation was observed with low-β power. The maximum high-β power and the distance to the contact with maximum high-β power were both significant predictors for bradykinesia–rigidity improvement in the multiple regression analysis, explaining 37.4% of the variance altogether. Tremor improvement was not significantly correlated with any frequency.ConclusionHigh-β oscillations, but not low-β oscillations, recorded from the STN region with the DBS lead can inform stimulation-induced improvement in contralateral bradykinesia–rigidity in patients with PD. High-β oscillations can help refine electrode targeting and inform contact selection for DBS therapy.
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Affiliation(s)
- Po-Lin Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chieh Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hsun Tu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chi Liu
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Mathematics, National Taiwan University, Taipei, Taiwan
| | - Min-Chi Chen
- Department of Public Health, Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, United States
- Department of Statistical Science, Duke University, Durham, NC, United States
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neuroradiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin-Song Lu
- Professor Lu Neurological Clinic, Taoyuan, Taiwan
| | - Chiung-Chu Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chiung-Chu Chen
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Cortical network formation based on subthalamic beta bursts in Parkinson's disease. Neuroimage 2022; 263:119619. [PMID: 36087901 DOI: 10.1016/j.neuroimage.2022.119619] [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: 06/03/2022] [Revised: 08/02/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
Recent evidence suggests that beta bursts in subthalamic nucleus (STN) play an important role in Parkinsonian pathophysiology. We studied the spatio-temporal relationship between STN beta bursts and cortical activity in 26 Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery. Postoperatively, we simultaneously recorded STN local field potentials (LFP) from externalized DBS leads and cortical activity using whole-brain magnetoencephalography. Event-related magnetic fields (ERF) were averaged time-locked to STN beta bursts and subjected to source localization. Our results demonstrate that ERF exhibiting activity significantly different from baseline activity were localized within areas functionally related to associative, limbic, and motor systems as well as regions pertinent for visual and language processing. Our data suggest that STN beta bursts are involved in network formation between STN and cortex. This interaction is in line with the idea of parallel processing within the basal ganglia-cortex loop, specifically within the functional subsystems of the STN (i.e., associative, limbic, motor, and the related cortical areas). ERFs within visual and language-related cortical areas indicate involvement of beta bursts in STN-cortex networks beyond the associative, limbic, and motor loops. In sum, our results highlight the involvement of STN beta bursts in the formation of multiple STN - cortex loops in patients with PD.
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Campbell BA, Cho H, Faulhammer RM, Hogue O, Tsai JPC, Hussain MS, Machado AG, Baker KB. Stability and Effect of Parkinsonian State on Deep Brain Stimulation Cortical Evoked Potentials. Neuromodulation 2022; 25:804-816. [PMID: 34309115 PMCID: PMC10246651 DOI: 10.1111/ner.13508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To characterize and compare the stability of cortical potentials evoked by deep brain stimulation (DBS) of the subthalamic nucleus (STN) across the naïve, parkinsonian, and pharmacologically treated parkinsonian states. To advance cortical potentials as possible biomarkers for DBS programming. MATERIALS AND METHODS Serial electrocorticographic (ECoG) recordings were made more than nine months from a single non-human primate instrumented with bilateral ECoG grids spanning anterior parietal to prefrontal cortex. Cortical evoked potentials (CEPs) were generated through time-lock averaging of the ECoG recordings to DBS pulses delivered unilaterally in the STN region using a chronically implanted, six-contact, scaled DBS lead. Recordings were made across the naïve followed by mild and moderate parkinsonian conditions achieved by staged injections of the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) neurotoxin. In addition to characterizing the spatial distribution and stability of the response within each state, changes in the amplitude and latency of CEP components as well as in the frequency content were examined in relation to parkinsonian severity and dopamine replacement. RESULTS In the naïve state, the STN DBS CEP presented as a multiphase response maximal over M1 cortex, with components attributable to physiological activity distinguishable from stimulus artifact as early as 0.45-0.75 msec poststimulation. When delivered using therapeutically effective parameters in the parkinsonian state, the CEP was highly stable across multiple recording sessions within each behavioral state. Across states, significant differences were present with respect to both the latency and amplitude of individual response components, with greater differences present for longer-latency components (all p < 0.05). Power spectral density analysis revealed a high-beta peak within the evoked response, with significant changes in power between disease states across multiple frequency bands. CONCLUSIONS Our findings underscore the spatiotemporal specificity and relative stability of the DBS-CEP associated with different disease states and with therapeutic benefit. DBS-CEP may be a viable biomarker for therapeutic programming.
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Affiliation(s)
- Brett A Campbell
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Neurosciences, Cleveland Clinic, Cleveland, OH, USA
| | - Hanbin Cho
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Olivia Hogue
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Andre G Machado
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kenneth B Baker
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, USA.
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Schor JS, Gonzalez Montalvo I, Spratt PWE, Brakaj RJ, Stansil JA, Twedell EL, Bender KJ, Nelson AB. Therapeutic deep brain stimulation disrupts movement-related subthalamic nucleus activity in Parkinsonian mice. eLife 2022; 11:75253. [PMID: 35786442 PMCID: PMC9342952 DOI: 10.7554/elife.75253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation (STN DBS) relieves many motor symptoms of Parkinson’s disease (PD), but its underlying therapeutic mechanisms remain unclear. Since its advent, three major theories have been proposed: (1) DBS inhibits the STN and basal ganglia output; (2) DBS antidromically activates motor cortex; and (3) DBS disrupts firing dynamics within the STN. Previously, stimulation-related electrical artifacts limited mechanistic investigations using electrophysiology. We used electrical artifact-free GCaMP fiber photometry to investigate activity in basal ganglia nuclei during STN DBS in parkinsonian mice. To test whether the observed changes in activity were sufficient to relieve motor symptoms, we then combined electrophysiological recording with targeted optical DBS protocols. Our findings suggest that STN DBS exerts its therapeutic effect through the disruption of movement-related STN activity, rather than inhibition or antidromic activation. These results provide insight into optimizing PD treatments and establish an approach for investigating DBS in other neuropsychiatric conditions.
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Affiliation(s)
- Jonathan S Schor
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | | | - Perry W E Spratt
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | - Rea J Brakaj
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Jasmine A Stansil
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Emily L Twedell
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | - Kevin J Bender
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Alexandra B Nelson
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
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Dale J, Schmidt SL, Mitchell K, Turner DA, Grill WM. Evoked potentials generated by deep brain stimulation for Parkinson's disease. Brain Stimul 2022; 15:1040-1047. [DOI: 10.1016/j.brs.2022.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/18/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
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Guest AC, O'Neill KJ, Graham D, Mirzadeh Z, Ponce FA, Greger B. Microscale electrophysiological functional connectivity in human cortico-basal ganglia network. Clin Neurophysiol 2022; 142:11-19. [DOI: 10.1016/j.clinph.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
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Zhang Q, Zhao B, Neumann WJ, Xie H, Shi L, Zhu G, Yin Z, Qin G, Bai Y, Meng F, Yang A, Jiang Y, Zhang J. Low-frequency oscillations link frontal and parietal cortex with subthalamic nucleus in conflicts. Neuroimage 2022; 258:119389. [PMID: 35714885 DOI: 10.1016/j.neuroimage.2022.119389] [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: 01/26/2022] [Revised: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Low-frequency oscillations (LFOs, 28 Hz) in the subthalamic nucleus(STN) are known to reflect cognitive conflict. However, it is unclear if LFOs mediate communication and functional interactions among regions implicated in conflict processing, such as the motor cortex (M1), premotor cortex (PMC), and superior parietal lobule (SPL). To investigate the potential contribution of LFOs to cognitive conflict mediation, we recorded M1, PMC, and SPL activities by right subdural electrocorticography (ECoG) simultaneously with bilateral STN local field potentials (LFPs) by deep brain stimulation electrodes in 13 patients with Parkinson's disease who performed the arrow version of the Eriksen flanker task. Elevated cue-related LFO activity was observed across patients during task trials, with the earliest onset in PMC and SPL. At cue onset, LFO power exhibited a significantly greater increase or a trend of a greater increase in the PMC, M1, and STN, and less increase in the SPL during high-conflict (incongruent) trials than in low-conflict (congruent) trials. The local LFO power increases in PMC, SPL, and right STN were correlated with response time, supporting the notion that these structures are critical hubs for cognitive conflict processing. This power increase was accompanied by increased functional connectivity between the PMC and right STN, which was correlated with response time across subjects. Finally, ipsilateral PMC-STN Granger causality was enhanced during high-conflict trials, with direction from STN to PMC. Our study indicates that LFOs link the frontal and parietal cortex with STN during conflicts, and the ipsilateral PMC-STN connection is specifically involved in this cognitive conflict processing.
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Affiliation(s)
- Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charite´, Universita¨Tsmedizin Berlin, Charite´ Campus Mitte, Berlin 10117, Germany
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Guofan Qin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China; Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, The South Fourth Ring Road, West Road, Fengtai District & No. 119, Beijing 100070, China; Beijing Key Laboratory of Neurostimulation, Beijing, 100070, China.
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40
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Peeters J, Boogers A, Van Bogaert T, Gransier R, Wouters J, Nuttin B, Mc Laughlin M. Current Steering Using Multiple Independent Current Control Deep Brain Stimulation Technology Results in Distinct Neurophysiological Responses in Parkinson’s Disease Patients. Front Hum Neurosci 2022; 16:896435. [PMID: 35721356 PMCID: PMC9203070 DOI: 10.3389/fnhum.2022.896435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background Deep brain stimulation (DBS) is an effective neuromodulation therapy to treat people with medication-refractory Parkinson’s disease (PD). However, the neural networks affected by DBS are not yet fully understood. Recent studies show that stimulating on different DBS-contacts using a single current source results in distinct EEG-based evoked potentials (EPs), with a peak at 3 ms (P3) associated with dorsolateral subthalamic nucleus stimulation and a peak at 10 ms associated with substantia nigra stimulation. Multiple independent current control (MICC) technology allows the center of the electric field to be moved in between two adjacent DBS-contacts, offering a potential advantage in spatial precision. Objective Determine if MICC precision targeting results in distinct neurophysiological responses recorded via EEG. Materials and Methods We recorded cortical EPs in five hemispheres (four PD patients) using EEG whilst employing MICC to move the electric field from the most dorsal DBS-contact to the most ventral in 15 incremental steps. Results The center of the electric field location had a significant effect on both the P3 and P10 amplitude in all hemispheres where a peak was detected (P3, detected in 4 of 5 hemispheres, p < 0.0001; P10, detected in 5 of 5 hemispheres, p < 0.0001). Post hoc analysis indicated furthermore that MICC technology can significantly refine the resolution of steering. Conclusion Using MICC to incrementally move the center of the electric field to locations between adjacent DBS-contacts resulted in significantly different neurophysiological responses that may allow further precision of the programming of individual patients.
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Affiliation(s)
- Jana Peeters
- Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- *Correspondence: Jana Peeters,
| | - Alexandra Boogers
- Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neurology, UZ Leuven, Leuven, Belgium
| | - Tine Van Bogaert
- Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Robin Gransier
- Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Bart Nuttin
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neurosurgery, UZ Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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41
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Pozzi NG, Palmisano C, Reich MM, Capetian P, Pacchetti C, Volkmann J, Isaias IU. Troubleshooting Gait Disturbances in Parkinson's Disease With Deep Brain Stimulation. Front Hum Neurosci 2022; 16:806513. [PMID: 35652005 PMCID: PMC9148971 DOI: 10.3389/fnhum.2022.806513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson's disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management.
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Affiliation(s)
- Nicoló G. Pozzi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Martin M. Reich
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Philip Capetian
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Claudio Pacchetti
- Parkinson’s Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Gaetano Pini-CTO, Milan, Italy
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42
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Pujol S, Cabeen RP, Yelnik J, François C, Fernandez Vidal S, Karachi C, Bardinet E, Cosgrove GR, Kikinis R. Somatotopic Organization of Hyperdirect Pathway Projections From the Primary Motor Cortex in the Human Brain. Front Neurol 2022; 13:791092. [PMID: 35547388 PMCID: PMC9081715 DOI: 10.3389/fneur.2022.791092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The subthalamic nucleus (STN) is an effective neurosurgical target to improve motor symptoms in Parkinson's Disease (PD) patients. MR-guided Focused Ultrasound (MRgFUS) subthalamotomy is being explored as a therapeutic alternative to Deep Brain Stimulation (DBS) of the STN. The hyperdirect pathway provides a direct connection between the cortex and the STN and is likely to play a key role in the therapeutic effects of MRgFUS intervention in PD patients. Objective This study aims to investigate the topography and somatotopy of hyperdirect pathway projections from the primary motor cortex (M1). Methods We used advanced multi-fiber tractography and high-resolution diffusion MRI data acquired on five subjects of the Human Connectome Project (HCP) to reconstruct hyperdirect pathway projections from M1. Two neuroanatomy experts reviewed the anatomical accuracy of the tracts. We extracted the fascicles arising from the trunk, arm, hand, face and tongue area from the reconstructed pathways. We assessed the variability among subjects based on the fractional anisotropy (FA) and mean diffusivity (MD) of the fibers. We evaluated the spatial arrangement of the different fascicles using the Dice Similarity Coefficient (DSC) of spatial overlap and the centroids of the bundles. Results We successfully reconstructed hyperdirect pathway projections from M1 in all five subjects. The tracts were in agreement with the expected anatomy. We identified hyperdirect pathway fascicles projecting from the trunk, arm, hand, face and tongue area in all subjects. Tract-derived measurements showed low variability among subjects, and similar distributions of FA and MD values among the fascicles projecting from different M1 areas. We found an anterolateral somatotopic arrangement of the fascicles in the corona radiata, and an average overlap of 0.63 in the internal capsule and 0.65 in the zona incerta. Conclusion Multi-fiber tractography combined with high-resolution diffusion MRI data enables the identification of the somatotopic organization of the hyperdirect pathway. Our preliminary results suggest that the subdivisions of the hyperdirect pathway projecting from the trunk, arm, hand, face, and tongue motor area are intermixed at the level of the zona incerta and posterior limb of the internal capsule, with a predominantly overlapping topographical organization in both regions. Subject-specific knowledge of the hyperdirect pathway somatotopy could help optimize target definition in MRgFUS intervention.
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Affiliation(s)
- Sonia Pujol
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ryan P Cabeen
- Laboratory of Neuro Imaging, Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine of the USC, University of Southern California, Los Angeles, CA, United States
| | - Jérôme Yelnik
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Chantal François
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Sara Fernandez Vidal
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Carine Karachi
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France.,Department of Neurosurgery, APHP, Hôpitaux Universitaires Pitié-Salpêtriére/Charles Foix, Paris, France
| | - Eric Bardinet
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ron Kikinis
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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43
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Korsun O, Renvall H, Nurminen J, Mäkelä JP, Pekkonen E. Modulation of sensory cortical activity by deep brain stimulation in advanced Parkinson's Disease. Eur J Neurosci 2022; 56:3979-3990. [PMID: 35560964 PMCID: PMC9544049 DOI: 10.1111/ejn.15692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Despite optimal oral drug treatment, about 90% of patients with Parkinson's disease develop motor fluctuation and dyskinesia within 5-10 years from the diagnosis. Moreover, the patients show non-motor symptoms in different sensory domains. Bilateral deep brain stimulation applied to the subthalamic nucleus is considered the most effective treatment in advanced Parkinson's disease and it has been suggested to affect sensorimotor modulation and relate to motor improvement in patients. However, observations on the relationship between sensorimotor activity and clinical improvement have remained sparse. Here we studied the somatosensory evoked magnetic fields in thirteen right-handed patients with advanced Parkinson's disease before and 7 months after stimulator implantation. Somatosensory processing was addressed with magnetoencephalography during alternated median nerve stimulation at both wrists. The strengths and the latencies of the ~60-ms responses at the contralateral primary somatosensory cortices were highly variable but detectable and reliably localized in all patients. The response strengths did not differ between preoperative and postoperative DBSON measurements. The change in the response strength between pre- and postoperative condition in the dominant left hemisphere of our right-handed patients correlated with the alleviation of their motor symptoms (p = 0.04). However, the result did not survive correction for multiple comparisons. Magnetoencephalography appears an effective tool to explore non-motor effects in patients with Parkinson's disease, and it may help in understanding the neurophysiological basis of deep brain stimulation. However, the high interindividual variability in the somatosensory responses and poor tolerability of DBSOFF condition warrants larger patient groups and measurements also in non-medicated patients.
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Affiliation(s)
- Olesia Korsun
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, Espoo, Finland
| | - Hanna Renvall
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, Espoo, Finland
| | - Jussi Nurminen
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland.,Motion Analysis Laboratory, Children's Hospital, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jyrki P Mäkelä
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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44
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Adkinson JA, Tsolaki E, Sheth SA, Metzger BA, Robinson ME, Oswalt D, McIntyre CC, Mathura RK, Waters AC, Allawala AB, Noecker AM, Malekmohammadi M, Chiu K, Mustakos R, Goodman W, Borton D, Pouratian N, Bijanki KR. Imaging versus electrographic connectivity in human mood-related fronto-temporal networks. Brain Stimul 2022; 15:554-565. [PMID: 35292403 PMCID: PMC9232982 DOI: 10.1016/j.brs.2022.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/09/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The efficacy of psychiatric DBS is thought to be driven by the connectivity of stimulation targets with mood-relevant fronto-temporal networks, which is typically evaluated using diffusion-weighted tractography. OBJECTIVE Leverage intracranial electrophysiology recordings to better predict the circuit-wide effects of neuromodulation to white matter targets. We hypothesize strong convergence between tractography-predicted structural connectivity and stimulation-induced electrophysiological responses. METHODS Evoked potentials were elicited by single-pulse stimulation to two common DBS targets for treatment-resistant depression - the subcallosal cingulate (SCC) and ventral capsule/ventral striatum (VCVS) - in two patients undergoing DBS with stereo-electroencephalographic (sEEG) monitoring. Evoked potentials were compared with predicted structural connectivity between DBS leads and sEEG contacts using probabilistic, patient-specific diffusion-weighted tractography. RESULTS Evoked potentials and tractography showed strong convergence in both patients in orbitofrontal, ventromedial prefrontal, and lateral prefrontal cortices for both SCC and VCVS stimulation targets. Low convergence was found in anterior cingulate (ACC), where tractography predicted structural connectivity from SCC targets but produced no evoked potentials during SCC stimulation. Further, tractography predicted no connectivity to ACC from VCVS targets, but VCVS stimulation produced robust evoked potentials. CONCLUSION The two connectivity methods showed significant convergence, but important differences emerged with respect to the ability of tractography to predict electrophysiological connectivity between SCC and VCVS to regions of the mood-related network. This multimodal approach raises intriguing implications for the use of tractography in surgical targeting and provides new data to enhance our understanding of the network-wide effects of neuromodulation.
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Affiliation(s)
- Joshua A Adkinson
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Evangelia Tsolaki
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, 300 Stein Plaza Suite 562, Los Angeles, CA, 90095, USA.
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Brian A Metzger
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Meghan E Robinson
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Denise Oswalt
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Allison C Waters
- Department of Psychiatry, Mount Sinai School of Medicine, 1000 10th Ave., New York, NY, 10019, USA.
| | - Anusha B Allawala
- School of Engineering, Brown University, 182 Hope St., Providence, RI, 02912, USA.
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Mahsa Malekmohammadi
- Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA, 91355, USA.
| | - Kevin Chiu
- Brainlab, Inc., 5 Westbrook Corporate Center, Suite 1000, Westchester IL, 60154, USA.
| | - Richard Mustakos
- Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA, 91355, USA.
| | - Wayne Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA.
| | - David Borton
- School of Engineering, Brown University, 182 Hope St., Providence, RI, 02912, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs, Providence, RI, 02912, USA.
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 8353 Harry Hines Blvd MC8855, Dallas, TX, 75239, USA.
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
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45
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Leon-Ariza JS, Mosquera MA, Siomin V, Fonseca A, Leon-Ariza DS, Gualdron MA, Leon-Sarmiento FE. The Vagus Nerve Somatosensory-evoked Potential in Neural Disorders: Systematic Review and Illustrative Vignettes. Clin EEG Neurosci 2022; 53:256-263. [PMID: 33709798 DOI: 10.1177/15500594211001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To review the scientific publications reporting vagal nerve somatosensory-evoked potential (VSEP) findings from individuals with brain disorders, and present novel physiological explanations on the VSEP origin. Methods. We did a systematic review on the papers reporting VSEP findings from individuals with brain disorders and their controls. We evaluated papers published from 2003 to date indexed in PubMed, Web of Science, and Scielo databases. We extracted the following information: number of patients and controls, type of neural disorder, age, gender, stimulating/recording and grounding electrodes as well as stimulus side, intensity, duration, frequency, and polarity. Information about physiological parameters, neurobiological variables, and correlation studies was also reviewed. Representative vignettes were included to add support to our conclusions. Results. The VSEP was studied in 297 patients with neural disorders such as Parkinson's disease (PD), Alzheimer's disease, vascular dementia, mild cognitive impairment, subjective memory impairment, major depression, and multiple sclerosis. Scalp responses marked as the VSEP showed high variability, low validity, and poor reproducibility. VSEP latencies and amplitudes did not correlate with disease duration, unified PD rating scale score, or heart function in PD patients nor with cerebrospinal fluid β amyloid, phosphor-τ, and cognitive tests from patients with mental disorders. Vignettes demonstrated that the VSEP was volume conduction propagating from muscles surrounding the scalp recording electrodes. Conclusion. The VSEP is not a brain-evoked potential of neural origin but muscle activity induced by electrical stimulation of the tragus region of the ear. This review and illustrative vignettes argue against assessing the parasympathetic system using the so-called VSEP.
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Affiliation(s)
| | - Mario A Mosquera
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Vitaly Siomin
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Angelo Fonseca
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | | | | | - Fidias E Leon-Sarmiento
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA.,Parkinson's Disease Research Laboratory, 5450Florida International University, Miami, FL, USA
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46
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Cassar IR, Grill WM. The cortical evoked potential corresponds with deep brain stimulation efficacy in rats. J Neurophysiol 2022; 127:1253-1268. [PMID: 35389751 PMCID: PMC9054265 DOI: 10.1152/jn.00353.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 01/21/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) antidromically activates the motor cortex (M1), and this cortical activation appears to play a role in the treatment of hypokinetic motor behaviors (Gradinaru V, Mogri M, Thompson KR, Henderson JM, Deisseroth K. Science 324: 354-359, 2009; Yu C, Cassar IR, Sambangi J, Grill WM. J Neurosci 40: 4323-4334, 2020). The synchronous antidromic activation takes the form of a short-latency cortical evoked potential (cEP) in electrocorticography (ECoG) recordings of M1. We assessed the utility of the cEP as a biomarker for STN DBS in unilateral 6-hydroxydopamine-lesioned female Sprague Dawley rats, with stimulating electrodes implanted in the STN and the ECoG recorded above M1. We quantified the correlations of the cEP magnitude and latency with changes in motor behavior from DBS and compared them to the correlation between motor behaviors and several commonly used spectral-based biomarkers. The cEP features correlated strongly with motor behaviors and were highly consistent across animals, whereas the spectral biomarkers correlated weakly with motor behaviors and were highly variable across animals. The cEP may thus be a useful biomarker for assessing the therapeutic efficacy of DBS parameters, as its features strongly correlate with motor behavior, it is consistent across time and subjects, it can be recorded under anesthesia, and it is simple to quantify with a large signal-to-noise ratio, enabling rapid, real-time evaluation. Additionally, our work provides further evidence that antidromic cortical activation mediates changes in motor behavior from STN DBS and that the dependence of DBS efficacy on stimulation frequency may be related to antidromic spike failure.NEW & NOTEWORTHY We characterize a new potential biomarker for deep brain stimulation (DBS), the cortical evoked potential (cEP), and demonstrate that it exhibits a robust correlation with motor behaviors as a function of stimulation frequency. The cEP may thus be a useful clinical biomarker for changes in motor behavior. This work also provides insight into the cortical mechanisms of DBS, suggesting that motor behaviors are strongly affected by the rate of antidromic spike failure during DBS.
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Affiliation(s)
- Isaac R Cassar
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Department of Neurobiology, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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47
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Sharf T, Kalakuntla T, J Lee D, Gokoffski KK. Electrical devices for visual restoration. Surv Ophthalmol 2022; 67:793-800. [PMID: 34487742 PMCID: PMC9241872 DOI: 10.1016/j.survophthal.2021.08.008] [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: 03/25/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022]
Abstract
Given the rising number of patients with blindness from macular, optic nerve, and visual pathway disease, there is considerable interest in the potential of electrical stimulation devices to restore vision. Electrical devices for restoration of visual function can be grouped into three categories: (1) visual prostheses whose goal is to bypass damaged areas and directly activate downstream intact portions of the visual pathway; (2) electric field stimulation whose goal is to activate endogenous transcriptional and molecular signaling pathways to promote neuroprotection and neuro-regeneration; and (3) neuromodulation whose stimulation would resuscitate neural circuits vital to coordinating responses to visual input. In this review, we discuss these three approaches, describe advances made in the different fields, and comment on limitations and potential future directions.
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Affiliation(s)
- Tamara Sharf
- Keck School of Medicine, University of Southern California, CA, USA
| | - Tej Kalakuntla
- Keck School of Medicine, University of Southern California, CA, USA
| | - Darrin J Lee
- Department of Neurological Surgery, University of Southern California, CA, USA
| | - Kimberly K Gokoffski
- Department of Ophthalmology, Roski Eye Institute, University of Southern California, CA, USA.
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48
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Bingham CS, McIntyre CC. Subthalamic deep brain stimulation of an anatomically detailed model of the human hyperdirect pathway. J Neurophysiol 2022; 127:1209-1220. [PMID: 35320026 PMCID: PMC9054256 DOI: 10.1152/jn.00004.2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
The motor hyperdirect pathway (HDP) is considered a key target in the treatment of Parkinson's disease with subthalamic deep brain stimulation (DBS). This hypothesis is partially derived from the association of HDP activation with evoked potentials (EPs) generated in the motor cortex and subthalamic nucleus (STN) after a DBS pulse. However, the biophysical details of how and when DBS-induced action potentials (APs) in HDP neurons reach their terminations in the cortex or STN remain unclear. Therefore, we used an anatomically detailed representation of the motor HDP, as well as the internal capsule (IC), in a model of human subthalamic DBS to explore AP activation and transmission in the HDP and IC. Our results show that small diameter HDP axons exhibited AP initiation in their subthalamic terminal arbor, which resulted in relatively long transmission latencies to cortex (∼3.5-8 ms). Alternatively, large diameter HDP axons were most likely to be directly activated in the capsular region, which resulted in short transmission times to the cortex (∼1-3 ms). However, those large diameter HDP antidromic APs would be indistinguishable from any other IC axons that were also activated by the stimulus. Conversely, DBS-induced APs in both small and large diameter HDP axons reached their synaptic boutons in the STN with similar timings, but both spanned a wide temporal range (∼0.5-5 ms). We also found that using anodic or bipolar stimulation helped to bias activation of the HDP over the IC. These computational results provide useful information for linking HDP activation with EP recordings in clinical experiments.NEW & NOTEWORTHY We used biophysical models to study pathway recruitment and conduction latencies of the hyperdirect pathway (HDP) in response to subthalamic deep brain stimulation (DBS). The model system allowed us to assess the influence of increased anatomical realism on pathway activity and the possibility of identifying HDP activity in evoked potentials (EPs) recorded in either the subthalamic nucleus (STN) or cortex. The model predicts that HDP activation is accentuated by complex axonal branching in the STN.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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Hyperdirect connectivity of opercular speech network to the subthalamic nucleus. Cell Rep 2022; 38:110477. [PMID: 35263607 PMCID: PMC8971827 DOI: 10.1016/j.celrep.2022.110477] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/18/2022] Open
Abstract
How the basal ganglia participate in the uniquely human behavior of speech is poorly understood, despite their known role in modulating critical aspects of cognitive and motor behavior. The subthalamic nucleus (STN) is well positioned to facilitate basal ganglia functions critical for speech. Using electrocorticography in patients undergoing awake deep brain stimulation (DBS) surgery, evidence is reported for a left opercular hyperdirect pathway in humans via stimulating the STN and examining antidromic-evoked activity in the left temporal, parietal, and frontal opercular cortex. These high-resolution cortical and subcortical mapping data provide evidence for hyperdirect connectivity between the inferior frontal gyrus and the STN. In addition, evoked potential data are consistent with the presence of monosynaptic projections from areas of the opercular ections may be unique to humans, evolving alongside the ability for speech. Using electrical stimulation of the subthalamic nucleus and simultaneous cortical recordings in individuals undergoing deep brain stimulation, Jorge et al. provide electrophysiological evidence for a hyperdirect pathway to the basal ganglia from cortical areas that control sensory and motor-planning aspects of speech.
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Bahners BH, Waterstraat G, Kannenberg S, Curio G, Schnitzler A, Nikulin V, Florin E. Electrophysiological characterization of the hyperdirect pathway and its functional relevance for subthalamic deep brain stimulation. Exp Neurol 2022; 352:114031. [PMID: 35247373 DOI: 10.1016/j.expneurol.2022.114031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
The subthalamic nucleus (STN) receives input from various cortical areas via hyperdirect pathway (HDP) which bypasses the basal-ganglia loop. Recently, the HDP has gained increasing interest, because of its relevance for STN deep brain stimulation (DBS). To understand the HDP's role cortical responses evoked by STN-DBS have been investigated. These responses have short (<2 ms), medium (2-15 ms), and long (20-70 ms) latencies. Medium-latency responses are supposed to represent antidromic cortical activations via HDP. Together with long-latency responses the medium responses can potentially be used as biomarker of DBS efficacy as well as side effects. We here propose that the activation sequence of the cortical evoked responses can be conceptualized as high frequency oscillations (HFO) for signal analysis. HFO might therefore serve as marker for antidromic activation. Using existing knowledge on HFO recordings, this approach allows data analyses and physiological modeling to advance the pathophysiological understanding of cortical DBS-evoked high-frequency activity.
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Affiliation(s)
- Bahne Hendrik Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gunnar Waterstraat
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurophysics Group, Department of Neurology, Berlin, Germany
| | - Silja Kannenberg
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gabriel Curio
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurophysics Group, Department of Neurology, Berlin, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Vadim Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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