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Huang Y, Yao K, Zhang Q, Huang X, Chen Z, Zhou Y, Yu X. Bioelectronics for electrical stimulation: materials, devices and biomedical applications. Chem Soc Rev 2024; 53:8632-8712. [PMID: 39132912 DOI: 10.1039/d4cs00413b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Bioelectronics is a hot research topic, yet an important tool, as it facilitates the creation of advanced medical devices that interact with biological systems to effectively diagnose, monitor and treat a broad spectrum of health conditions. Electrical stimulation (ES) is a pivotal technique in bioelectronics, offering a precise, non-pharmacological means to modulate and control biological processes across molecular, cellular, tissue, and organ levels. This method holds the potential to restore or enhance physiological functions compromised by diseases or injuries by integrating sophisticated electrical signals, device interfaces, and designs tailored to specific biological mechanisms. This review explains the mechanisms by which ES influences cellular behaviors, introduces the essential stimulation principles, discusses the performance requirements for optimal ES systems, and highlights the representative applications. From this review, we can realize the potential of ES based bioelectronics in therapy, regenerative medicine and rehabilitation engineering technologies, ranging from tissue engineering to neurological technologies, and the modulation of cardiovascular and cognitive functions. This review underscores the versatility of ES in various biomedical contexts and emphasizes the need to adapt to complex biological and clinical landscapes it addresses.
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Affiliation(s)
- Ya Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Kuanming Yao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Qiang Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Xingcan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Zhenlin Chen
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Yu Zhou
- Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong, China.
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
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Fiorin FDS, de Araújo E Silva M, de Medeiros RE, Viana da Silva GH, Rodrigues AC, Morya E. Spinal Cord Stimulation Modulates Rat Cortico-Basal Ganglia Locomotor Circuit. Neuromodulation 2024:S1094-7159(24)00656-1. [PMID: 39140936 DOI: 10.1016/j.neurom.2024.07.004] [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: 04/12/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE The cortico-basal ganglia circuit is crucial to understanding locomotor behavior and movement disorders. Spinal cord stimulation modulates that circuit, which is a promising approach to restoring motor functions. However, the effects of electrical spinal cord stimulation in the healthy brain motor circuit in pre- and postgait are poorly understood. Thus, this report aims to evaluate, through electrophysiological analyses, the dynamic spectral features of motor networks underlying locomotor initiation with spinal cord stimulation. MATERIALS AND METHODS Wistar male rats underwent spinal cord stimulation (current 30-150 μA, frequency 100, 333, and 500 Hz) with the electrophysiological recording of the caudate and putamen nuclei, primary and secondary motor cortices, and primary somatosensory cortex. Video tracking recorded treadmill locomotion and extracted the motor planning and gait initiation. RESULTS Spectral analysis of segments of gait initiation (pre- and postgait), with stimulation off, showed increased low-frequency activity. Postgait initiation showed increased alpha and beta rhythms and decreased delta rhythm with the stimulation off. Overall, the stimulation frequencies reduced alpha and beta rhythms in all brain areas during movement initiation. Regarding movement planning, such an effect was observed in the sensorimotor area, comprising the delta and alpha rhythms. CONCLUSION This study showed a short-term effect of spinal cord stimulation on the brain areas of the motor circuit, suggesting possible facilitation of movement planning and starting through neuromodulation. Thus, the electrophysiological characterization of this study may contribute to understanding basal ganglia networks and developing new approaches to treat movement disorders in the gait initiation phase.
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Affiliation(s)
- Fernando da Silva Fiorin
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil.
| | - Mariane de Araújo E Silva
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Raquel E de Medeiros
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Guilherme H Viana da Silva
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Abner Cardoso Rodrigues
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Edgard Morya
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
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Jia Q, Liu Y, Lv S, Wang Y, Jiao P, Xu W, Xu Z, Wang M, Cai X. Wireless closed-loop deep brain stimulation using microelectrode array probes. J Zhejiang Univ Sci B 2024:1-21. [PMID: 38423536 DOI: 10.1631/jzus.b2300400] [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: 06/05/2023] [Accepted: 08/25/2023] [Indexed: 03/02/2024]
Abstract
Deep brain stimulation (DBS), including optical stimulation and electrical stimulation, has been demonstrated considerable value in exploring pathological brain activity and developing treatments for neural disorders. Advances in DBS microsystems based on implantable microelectrode array (MEA) probes have opened up new opportunities for closed-loop DBS (CL-DBS) in situ. This technology can be used to detect damaged brain circuits and test the therapeutic potential for modulating the output of these circuits in a variety of diseases simultaneously. Despite the success and rapid utilization of MEA probe-based CL-DBS microsystems, key challenges, including excessive wired communication, need to be urgently resolved. In this review, we considered recent advances in MEA probe-based wireless CL-DBS microsystems and outlined the major issues and promising prospects in this field. This technology has the potential to offer novel therapeutic options for psychiatric disorders in the future.
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Affiliation(s)
- Qianli Jia
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yaoyao Liu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shiya Lv
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yiding Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Peiyao Jiao
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Xu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhaojie Xu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Mixia Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China.
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Xinxia Cai
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China. ,
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China. ,
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Rački V, Hero M, Papić E, Rožmarić G, Čizmarević NS, Chudy D, Peterlin B, Vuletić V. Applicability of clinical genetic testing for deep brain stimulation treatment in monogenic Parkinson's disease and monogenic dystonia: a multidisciplinary team perspective. Front Neurosci 2023; 17:1282267. [PMID: 38027472 PMCID: PMC10667448 DOI: 10.3389/fnins.2023.1282267] [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: 08/23/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
In this perspective article, we highlight the possible applicability of genetic testing in Parkinson's disease and dystonia patients treated with deep brain stimulation (DBS). DBS, a neuromodulatory technique employing electrical stimulation, has historically targeted motor symptoms in advanced PD and dystonia, yet its precise mechanisms remain elusive. Genetic insights have emerged as potential determinants of DBS efficacy. Known PD genes such as GBA, SNCA, LRRK2, and PRKN are most studied, even though further studies are required to make firm conclusions. Variable outcomes depending on genotype is present in genetic dystonia, as DYT-TOR1A, NBIA/DYTPANK2, DYT-SCGE and X-linked dystonia-parkinsonism have demonstrated promising outcomes following GPi-DBS, while varying outcomes have been documented in DYT-THAP1. We present two clinical vignettes that illustrate the applicability of genetics in clinical practice, with one PD patient with compound GBA mutations and one GNAL dystonia patient. Integrating genetic testing into clinical practice is pivotal, particularly with advancements in next-generation sequencing. However, there is a clear need for further research, especially in rarer monogenic forms. Our perspective is that applying genetics in PD and dystonia is possible today, and despite challenges, it has the potential to refine patient selection and enhance treatment outcomes.
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Affiliation(s)
- Valentino Rački
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mario Hero
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Eliša Papić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Gloria Rožmarić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Nada Starčević Čizmarević
- Department of Medical Genomics and Biology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vladimira Vuletić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Fraczek-Szczypta A, Kondracka N, Zambrzycki M, Gubernat M, Czaja P, Pawlyta M, Jelen P, Wielowski R, Jantas D. Exploring CVD Method for Synthesizing Carbon-Carbon Composites as Materials to Contact with Nerve Tissue. J Funct Biomater 2023; 14:443. [PMID: 37754857 PMCID: PMC10532388 DOI: 10.3390/jfb14090443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
The main purpose of these studies was to obtain carbon-carbon composites with a core built of carbon fibers and a matrix in the form of pyrolytic carbon (PyC), obtained by using the chemical vapor deposition (CVD) method with direct electrical heating of a bundle of carbon fibers as a potential electrode material for nerve tissue stimulation. The methods used for the synthesis of PyC proposed in this paper allow us, with the appropriate selection of parameters, to obtain reproducible composites in the form of rods with diameters of about 300 µm in 120 s (CF_PyC_120). To evaluate the materials, various methods such as scanning electron microscopy (SEM), scanning transmission electron microscope (STEM), high-resolution transmission electron microscopy (HRTEM), selected area electron diffraction (SAED), Raman spectroscopy, X-ray photoelectron spectroscopy (XPS), and tensiometer techniques were used to study their microstructural, structural, chemical composition, surface morphology, and surface wettability. Assessing their applicability for contact with nervous tissue cells, the evaluation of cytotoxicity and biocompatibility using the SH-SY5Y human neuroblastoma cell line was performed. Viability and cytotoxicity tests (WST-1 and LDH release) along with cell morphology examination demonstrated that the CF_PyC_120 composites showed high biocompatibility compared to the reference sample (Pt wire), and the best adhesion of cells to the surface among all tested materials.
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Affiliation(s)
- Aneta Fraczek-Szczypta
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Natalia Kondracka
- Faculty of Electrical Engineering, Automatics, Computer Science and Biomedical Engineering, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland;
| | - Marcel Zambrzycki
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Maciej Gubernat
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Pawel Czaja
- Institute of Metallurgy and Materials Science, Polish Academy of Science, Reymonta 25 St., 30-059 Krakow, Poland;
| | - Miroslawa Pawlyta
- Materials Research Laboratory, Faculty of Mechanical Engineering, Silesian University of Technology, Akademicka 2A Str., 44-100 Gliwice, Poland;
| | - Piotr Jelen
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Ryszard Wielowski
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Danuta Jantas
- Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smetna 12 Str., 31-343 Krakow, Poland;
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Xiao L, Huo X, Wang Y, Li W, Li M, Wang C, Wang F, Sun T. A bibliometric analysis of global research status and trends in neuromodulation techniques in the treatment of autism spectrum disorder. BMC Psychiatry 2023; 23:183. [PMID: 36941549 PMCID: PMC10026211 DOI: 10.1186/s12888-023-04666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disease which has risen to become the main cause of childhood disability, placing a heavy burden on families and society. To date, the treatment of patients with ASD remains a complicated problem, for which neuromodulation techniques are a promising solution. This study analyzed the global research situation of neuromodulation techniques in the treatment of ASD from 1992 to 2022, aiming to explore the global research status and frontier trends in this field. METHODS The Web of Science (WoS) was searched for literature related to neuromodulation techniques for ASD from 1992 to October 2022. A knowledge atlas to analyze collaboration among countries, institutions, authors, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and burst keywords was constructed using Rstudio software, CiteSpace, and VOSviewer. RESULTS In total, 392 publications related to the treatment of ASD using neuromodulation techniques were included. Despite some fluctuations, the number of publications in this field has shown a growing trend in recent years. The United States and Deakin University are the leading country and institution in this field, respectively. The greatest contributing authors are Peter G Enticott, Manuel F Casanova, and Paul B Fitzgerald et al. The most prolific and cited journal is Brain Stimulation and the most commonly co-cited journal is The Journal of Autism and Developmental Disorders. The most frequently cited article was that of Simone Rossi (Safety, ethical considerations, and application guidelines for the use of transverse magnetic stimulation in clinical practice and research, 2009). "Obsessive-compulsive disorder," "transcranial direct current stimulation," "working memory," "double blind" and "adolescent" were identified as hotspots and frontier trends of neuromodulation techniques in the treatment of ASD. CONCLUSION The application of neuromodulation techniques for ASD has attracted the attention of researchers worldwide. Restoring the social ability and improving the comorbid symptoms in autistic children and adults have always been the focus of research. Neuromodulation techniques have demonstrated significant advantages and effects on these issues. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are new therapeutic methods introduced in recent years, and are also directions for further exploration.
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Affiliation(s)
- Lifei Xiao
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Xianhao Huo
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Yangyang Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Wenchao Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Mei Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Chaofan Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Feng Wang
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.
| | - Tao Sun
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China.
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China.
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Jung B, Yang C, Lee SH. Electroceutical and Bioelectric Therapy: Its Advantages and Limitations. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:19-31. [PMID: 36700309 PMCID: PMC9889897 DOI: 10.9758/cpn.2023.21.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023]
Abstract
Given the long history, the field of electroceutical and bioelectric therapy has grown impressively, recognized as the main modality of mental health treatments along with psychotherapy and pharmacotherapy. Electroceutical and bioelectric therapy comprises electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), transcranial electrical stimulation (tES), and other brain stimulation techniques. Much empirical research has been published regarding the application guidelines, mechanism of action, and efficacy of respective brain stimulation techniques, but no comparative study that delineates the advantages and limitations of each therapy exists for a comprehensive understanding of each technique. This review provides a comparison of existing electroceutical and bioelectric techniques, primarily focusing on the therapeutic advantages and limitations of each therapy in the current electroceutical and bioelectric field.
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Affiliation(s)
- Bori Jung
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea,Department of Psychology, Sogang University, Seoul, Korea
| | - Chaeyeon Yang
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea,Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea,Address for correspondence: Seung-Hwan Lee Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang 10380, Korea, E-mail: , ORCID: https://orcid.org/0000-0003-0305-3709
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Khan MA, Haider N, Singh T, Bandopadhyay R, Ghoneim MM, Alshehri S, Taha M, Ahmad J, Mishra A. Promising biomarkers and therapeutic targets for the management of Parkinson's disease: recent advancements and contemporary research. Metab Brain Dis 2023; 38:873-919. [PMID: 36807081 DOI: 10.1007/s11011-023-01180-z] [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] [Received: 08/11/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
Parkinson's disease (PD) is one of the progressive neurological diseases which affect around 10 million population worldwide. The clinical manifestation of motor symptoms in PD patients appears later when most dopaminergic neurons have degenerated. Thus, for better management of PD, the development of accurate biomarkers for the early prognosis of PD is imperative. The present work will discuss the potential biomarkers from various attributes covering biochemical, microRNA, and neuroimaging aspects (α-synuclein, DJ-1, UCH-L1, β-glucocerebrosidase, BDNF, etc.) for diagnosis, recent development in PD management, and major limitations with current and conventional anti-Parkinson therapy. This manuscript summarizes potential biomarkers and therapeutic targets, based on available preclinical and clinical evidence, for better management of PD.
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Affiliation(s)
- Mohammad Ahmed Khan
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Nafis Haider
- Prince Sultan Military College of Health Sciences, Dhahran, 34313, Saudi Arabia
| | - Tanveer Singh
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX, 77807, USA
| | - Ritam Bandopadhyay
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Mohammed M Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah, 13713, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Murtada Taha
- Prince Sultan Military College of Health Sciences, Dhahran, 34313, Saudi Arabia
| | - Javed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran, 11001, Saudi Arabia
| | - Awanish Mishra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) - Guwahati, Sila Katamur (Halugurisuk), Kamrup, Changsari, Assam, 781101, India.
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Razmkon A, Abdollahifard S, Taherifard E, Roshanshad A, Shahrivar K. Effect of deep brain stimulation on freezing of gait in patients with Parkinson's disease: a systematic review. Br J Neurosurg 2023; 37:3-11. [PMID: 35603983 DOI: 10.1080/02688697.2022.2077308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Freezing of gait (FOG) is a disabling gait disorder in patients with Parkinson's disease (PD), characterized by recurrent episodes of halting steps. Dopaminergic drugs are common treatments for PD and FOG; however, these drugs may worsen FOG. Deep brain stimulation (DBS) is another option used to treat selected patients. The device needs to be programmed at a specific frequency, amplitude, and pulse width to achieve optimum effects for each patient. This systematic review aimed to evaluate the efficacy of DBS for FOG and its correlation with programmed parameters and the location of the electrodes in the brain. MATERIALS AND METHODS Data for this systematic review were gathered from five online databases: Medline (via PubMed), Scopus, Embase, Web of Science, and Cochrane Library (including both Cochrane Reviews and Cochrane Trials) with a broad search strategy. We included those articles that reported clinical trials and a specific measurement for FOG. RESULTS This review included 13 studies of DBS that targeted the subthalamic nucleus (STN), substantia nigra (SNr), or pedunculopontine nucleus (PPN). Our analysis showed that low-frequency stimulation (LFS) was superior to high-frequency stimulation (HFS) for improving FOG. In the long term, the efficacy of both LFS and HFS decreased. The effect of amplitude was variable, and this parameter needed to be adjusted for each patient. Bilateral stimulation was better than unilateral stimulation. CONCLUSION DBS is a promising choice for the treatment of severe FOG in patients with PD. Bilateral, low-frequency stimulation combined with medical therapy is associated with better responses, especially in the first 2 years of treatment. However, individualizing the DBS parameters should be considered to optimize treatment response.
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Affiliation(s)
- Ali Razmkon
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Saeed Abdollahifard
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Erfan Taherifard
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Department of Master Public Health (MPH), School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Roshanshad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Master Public Health (MPH), School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyab Shahrivar
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Vasudevan S, Dotti A, Kajtez J, Martínez-Serrano A, Gundlach C, Campos Maçãs S, Lauschke K, Vinngaard AM, García López S, Pereira M, Heiskanen A, Keller SS, Emnéus J. OMNIDIRECTIONAL LEAKY OPTO-ELECTRICAL FIBER FOR OPTOGENETIC CONTROL OF NEURONS IN CELL REPLACEMENT THERAPY. Bioelectrochemistry 2022; 149:108306. [DOI: 10.1016/j.bioelechem.2022.108306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
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11
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Palomeque-Mangut D, Rodríguez-Vázquez Á, Delgado-Restituto M. A Fully Integrated, Power-Efficient, 0.07-2.08 mA, High-Voltage Neural Stimulator in a Standard CMOS Process. SENSORS (BASEL, SWITZERLAND) 2022; 22:6429. [PMID: 36080888 PMCID: PMC9460620 DOI: 10.3390/s22176429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
This paper presents a fully integrated high-voltage (HV) neural stimulator with on-chip HV generation. It consists of a neural stimulator front-end that delivers stimulation currents up to 2.08 mA with 5 bits resolution and a switched-capacitor DC-DC converter that generates a programmable voltage supply from 4.2 V to 13.2 V with 4 bits resolution. The solution was designed and fabricated in a standard 180 nm 1.8 V/3.3 V CMOS process and occupied an active area of 2.34 mm2. Circuit-level and block-level techniques, such as a proposed high-compliance voltage cell, have been used for implementing HV circuits in a low-voltage CMOS process. Experimental validation with an electrical model of the electrode−tissue interface showed that (1) the neural stimulator can handle voltage supplies up to 4 times higher than the technology’s nominal supply, (2) residual charge—without passive discharging phase—was below 0.12% for the whole range of stimulation currents, (3) a stimulation current of 2 mA can be delivered with a voltage drop of 0.9 V, and (4) an overall power efficiency of 48% was obtained at maximum stimulation current.
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12
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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:e75253. [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] [MESH Headings] [Grants] [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 FranciscoSan FranciscoUnited States
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
| | - Isabelle Gonzalez Montalvo
- Neuroscience Program, University of California, San FranciscoSan FranciscoUnited States
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
| | - Perry WE Spratt
- Neuroscience Program, University of California, San FranciscoSan FranciscoUnited States
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
| | - Rea J Brakaj
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
- Department of Neurology, University of California, San FranciscoSan FranciscoUnited States
| | - Jasmine A Stansil
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
- Department of Neurology, University of California, San FranciscoSan FranciscoUnited States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research NetworkChevy ChaseUnited States
| | - Emily L Twedell
- Neuroscience Program, University of California, San FranciscoSan FranciscoUnited States
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research NetworkChevy ChaseUnited States
| | - Kevin J Bender
- Neuroscience Program, University of California, San FranciscoSan FranciscoUnited States
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
- Department of Neurology, University of California, San FranciscoSan FranciscoUnited States
| | - Alexandra B Nelson
- Neuroscience Program, University of California, San FranciscoSan FranciscoUnited States
- Kavli Institute for Fundamental Neuroscience, University of CaliforniaSan FranciscoUnited States
- Weill Institute for Neuroscience, University of California,San FranciscoUnited States
- Department of Neurology, University of California, San FranciscoSan FranciscoUnited States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research NetworkChevy ChaseUnited States
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13
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Zufiria B, Qiu S, Yan K, Zhao R, Wang R, She H, Zhang C, Sun B, Herman P, Du Y, Feng Y. A feature-based convolutional neural network for reconstruction of interventional MRI. NMR IN BIOMEDICINE 2022; 35:e4231. [PMID: 31856431 DOI: 10.1002/nbm.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
Real-time interventional MRI (I-MRI) could help to visualize the position of the interventional feature, thus improving patient outcomes in MR-guided neurosurgery. In particular, in deep brain stimulation, real-time visualization of the intervention procedure using I-MRI could improve the accuracy of the electrode placement. However, the requirements of a high undersampling rate and fast reconstruction speed for real-time imaging pose a great challenge for reconstruction of the interventional images. Based on recent advances in deep learning (DL), we proposed a feature-based convolutional neural network (FbCNN) for reconstructing interventional images from golden-angle radially sampled data. The method was composed of two stages: (a) reconstruction of the interventional feature and (b) feature refinement and postprocessing. With only five radially sampled spokes, the interventional feature was reconstructed with a cascade CNN. The final interventional image was constructed with a refined feature and a fully sampled reference image. With a comparison of traditional reconstruction techniques and recent DL-based methods, it was shown that only FbCNN could reconstruct the interventional feature and the final interventional image. With a reconstruction time of ~ 500 ms per frame and an acceleration factor of ~ 80, it was demonstrated that FbCNN had the potential for application in real-time I-MRI.
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Affiliation(s)
- Blanca Zufiria
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- KTH School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Suhao Qiu
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Kang Yan
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ruiyang Zhao
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Runke Wang
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huajun She
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chengcheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Pawel Herman
- Division of Computational Science and Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Yiping Du
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Feng
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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14
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Mousa A, Bliman D, Hiram Betancourt L, Hellman K, Ekström P, Savvakis M, Strakosas X, Marko-Varga G, Berggren M, Hjort M, Ek F, Olsson R. Method Matters: Exploring Alkoxysulfonate-Functionalized Poly(3,4-ethylenedioxythiophene) and Its Unintentional Self-Aggregating Copolymer toward Injectable Bioelectronics. CHEMISTRY OF MATERIALS : A PUBLICATION OF THE AMERICAN CHEMICAL SOCIETY 2022; 34:2752-2763. [PMID: 35360437 PMCID: PMC8944941 DOI: 10.1021/acs.chemmater.1c04342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Injectable bioelectronics could become an alternative or a complement to traditional drug treatments. To this end, a new self-doped p-type conducting PEDOT-S copolymer (A5) was synthesized. This copolymer formed highly water-dispersed nanoparticles and aggregated into a mixed ion-electron conducting hydrogel when injected into a tissue model. First, we synthetically repeated most of the published methods for PEDOT-S at the lab scale. Surprisingly, analysis using high-resolution matrix-assisted laser desorption ionization-mass spectroscopy showed that almost all the methods generated PEDOT-S derivatives with the same polymer lengths (i.e., oligomers, seven to eight monomers in average); thus, the polymer length cannot account for the differences in the conductivities reported earlier. The main difference, however, was that some methods generated an unintentional copolymer P(EDOT-S/EDOT-OH) that is more prone to aggregate and display higher conductivities in general than the PEDOT-S homopolymer. Based on this, we synthesized the PEDOT-S derivative A5, that displayed the highest film conductivity (33 S cm-1) among all PEDOT-S derivatives synthesized. Injecting A5 nanoparticles into the agarose gel cast with a physiological buffer generated a stable and highly conductive hydrogel (1-5 S cm-1), where no conductive structures were seen in agarose with the other PEDOT-S derivatives. Furthermore, the ion-treated A5 hydrogel remained stable and maintained initial conductivities for 7 months (the longest period tested) in pure water, and A5 mixed with Fe3O4 nanoparticles generated a magnetoconductive relay device in water. Thus, we have successfully synthesized a water-processable, syringe-injectable, and self-doped PEDOT-S polymer capable of forming a conductive hydrogel in tissue mimics, thereby paving a way for future applications within in vivo electronics.
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Affiliation(s)
- Abdelrazek
H. Mousa
- Department
of Chemistry and Molecular Biology, University
of Gothenburg, 405 30 Gothenburg, Sweden
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - David Bliman
- Department
of Chemistry and Molecular Biology, University
of Gothenburg, 405 30 Gothenburg, Sweden
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Lazaro Hiram Betancourt
- Division
of Oncology, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
- Department
of Translational Medicine, Lund University,
Skåne University Hospital Malmö, 202 13 Malmö, Sweden
| | - Karin Hellman
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Peter Ekström
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Marios Savvakis
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Xenofon Strakosas
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - György Marko-Varga
- Division
of Clinical Protein Science & Imaging, Department of Clinical
Sciences and Department of Biomedical Engineering, Lund University, 221 00 Lund, Sweden
| | - Magnus Berggren
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Martin Hjort
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Fredrik Ek
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Roger Olsson
- Department
of Chemistry and Molecular Biology, University
of Gothenburg, 405 30 Gothenburg, Sweden
- Chemical
Biology & Therapeutics, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
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15
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Low-Noise Amplifier for Deep-Brain Stimulation (DBS). ELECTRONICS 2022. [DOI: 10.3390/electronics11060939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Deep-brain stimulation (DBS) is an emerging research topic aiming to improve the quality of life of patients with brain diseases, and a great deal of effort has been focused on the development of implantable devices. This paper presents a low-noise amplifier (LNA) for the acquisition of biopotentials on DBS. This electronic module was designed in a low-voltage/low-power CMOS process, targeting implantable applications. The measurement results showed a gain of 38.6 dB and a −3 dB bandwidth of 2.3 kHz. The measurements also showed a power consumption of 2.8 μW. Simulations showed an input-referred noise of 6.2 μVRMS. The LNA occupies a microdevice area of 122 μm × 283 μm, supporting its application in implanted systems.
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16
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Hunt J, Coulson EJ, Rajnarayanan R, Oster H, Videnovic A, Rawashdeh O. Sleep and circadian rhythms in Parkinson's disease and preclinical models. Mol Neurodegener 2022; 17:2. [PMID: 35000606 PMCID: PMC8744293 DOI: 10.1186/s13024-021-00504-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
The use of animals as models of human physiology is, and has been for many years, an indispensable tool for understanding the mechanisms of human disease. In Parkinson's disease, various mouse models form the cornerstone of these investigations. Early models were developed to reflect the traditional histological features and motor symptoms of Parkinson's disease. However, it is important that models accurately encompass important facets of the disease to allow for comprehensive mechanistic understanding and translational significance. Circadian rhythm and sleep issues are tightly correlated to Parkinson's disease, and often arise prior to the presentation of typical motor deficits. It is essential that models used to understand Parkinson's disease reflect these dysfunctions in circadian rhythms and sleep, both to facilitate investigations into mechanistic interplay between sleep and disease, and to assist in the development of circadian rhythm-facing therapeutic treatments. This review describes the extent to which various genetically- and neurotoxically-induced murine models of Parkinson's reflect the sleep and circadian abnormalities of Parkinson's disease observed in the clinic.
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Affiliation(s)
- Jeremy Hunt
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Elizabeth J. Coulson
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | | | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | - Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Oliver Rawashdeh
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
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17
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Cabrera LY, Young Han C, Ostendorf T, Jimenez-Shahed J, Sarva H. Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation. Neurol Clin Pract 2021; 11:506-516. [PMID: 34992957 PMCID: PMC8723941 DOI: 10.1212/cpj.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Affiliation(s)
- Laura Yenisa Cabrera
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Catherine Young Han
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Tasha Ostendorf
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Joohi Jimenez-Shahed
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Harini Sarva
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
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18
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Park Y, Chung TS, Lee G, Rogers JA. Materials Chemistry of Neural Interface Technologies and Recent Advances in Three-Dimensional Systems. Chem Rev 2021; 122:5277-5316. [PMID: 34739219 DOI: 10.1021/acs.chemrev.1c00639] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Advances in materials chemistry and engineering serve as the basis for multifunctional neural interfaces that span length scales from individual neurons to neural networks, neural tissues, and complete neural systems. Such technologies exploit electrical, electrochemical, optical, and/or pharmacological modalities in sensing and neuromodulation for fundamental studies in neuroscience research, with additional potential to serve as routes for monitoring and treating neurodegenerative diseases and for rehabilitating patients. This review summarizes the essential role of chemistry in this field of research, with an emphasis on recently published results and developing trends. The focus is on enabling materials in diverse device constructs, including their latest utilization in 3D bioelectronic frameworks formed by 3D printing, self-folding, and mechanically guided assembly. A concluding section highlights key challenges and future directions.
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Affiliation(s)
- Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60208, United States
| | - Ted S Chung
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60208, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, United States
| | - Geumbee Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60208, United States
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois 60208, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, United States.,Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois 60208, United States.,Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois 60208, United States.,Department of Chemistry, Northwestern University, Evanston, Illinois 60208, United States.,Department of Mechanical Engineering, Northwestern University, Evanston, Illinois 60208, United States.,Department of Neurological Surgery, Northwestern University, Evanston, Illinois 60208, United States
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19
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Cleary RT, Bucholz R. Neuromodulation Approaches in Parkinson's Disease Using Deep Brain Stimulation and Transcranial Magnetic Stimulation. J Geriatr Psychiatry Neurol 2021; 34:301-309. [PMID: 34219521 DOI: 10.1177/08919887211018269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parkinson's Disease (PD) is the second most common neurodegenerative disease, characterized by progressive motor (such as resting tremor, hypokinesia, postural instability) and non-motor symptoms (such as neuropsychiatric decline and autonomic dysfunction). Since its introduction in the late 1980s, deep brain stimulation (DBS) has revolutionized the treatment of PD. Initially used in patients' with advanced PD with either medically refractory motor symptoms or medication intolerance, DBS typically provides excellent improvement in motor symptoms. Indications for DBS have continued to expand, with demonstrated efficacy in early PD and essential tremor, and promising preliminary results in the treatment of epilepsy, psychiatric disease, and depression. Advancements in DBS hardware, programming, neuroimaging, and surgical techniques have led to progressive improvement in efficacy and safety profiles. Thanks to ongoing research into remote programming, adaptive DBS, new targets, and alternative interventions, such as transcranial magnetic stimulation, the opportunities for further improvements in DBS and neuromodulation are bright.
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Affiliation(s)
- Ryan T Cleary
- Department of Neurosurgery, 25213Saint Louis University Hospital, Saint Louis, MO, USA
| | - Richard Bucholz
- Department of Neurosurgery, 25213Saint Louis University Hospital, Saint Louis, MO, USA
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20
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He T, Guo X, Lee C. Flourishing energy harvesters for future body sensor network: from single to multiple energy sources. iScience 2021; 24:101934. [PMID: 33392482 PMCID: PMC7773596 DOI: 10.1016/j.isci.2020.101934] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Body sensor network (bodyNET) offers possibilities for future disease diagnosis, preventive health care, rehabilitation, and treatment. However, the eventual realization demands reliable and sustainable power sources. The flourishing energy harvesters (EHs) have provided prominent techniques for practically addressing the concurrent energy issue. Targeting for a specific energy source, wearable EHs with a sole conversion mechanism are well investigated. Hybrid EHs integrating different effects for a single source or multi-sources are attaining growing attention, for they provide another degree of freedom concerning a higher-level energy utility. Merging EHs with other functional electronics, diversified functional self-sustainable systems are developed, paving the way for the accomplishment of bodyNET. This review introduces the evolution of wearable EHs from a single effect to hybridized mechanisms for multiple energy sources and wearable to implantable self-sustainable systems. Last, we provide our perspectives on the future development of hybrid EHs to be more competitive with conventional batteries.
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Affiliation(s)
- Tianyiyi He
- Department of Electrical & Computer Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117576, Singapore
- Center for Intelligent Sensors and MEMS (CISM), National University of Singapore, 5 Engineering Drive 1, Singapore 117608, Singapore
- National University of Singapore Suzhou Research Institute (NUSRI), Suzhou Industrial Park, Suzhou 215123, China
| | - Xinge Guo
- Department of Electrical & Computer Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117576, Singapore
- Center for Intelligent Sensors and MEMS (CISM), National University of Singapore, 5 Engineering Drive 1, Singapore 117608, Singapore
| | - Chengkuo Lee
- Department of Electrical & Computer Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117576, Singapore
- Center for Intelligent Sensors and MEMS (CISM), National University of Singapore, 5 Engineering Drive 1, Singapore 117608, Singapore
- National University of Singapore Suzhou Research Institute (NUSRI), Suzhou Industrial Park, Suzhou 215123, China
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore 117456, Singapore
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21
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Thyagarajan K, Lujan RA, Wang Q, Lu J, Kor S, Kakimoto B, Chang N, Bert JA. Micro-coil probes for magnetic intracortical neural stimulation: Trade-offs in materials and design. APL MATERIALS 2021; 9:011102. [PMID: 33520428 PMCID: PMC7808331 DOI: 10.1063/5.0023486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/20/2020] [Indexed: 05/04/2023]
Abstract
Neural probes for intracortical neuromodulation in the brain have advanced with the developments in micro- and nanofabrication technologies. Most of these technologies for the intracortical stimulation have relied on the direct electrical stimulation via electrodes or arrays of electrodes. Generating electric fields using time-varying magnetic fields is a more recent neuromodulation technique that has proven to be more specifically effective for the intracortical stimulation. Additionally, current-actuated coils require no conductive contact with tissues and enable precise tailoring of magnetic fields, which are unaffected by the non-magnetic nature of the biological tissue and encapsulation layers. The material and design parameter space for such micro-coil fabrication can be optimized and tailored to deliver the ideal performance depending on the parameters needed for operation. In this work, we review the key requirements for implantable microcoils including the probe structure and material properties and discuss their characteristics and related challenges for the applications in intracortical neuromodulation.
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22
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Tanskanen JM, Ahtiainen A, Hyttinen JA. Toward Closed-Loop Electrical Stimulation of Neuronal Systems: A Review. Bioelectricity 2020; 2:328-347. [PMID: 34471853 PMCID: PMC8370352 DOI: 10.1089/bioe.2020.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Biological neuronal cells communicate using neurochemistry and electrical signals. The same phenomena also allow us to probe and manipulate neuronal systems and communicate with them. Neuronal system malfunctions cause a multitude of symptoms and functional deficiencies that can be assessed and sometimes alleviated by electrical stimulation. Our working hypothesis is that real-time closed-loop full-duplex measurement and stimulation paradigms can provide more in-depth insight into neuronal networks and enhance our capability to control diseases of the nervous system. In this study, we review extracellular electrical stimulation methods used in in vivo, in vitro, and in silico neuroscience research and in the clinic (excluding methods mainly aimed at neuronal growth and other similar effects) and highlight the potential of closed-loop measurement and stimulation systems. A multitude of electrical stimulation and measurement-based methods are widely used in research and the clinic. Closed-loop methods have been proposed, and some are used in the clinic. However, closed-loop systems utilizing more complex measurement analysis and adaptive stimulation systems, such as artificial intelligence systems connected to biological neuronal systems, do not yet exist. Our review promotes the research and development of intelligent paradigms aimed at meaningful communications between neuronal and information and communications technology systems, "dialogical paradigms," which have the potential to take neuroscience and clinical methods to a new level.
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Affiliation(s)
- Jarno M.A. Tanskanen
- BioMediTech Institute and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Annika Ahtiainen
- BioMediTech Institute and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari A.K. Hyttinen
- BioMediTech Institute and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Mapping of subthalamic nucleus using microelectrode recordings during deep brain stimulation. Sci Rep 2020; 10:19241. [PMID: 33159098 PMCID: PMC7648837 DOI: 10.1038/s41598-020-74196-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Alongside stereotactic magnetic resonance imaging, microelectrode recording (MER) is frequently used during the deep brain stimulation (DBS) surgery for optimal target localization. The aim of this study is to optimize subthalamic nucleus (STN) mapping using MER analytical patterns. 16 patients underwent bilateral STN-DBS. MER was performed simultaneously for 5 microelectrodes in a setting of Ben’s-gun pattern in awake patients. Using spikes and background activity several different parameters and their spectral estimates in various frequency bands including low frequency (2–7 Hz), Alpha (8–12 Hz), Beta (sub-divided as Low_Beta (13–20 Hz) and High_Beta (21–30 Hz)) and Gamma (31 to 49 Hz) were computed. The optimal STN lead placement with the most optimal clinical effect/side-effect ratio accorded to the maximum spike rate in 85% of the implantation. Mean amplitude of background activity in the low beta frequency range was corresponding to right depth in 85% and right location in 94% of the implantation respectively. MER can be used for STN mapping and intraoperative decisions for the implantation of DBS electrode leads with a high accuracy. Spiking and background activity in the beta range are the most promising independent parameters for the delimitation of the proper anatomical site.
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Pu L, Qureshi NK, Ly J, Zhang B, Cong F, Tang WC, Liang Z. Therapeutic benefits of music-based synchronous finger tapping in Parkinson's disease-an fNIRS study protocol for randomized controlled trial in Dalian, China. Trials 2020; 21:864. [PMID: 33066811 PMCID: PMC7568348 DOI: 10.1186/s13063-020-04770-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/24/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Music therapy improves neuronal activity and connectivity of healthy persons and patients with clinical symptoms of neurological diseases like Parkinson's disease, Alzheimer's disease, and major depression. Despite the plethora of publications that have reported the positive effects of music interventions, little is known about how music improves neuronal activity and connectivity in afflicted patients. METHODS For patients suffering from Parkinson's disease (PD), we propose a daily 25-min music-based synchronous finger tapping (SFT) intervention for 8 weeks. Eligible participants with PD are split into two groups: an intervention group and a control arm. In addition, a third cohort of healthy controls will be recruited. Assessment of finger tapping performances, the Unified Parkinson's Disease Rating Scale (UPDRS), an n-back test, the Montreal Cognitive Assessment (MoCA), as well as oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (HbR), and total hemoglobin activation collected by functional near-infrared spectroscopy (fNIRS) are measured at baseline, week 4 (during), week 8 (post), and week 12 (retention) of the study. Data collected from the two PD groups are compared to baseline performances from healthy controls. DISCUSSION This exploratory prospective trial study investigates the cortical neuronal activity and therapeutic effects associated with an auditory external cue used to induce automatic and implicit synchronous finger tapping in patients diagnosed with PD. The extent to which the intervention is effective may be dependent on the severity of the disease. The study's findings are used to inform larger clinical studies for optimization and further exploration of the therapeutic effects of movement-based music therapy on neural activity in neurological diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT04212897 . Registered on December 30, 2019. The participant recruitment and study protocol have received ethical approval from the First Affiliated Hospital of Dalian Medical University. The hospital Protocol Record number is PJ-KY-2019-123. The protocol was named "fNIRS Studies of Music Intervention of Parkinson's Disease." The current protocol is version 1.1, revised on September 1, 2020.
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Affiliation(s)
- Lanlan Pu
- Department of Neurology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Nauman Khalid Qureshi
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, Liaoning Province, China
| | - Joanne Ly
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Bingwei Zhang
- Department of Neurology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Fengyu Cong
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, Liaoning Province, China
- Faculty of Information Technology, University of Jyvaskyla, Jyvaskyla, Finland
| | - William C Tang
- Department of Biomedical Engineering, University of California, Irvine, CA, USA.
| | - Zhanhua Liang
- Department of Neurology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
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25
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Ronde EM, Silvasti-Lundell M, Pekkola J, Tallgren M, Kivisaari R. Preoperative Magnetic Resonance Image Quality in Motion Disorder Patients Scheduled for Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2020; 98:363-370. [PMID: 32957096 DOI: 10.1159/000506998] [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: 10/15/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To obtain magnetic resonance (MR) images of good quality for accurate target localization in deep brain stimulation (DBS) surgery, sedation or anesthesia may be used, although their usefulness has not been proven. OBJECTIVE To assess whether sedation or general anesthesia (GA) improve the quality of MR imaging (MRI). METHODS The records of DBS procedures for Parkinson's disease (PD), dystonia, and essential tremor in our tertiary neurosurgical unit between January 2011 and June 2016 were reviewed. Adult patients with preoperative MR images were included. Patient records concerning MRI, surgery, adverse events, and clinical outcome were retrospectively scrutinized and analyzed. MR image quality was assessed by two independent radiologists. RESULTS A total of 215 preoperative MR images for 177 DBS procedures were analyzed. The MRI sequences performed under GA were superior to those performed without anesthesia or under sedation (p < 0.01). Virtually all images captured under GA were of good quality, while the proportions among those captured with sedation or without anesthesia were <65%. Good image quality was not associated with better clinical outcome (>50% improvement in the Unified Parkinson's Disease Rating Scale III score) among patients with PD. CONCLUSION GA was associated with better MRI sequences than intravenous sedation or no anesthesia.
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Affiliation(s)
- Elsa M Ronde
- Department of Anesthesia, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja Silvasti-Lundell
- Department of Anesthesia, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Pekkola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Tallgren
- Department of Anesthesia, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
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26
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Benady A, Zadik S, Eimerl D, Heymann S, Bergman H, Israel Z, Raz A. Sedative drugs modulate the neuronal activity in the subthalamic nucleus of parkinsonian patients. Sci Rep 2020; 10:14536. [PMID: 32884017 PMCID: PMC7471283 DOI: 10.1038/s41598-020-71358-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
Microelectrode recording (MER) is often used to identify electrode location which is critical for the success of deep brain stimulation (DBS) treatment of Parkinson’s disease. The usage of anesthesia and its’ impact on MER quality and electrode placement is controversial. We recorded neuronal activity at a single depth inside the Subthalamic Nucleus (STN) before, during, and after remifentanil infusion. The root mean square (RMS) of the 250–6000 Hz band-passed signal was used to evaluate the regional spiking activity, the power spectrum to evaluate the oscillatory activity and the coherence to evaluate synchrony between two microelectrodes. We compare those to new frequency domain (spectral) analysis of previously obtained data during propofol sedation. Results showed Remifentanil decreased the normalized RMS by 9% (P < 0.001), a smaller decrease compared to propofol. Regarding the beta range oscillatory activity, remifentanil depressed oscillations (drop from 25 to 5% of oscillatory electrodes), while propofol did not (increase from 33.3 to 41.7% of oscillatory electrodes). In the cases of simultaneously recorded oscillatory electrodes, propofol did not change the synchronization while remifentanil depressed it. In conclusion, remifentanil interferes with the identification of the dorsolateral oscillatory region, whereas propofol interferes with RMS identification of the STN borders. Thus, both have undesired effect during the MER procedure. Trial registration: NCT00355927 and NCT00588926.
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Affiliation(s)
- Amit Benady
- St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel.,Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Sean Zadik
- St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel
| | - Dan Eimerl
- Department of Anesthesia, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sami Heymann
- Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University - Hadassah Medical Scholl, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Center affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Rambam Health Care Campus, Technion - Israel Institute of Technology, 8 HaAliya HaShniya St., 3109601, Haifa, Israel.
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27
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Abstract
Parkinson's disease (PD) is a common neurodegenerative disease typified by a movement disorder consisting of bradykinesia, rest tremor, rigidity, and postural instability. Treatment options for PD are limited, with most of the current approaches based on restoration of dopaminergic tone in the striatum. However, these do not alter disease course and do not treat the non-dopamine-dependent features of PD such as freezing of gait, cognitive impairment, and other non-motor features of the disorder, which often have the greatest impact on quality of life. As understanding of PD pathogenesis grows, novel therapeutic avenues are emerging. These include treatments that aim to control the symptoms of PD without the problematic side effects seen with currently available treatments and those that are aimed towards slowing pathology, reducing neuronal loss, and attenuating disease course. In this latter regard, there has been much interest in drug repurposing (the use of established drugs for a new indication), with many drugs being reported to affect PD-relevant intracellular processes. This approach offers an expedited route to the clinic, given that pharmacokinetic and safety data are potentially already available. In terms of better symptomatic therapies that are also regenerative, gene therapies and cell-based treatments are beginning to enter clinical trials, and developments in other neurosurgical strategies such as more nuanced deep brain stimulation approaches mean that the landscape of PD treatment is likely to evolve considerably over the coming years. In this review, we provide an overview of the novel therapeutic approaches that are close to, or are already in, clinical trials.
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Affiliation(s)
- Thomas B Stoker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
- Department of Neurology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
- Wellcome Trust – Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
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28
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You Z, Wu YY, Wu R, Xu ZX, Wu X, Wang XP. Efforts of subthalamic nucleus deep brain stimulation on cognitive spectrum: From explicit to implicit changes in the patients with Parkinson's disease for 1 year. CNS Neurosci Ther 2020; 26:972-980. [PMID: 32436660 PMCID: PMC7415202 DOI: 10.1111/cns.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the cognitive function of Chinese patients with Parkinson's disease PD postsubthalamic nucleus deep brain stimulation (STN-DBS). METHODS Cognitive function was assessed by neuropsychological methods in PD patients. Twenty matched healthy persons served as normal controls. t test, analysis of variance, and chi-square analysis were used to compare the difference among the groups. Reliable change index was utilized to analyze the changes in cognition from the individual level. RESULTS (a) Improvement in motor function was significantly better after STN-DBS (P < .01). (b) Notably, the increase error rates of implicit SRTT (serial reaction time task) was significantly higher after STN-DBS as compared with the conservative therapy group (P = .03). (c) The decline of verbal fluency (explicit) was also significantly higher after STN-DBS than that in the medication therapy group (P = .03). (d) In the explicit clock-drawing test, scores had significantly improved after STN-DBS (P = .04). CONCLUSIONS STN-DBS as a neuromodulatory tool in the Chinese PD population not only improves motor symptoms but also cognitive function to a certain extent, such as the decline of executive function and verbal fluency. The explicit cognitive decline was significantly quicker than that in patients on medication therapy. The improvement of visiospatial function was also noted. Implicit memory impairment during the 1-year follow-up period was not observed.
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Affiliation(s)
- ZhiFei You
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yi-Ying Wu
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Rong Wu
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Zhi-Xiang Xu
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
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29
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Obidin N, Tasnim F, Dagdeviren C. The Future of Neuroimplantable Devices: A Materials Science and Regulatory Perspective. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1901482. [PMID: 31206827 DOI: 10.1002/adma.201901482] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/12/2019] [Indexed: 06/09/2023]
Abstract
The past two decades have seen unprecedented progress in the development of novel materials, form factors, and functionalities in neuroimplantable technologies, including electrocorticography (ECoG) systems, multielectrode arrays (MEAs), Stentrode, and deep brain probes. The key considerations for the development of such devices intended for acute implantation and chronic use, from the perspective of biocompatible hybrid materials incorporation, conformable device design, implantation procedures, and mechanical and biological risk factors, are highlighted. These topics are connected with the role that the U.S. Food and Drug Administration (FDA) plays in its regulation of neuroimplantable technologies based on the above parameters. Existing neuroimplantable devices and efforts to improve their materials and implantation protocols are first discussed in detail. The effects of device implantation with regards to biocompatibility and brain heterogeneity are then explored. Topics examined include brain-specific risk factors, such as bacterial infection, tissue scarring, inflammation, and vasculature damage, as well as efforts to manage these dangers through emerging hybrid, bioelectronic device architectures. The current challenges of gaining clinical approval by the FDA-in particular, with regards to biological, mechanical, and materials risk factors-are summarized. The available regulatory pathways to accelerate next-generation neuroimplantable devices to market are then discussed.
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Affiliation(s)
- Nikita Obidin
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Farita Tasnim
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Canan Dagdeviren
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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30
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Luo M, Larson PS, Martin AJ, Miga MI. Accounting for Deformation in Deep Brain Stimulation Surgery With Models: Comparison to Interventional Magnetic Resonance Imaging. IEEE Trans Biomed Eng 2020; 67:2934-2944. [PMID: 32078527 DOI: 10.1109/tbme.2020.2974102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The efficacy of deep brain stimulation (DBS) depends on electrode placement accuracy, which can be jeopardized by brain shift due to burr hole and dura opening during surgery. Brain shift violates assumed rigid alignment between preoperative image and intraoperative anatomy, negatively impacting therapy. OBJECTIVE This study presents a deformation-atlas biomechanical model-based approach to address shift. METHODS Six patients, who underwent interventional magnetic resonance (iMR) image-guided DBS burr hole surgery, were studied. A patient-specific model was employed under varying surgical conditions, generating a collection of possible intraoperative shift estimations or a 'deformation atlas.' An inverse problem was driven by sparse measurements derived from iMR to determine an optimal fit of solutions of the atlas. This fit was then used to obtain a volumetric deformation field, which was utilized to update preoperative MR and estimate shift at surgical target region localized on iMR. Model performance was examined by quantitatively comparing intraoperative subsurface measurements to their model-predicted counterparts, and qualitatively comparing iMR, preoperative MR, and model updated MR. A nonrigid image registration was introduced as a comparator. RESULTS Model-based approach reduced general parenchyma shift from 8.2 ± 2.2 to 2.7 ± 1.1 mm (∼66.8% correction), and produced updated MR with better agreement to iMR than that of preoperative MR. The average model estimated shift at target region was 1.2 mm. CONCLUSIONS This study demonstrates the feasibility of a model-based shift correction strategy in DBS surgery with only sparse data. SIGNIFICANCE The developed strategy has the potential to complement and/or enhance current clinical approaches in addressing shift.
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31
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Abstract
Parkinson disease (PD) treatment options have conventionally focused on dopamine replacement and provision of symptomatic relief. Current treatments cause undesirable adverse effects, and a large unmet clinical need remains for treatments that offer disease modification and that address symptoms resistant to levodopa. Advances in high-throughput drug screening methods for small molecules, developments in disease modelling and improvements in analytical technologies have collectively contributed to the emergence of novel compounds, repurposed drugs and new technologies. In this Review, we focus on disease-modifying and symptomatic therapies under development for PD. We review cellular therapies and repurposed drugs, such as nilotinib, inosine, isradipine, iron chelators and anti-inflammatories, and discuss how their success in preclinical models has paved the way for clinical trials. We provide an update on immunotherapies and vaccines. In addition, we review non-pharmacological interventions targeting motor symptoms, including gene therapy, adaptive deep brain stimulation (DBS) and optogenetically inspired DBS. Given the many clinical phenotypes of PD, individualization of therapy and precision of treatment are likely to become important in the future.
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32
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Yu Y, Wang X, Wang Q, Wang Q. A review of computational modeling and deep brain stimulation: applications to Parkinson's disease. APPLIED MATHEMATICS AND MECHANICS 2020; 41:1747-1768. [PMID: 33223591 PMCID: PMC7672165 DOI: 10.1007/s10483-020-2689-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/12/2020] [Indexed: 05/11/2023]
Abstract
Biophysical computational models are complementary to experiments and theories, providing powerful tools for the study of neurological diseases. The focus of this review is the dynamic modeling and control strategies of Parkinson's disease (PD). In previous studies, the development of parkinsonian network dynamics modeling has made great progress. Modeling mainly focuses on the cortex-thalamus-basal ganglia (CTBG) circuit and its sub-circuits, which helps to explore the dynamic behavior of the parkinsonian network, such as synchronization. Deep brain stimulation (DBS) is an effective strategy for the treatment of PD. At present, many studies are based on the side effects of the DBS. However, the translation from modeling results to clinical disease mitigation therapy still faces huge challenges. Here, we introduce the progress of DBS improvement. Its specific purpose is to develop novel DBS treatment methods, optimize the treatment effect of DBS for each patient, and focus on the study in closed-loop DBS. Our goal is to review the inspiration and insights gained by combining the system theory with these computational models to analyze neurodynamics and optimize DBS treatment.
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Affiliation(s)
- Ying Yu
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
| | - Xiaomin Wang
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
| | - Qishao Wang
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
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Vasudevan S, Kajtez J, Bunea A, Gonzalez‐Ramos A, Ramos‐Moreno T, Heiskanen A, Kokaia M, Larsen NB, Martínez‐Serrano A, Keller SS, Emnéus J. Leaky Optoelectrical Fiber for Optogenetic Stimulation and Electrochemical Detection of Dopamine Exocytosis from Human Dopaminergic Neurons. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1902011. [PMID: 31871869 PMCID: PMC6918109 DOI: 10.1002/advs.201902011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/11/2019] [Indexed: 05/30/2023]
Abstract
In Parkinson's disease, the degeneration of dopaminergic neurons in substantia nigra leads to a decrease in the physiological levels of dopamine in striatum. The existing dopaminergic therapies effectively alleviate the symptoms, albeit they do not revert the disease progression and result in significant adverse effects. Transplanting dopaminergic neurons derived from stem cells could restore dopamine levels without additional motor complications. However, the transplanted cells disperse in vivo and it is not possible to stimulate them on demand to modulate dopamine release to prevent dyskinesia. In order to address these issues, this paper presents a multifunctional leaky optoelectrical fiber for potential neuromodulation and as a cell substrate for application in combined optogenetic stem cell therapy. Pyrolytic carbon coated optical fibers are laser ablated to pattern micro-optical windows to permit light leakage over a large area. The pyrolytic carbon acts as an excellent electrode for the electrochemical detection of dopamine. Human neural stem cells are genetically modified to express the light sensitive opsin channelrhodopsin-2 and are differentiated into dopaminergic neurons on the leaky optoelectrical fiber. Finally, light leaking from the micro-optical windows is used to stimulate the dopaminergic neurons resulting in the release of dopamine that is detected in real-time using chronoamperometry.
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Affiliation(s)
- Shashank Vasudevan
- Department of Biotechnology and Biomedicine (DTU Bioengineering)Technical University of DenmarkProduktionstorvetBuilding 423, Room 1222800Kongens LyngbyDenmark
| | - Janko Kajtez
- Department of Biotechnology and Biomedicine (DTU Bioengineering)Technical University of DenmarkProduktionstorvetBuilding 423, Room 1222800Kongens LyngbyDenmark
| | - Ada‐Ioana Bunea
- National Center for Nano Fabrication and Characterization (DTU Nanolab)Technical University of DenmarkØrsteds PladsBuilding 3472800Kongens LyngbyDenmark
| | - Ana Gonzalez‐Ramos
- Epilepsy CentreDepartment of Clinical SciencesLund University Hospital221 84LundSweden
| | - Tania Ramos‐Moreno
- Lund Stem Cell CenterDivision of NeurosurgeryDepartment of Clinical SciencesLund University221 84LundSweden
| | - Arto Heiskanen
- Department of Biotechnology and Biomedicine (DTU Bioengineering)Technical University of DenmarkProduktionstorvetBuilding 423, Room 1222800Kongens LyngbyDenmark
| | - Merab Kokaia
- Epilepsy CentreDepartment of Clinical SciencesLund University Hospital221 84LundSweden
| | - Niels B. Larsen
- Department of Health Technology (DTU Health Tech)Technical University of DenmarkProduktionstorvetBuilding 4232800Kongens LyngbyDenmark
| | - Alberto Martínez‐Serrano
- Department of Molecular BiologyUniversidad Autónoma de Madrid, and Department of Molecular NeuropathologyCenter of Molecular Biology Severo Ochoa (UAM‐CSIC)Nicolás Cabrera 128049MadridSpain
| | - Stephan S. Keller
- National Center for Nano Fabrication and Characterization (DTU Nanolab)Technical University of DenmarkØrsteds PladsBuilding 3472800Kongens LyngbyDenmark
| | - Jenny Emnéus
- Department of Biotechnology and Biomedicine (DTU Bioengineering)Technical University of DenmarkProduktionstorvetBuilding 423, Room 1222800Kongens LyngbyDenmark
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Tonda-Turo C, Origlia N, Mattu C, Accorroni A, Chiono V. Current Limitations in the Treatment of Parkinson's and Alzheimer's Diseases: State-of-the-Art and Future Perspective of Polymeric Carriers. Curr Med Chem 2019; 25:5755-5771. [PMID: 29473493 DOI: 10.2174/0929867325666180221125759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/18/2017] [Accepted: 02/06/2018] [Indexed: 12/18/2022]
Abstract
Alzheimer's and Parkinson's diseases are the most common neurodegenerative diseases worldwide and their incidence is increasing due to the aging population. At the moment, the available therapies are not disease modifying and have several limitations, some of which are discussed in this review. One of the main limitations of these treatments is the low concentration that drugs reach in the central nervous system after systemic administration. Indeed, the presence of biological barriers, particularly the blood-brain barrier (BBB), hinders the effective drug delivery to the brain, reducing the potential benefit coming from the administration of the medication. In this review, the mechanisms of transport across the BBB and new methods to improve drug passage across the BBB are discussed. These methods include non-invasive solutions such as intranasal and intravitreal administration, and the use of nanotechnology solutions based on polymeric carriers when the drug is intravenously injected, orally taken for intestine adsorption or delivered through the dermal mucosa. Also, it provides an analysis of more invasive solutions that include intracranially injected hydrogels and implanted devices for local drug delivery. Efforts in finding new therapeutic drugs blocking neurodegenerative disease progression or reverting their course should be coupled with efforts addressed to efficient drug delivery systems. Hence, new pharmacology discoveries together with advancements in nanotechnologies and biomaterials for regenerative medicine are required to effectively counteract neurodegenerative diseases.
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Affiliation(s)
- Chiara Tonda-Turo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Turin, Italy
| | - Nicola Origlia
- CNR, Neuroscience Institute Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Clara Mattu
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Turin, Italy
| | - Alice Accorroni
- CNR, Neuroscience Institute Via G. Moruzzi 1, 56124 Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Valeria Chiono
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Turin, Italy
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Farrell SM, Green A, Aziz T. The Use of Neuromodulation for Symptom Management. Brain Sci 2019; 9:brainsci9090232. [PMID: 31547392 PMCID: PMC6769574 DOI: 10.3390/brainsci9090232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023] Open
Abstract
Pain and other symptoms of autonomic dysregulation such as hypertension, dyspnoea and bladder instability can lead to intractable suffering. Incorporation of neuromodulation into symptom management, including palliative care treatment protocols, is becoming a viable option scientifically, ethically, and economically in order to relieve suffering. It provides further opportunity for symptom control that cannot otherwise be provided by pharmacology and other conventional methods.
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Affiliation(s)
- Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Alexander Green
- Nuffield department of clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
- Nuffield department of clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
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Segato A, Pieri V, Favaro A, Riva M, Falini A, De Momi E, Castellano A. Automated Steerable Path Planning for Deep Brain Stimulation Safeguarding Fiber Tracts and Deep Gray Matter Nuclei. Front Robot AI 2019; 6:70. [PMID: 33501085 PMCID: PMC7806057 DOI: 10.3389/frobt.2019.00070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Deep Brain Stimulation (DBS) is a neurosurgical procedure consisting in the stereotactic implantation of stimulation electrodes to specific brain targets, such as deep gray matter nuclei. Current solutions to place the electrodes rely on rectilinear stereotactic trajectories (RTs) manually defined by surgeons, based on pre-operative images. An automatic path planner that accurately targets subthalamic nuclei (STN) and safeguards critical surrounding structures is still lacking. Also, robotically-driven curvilinear trajectories (CTs) computed on the basis of state-of-the-art neuroimaging would decrease DBS invasiveness, circumventing patient-specific obstacles. This work presents a new algorithm able to estimate a pool of DBS curvilinear trajectories for reaching a given deep target in the brain, in the context of the EU's Horizon EDEN2020 project. The prospect of automatically computing trajectory plans relying on sophisticated newly engineered steerable devices represents a breakthrough in the field of microsurgical robotics. By tailoring the paths according to single-patient anatomical constraints, as defined by advanced preoperative neuroimaging including diffusion MR tractography, this planner ensures a higher level of safety than the standard rectilinear approach. Ten healthy controls underwent Magnetic Resonance Imaging (MRI) on 3T scanner, including 3DT1-weighted sequences, 3Dhigh-resolution time-of-flight MR angiography (TOF-MRA) and high angular resolution diffusion MR sequences. A probabilistic q-ball residual-bootstrap MR tractography algorithm was used to reconstruct motor fibers, while the other deep gray matter nuclei surrounding STN and vessels were segmented on T1 and TOF-MRA images, respectively. These structures were labeled as obstacles. The reliability of the automated planner was evaluated; CTs were compared to RTs in terms of efficacy and safety. Targeting the anterior STN, CTs performed significantly better in maximizing the minimal distance from critical structures, by finding a tuned balance between all obstacles. Moreover, CTs resulted superior in reaching the center of mass (COM) of STN, as well as in optimizing the entry angle in STN and in the skull surface.
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Affiliation(s)
- Alice Segato
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Valentina Pieri
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Favaro
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Marco Riva
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.,Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Shepherd RK, Carter PM, Enke YL, Wise AK, Fallon JB. Chronic intracochlear electrical stimulation at high charge densities results in platinum dissolution but not neural loss or functional changes in vivo. J Neural Eng 2019; 16:026009. [PMID: 30523828 PMCID: PMC8687872 DOI: 10.1088/1741-2552/aaf66b] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although there are useful guidelines defining the boundary between damaging and non-damaging electrical stimulation they were derived from acute studies using large surface area electrodes in direct contact with cortical neurons. These parameters are a small subset of the parameters used by neural stimulators. More recently, histological examination of cochleae from patients that were long-term cochlear implant users have shown evidence of particulate platinum (Pt). The pathophysiological effect of Pt within the cochlea is unknown. We examined the response of the cochlea to stimulus levels beyond those regarded as safe, and to evaluate the pathophysiological response of the cochlea following chronic stimulation at charge densities designed to induce Pt corrosion in vivo. APPROACH 19 guinea pigs were systemically deafened and implanted with a cochlear electrode array containing eight Pt electrodes of 0.05, 0.075 or 0.2 mm2 area. Animals were electrically stimulated continuously for 28 d using charge balanced current pulses at charge densities of 400, 267 or 100 µC/cm2/phase. Electrically-evoked auditory brainstem responses (EABRs) were recorded to monitor neural function. On completion of stimulation electrodes were examined using scanning electron microscopy (SEM) and cochleae examined histology. Finally, analysis of Pt was measured using energy dispersive x-ray spectroscopy (EDS) and inductively coupled plasma mass spectrometry (ICP-MS). MAIN RESULTS Compared with unstimulated control electrodes and electrodes stimulated at 100 µC/cm2/phase, stimulation at 267 or 400 µC/cm2/phase resulted in significant Pt corrosion. Cochleae stimulated at these high charge densities contained particulate Pt. The extent of the foreign body response depended on the level of stimulation; cochleae stimulated at 267 or 400 µC/cm2/phase exhibited an extensive tissue response that included a focal region of necrosis close to the electrode. Despite chronic stimulation at high charge densities there was no loss of auditory neurons (ANs) in stimulated cochleae compared with their contralateral controls. Indeed, we report a statistically significant increase in AN density proximal to electrodes stimulated at 267 or 400 µC/cm2/phase. Finally, there was no evidence of a reduction in AN function associated with chronic stimulation at 100, 267 or 400 µC/cm2/phase as evidenced by stable EABR thresholds over the stimulation program. SIGNIFICANCE Chronic electrical stimulation of Pt electrodes at 267 or 400 µC/cm2/phase evoked a vigorous tissue response and produced Pt corrosion products that were located close to the electrode. Despite these changes at the electrode/tissue interface there was no evidence of neural loss or a reduction in neural function.
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Affiliation(s)
- Robert K Shepherd
- Bionics Institute, St Vincent's Hospital, Melbourne, Australia. Medical Bionics Department, The University of Melbourne, Melbourne, Australia
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Sarno M, Gaztanaga W, Banerjee N, Bure-Reyes A, Rooks J, Margolesky J, Luca C, Singer C, Moore H, Jagid J, Levin B. Revisiting eligibility for deep brain stimulation: Do preoperative mood symptoms predict outcomes in Parkinson's disease patients? Parkinsonism Relat Disord 2019; 63:131-136. [PMID: 30799236 DOI: 10.1016/j.parkreldis.2019.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Anxiety and depression are common in PD, occurring in an estimated 30%-40% of PD patients. However, the extent to which these emotional symptoms interfere with Deep Brain Stimulation (DBS) outcomes is not well established. This study examined the association between pre-operative emotional well-being and postsurgical cognitive, emotional, and motor performance in PD. METHODS Forty-nine PD patients underwent neurological, neuropsychological (global cognition, processing speed, language, visuospatial, memory), and emotional assessments pre- and post-DBS. Fifteen patients were administered the UPDRS. Patients were divided into Anxious (Anx; n = 21), Comorbid Anxious and Depressed (Anx + Dep; n = 15), and Emotionally Asymptomatic (EA; n = 13) based on BAI and BDI-II cutoffs, and compared on pre-post changes in neurocognitive, mood, and motor scores using analyses of covariance (ANCOVA), controlling for education, ethnicity, and disease duration. RESULTS Pre-DBS, there were no significant differences between the three groups on any neuropsychological measure. Overall change from pre-to post-DBS revealed declines on multiple cognitive measures and lower symptom endorsement on the BAI among all participants. No group differences were observed on neurocognitive measures, mood, or UPDRS. CONCLUSIONS PD patients with mild-moderate anxiety or comorbid anxiety/depression pre-DBS do not show greater cognitive, emotional, and motor changes post-DBS compared to emotionally asymptomatic patients. These data emphasize the importance of discussing potential DBS outcomes, while keeping in mind that psychiatric comorbidity should not necessarily exclude patients from DBS. The notion that premorbid mood symptoms could disqualify a candidate for surgery would be a disservice, as this group performs comparably to asymptomatic peers.
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Affiliation(s)
- Marina Sarno
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA.
| | - Wendy Gaztanaga
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Nikhil Banerjee
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Annelly Bure-Reyes
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Joshua Rooks
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Jason Margolesky
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Corneliu Luca
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Carlos Singer
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Henry Moore
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Jonathan Jagid
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
| | - Bonnie Levin
- University of Miami, Department of Neurology, 1150 NW 14th Street Miami, 33136, Florida, USA
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Cubo R, Astrom M, Medvedev A. Optimization-Based Contact Fault Alleviation in Deep Brain Stimulation Leads. IEEE Trans Neural Syst Rehabil Eng 2019; 26:69-76. [PMID: 29324404 DOI: 10.1109/tnsre.2017.2769707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep brain stimulation (DBS) is a neurosurgical treatment in, e.g., Parkinson's Disease. Electrical stimulation in DBS is delivered to a certain target through electrodes implanted into the brain. Recent developments aiming at better stimulation target coverage and lesser side effects have led to an increase in the number of contacts in a DBS lead as well as higher hardware complexity. This paper proposes an optimization-based approach to alleviation of the fault impact on the resulting therapeutical effect in field steering DBS. Faulty contacts could be an issue given recent trends of increasing number of contacts in DBS leads. Hence, a fault detection/alleviation scheme, such as the one proposed in this paper, is necessary ensure resilience in the chronic stimulation. Two alternatives are considered and compared with the stimulation prior to the fault: one using higher amplitudes on the remaining contacts and another with alleviating contacts in the neighborhood of the faulty one. Satisfactory compensation for a faulty contact can be achieved in both ways. However, to designate alleviating contacts, a model-based optimization procedure is necessary. Results suggest that stimulating with more contacts yields configurations that are more robust to contact faults, though with reduced selectivity.
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40
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Herrnstadt G, McKeown MJ, Menon C. Controlling a motorized orthosis to follow elbow volitional movement: tests with individuals with pathological tremor. J Neuroeng Rehabil 2019; 16:23. [PMID: 30709409 PMCID: PMC6359763 DOI: 10.1186/s12984-019-0484-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for alternative treatment options for tremor patients who do not respond well to medications or surgery, either due to side effects or poor efficacy, or that are excluded from surgery. The study aims to evaluate feasibility of a voluntary-driven, speed-controlled tremor rejection approach with individuals with pathological tremor. The suppression approach was investigated using a robotic orthosis for suppression of elbow tremor. Importantly, the study emphasizes the performance in relation to the voluntary motion. METHODS Nine participants with either Essential Tremor (ET) or Parkinson's disease (PD) were recruited and tested off medication. The participants performed computerized pursuit tracking tasks following a sinusoid and a random target, both with and without the suppressive orthosis. The impact of the Tremor Suppression Orthosis (TSO) at the tremor and voluntary frequencies was determined by the relative power change calculated from the Power Spectral Density (PSD). Voluntary motion was, in addition, assessed by position and velocity tracking errors. RESULTS The suppressive orthosis resulted in a 94.4% mean power reduction of the tremor (p < 0.001) - a substantial improvement over reports in the literature. As for the impact to the voluntary motion, paired difference tests revealed no statistical effect of the TSO on the relative power change (p = 0.346) and velocity tracking error (p = 0.283). A marginal effect was observed for the position tracking error (p = 0.05). The interaction torque with the robotic orthosis was small (0.62 Nm) when compared to the maximum voluntary torque that can be exerted by adult individuals at the elbow joint. CONCLUSIONS Two key contributions of this work are first, a recently proposed approach is evaluated with individuals with tremor demonstrating high levels of tremor suppression; second, the impact of the approach to the voluntary motion is analyzed comprehensively, showing limited inhibition. This study also seeks to address a gap in studies with individuals with tremor where the impact of engineering solutions on voluntary motion is unreported. This study demonstrates feasibility of the wearable technology as an effective treatment that removes tremor with limited impediment to intentional motion. The goal for such wearable technology is to help individuals with pathological tremor regain independence in activities affected by the tremor condition. Further investigations are needed to validate the technology.
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Affiliation(s)
- Gil Herrnstadt
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Martin J McKeown
- Department of Medicine (Neurology) and Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, Canada.
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Chang AY, Dutta G, Siddiqui S, Arumugam PU. Surface Fouling of Ultrananocrystalline Diamond Microelectrodes during Dopamine Detection: Improving Lifetime via Electrochemical Cycling. ACS Chem Neurosci 2019; 10:313-322. [PMID: 30285418 DOI: 10.1021/acschemneuro.8b00257] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this work, we report the electrochemical response of a boron-doped ultrananocrystalline diamond (BDUNCD) microelectrode during long-term dopamine (DA) detection. Specifically, changes to its electrochemical activity and electroactive area due to DA byproducts and surface oxidation are studied via scanning electron microscopy, energy dispersive spectroscopy, electrochemical impedance spectroscopy, and silver deposition imaging (SDI). The fouling studies with amperometry (AM) and fast scan cyclic voltammetry (FSCV) methods suggest that the microelectrodes are heavily fouled due to poor DA-dopamine- o-quinone cyclization rates followed by a combination of polymer formation and major changes in their surface chemistry. SDI data confirms the presence of the insulating polymer with sparsely distributed tiny electroactive regions. This resulted in severely distorted DA signals and a 90% loss in signal starting as early as 3 h for AM and a 56% loss at 6.5 h for FSCV. This underscores the need for cleaning of the fouled microelectrodes if they have to be used long-term. Out of the three in vivo suitable electrochemical cycling cleaning waveforms investigated, the standard waveform (-0.4 V to +1.0 V) provides the best cleaned surface with a fully retained voltammogram shape, no hysteresis, no DA signal loss (a 90 ± 0.72 nA increase), and the smallest charge transfer resistance value of 0.4 ± 0.02 MΩ even after 6.5 h of monitoring. Most importantly, this is the same waveform that is widely used for in vivo detection with carbon fiber microelectrodes. Future work to test these microelectrodes for more than 24 h of DA detection is anticipated.
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Affiliation(s)
- An-Yi Chang
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
| | - Gaurab Dutta
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
| | - Shabnam Siddiqui
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
| | - Prabhu U. Arumugam
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
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Prorok T, Jana M, Patel D, Pahan K. Cinnamic Acid Protects the Nigrostriatum in a Mouse Model of Parkinson's Disease via Peroxisome Proliferator-Activated Receptorα. Neurochem Res 2019; 44:751-762. [PMID: 30612307 DOI: 10.1007/s11064-018-02705-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is the second most common devastating human neurodegenerative disorder and despite intense investigation, no effective therapy is available for PD. Cinnamic acid, a naturally occurring aromatic fatty acid of low toxicity, is a precursor for the synthesis of a huge number of plant substances. This study highlights the neuroprotective effect of cinnamic acid in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of PD. Oral administration of cinnamic acid protected tyrosine hydroxylase (TH)-positive dopaminergic neurons in the substantia nigra pars compacta (SNpc) and TH fibers in the striatum of MPTP-insulted mice. Accordingly, oral cinnamic acid also normalized striatal neurotransmitters and improved locomotor activities in MPTP-intoxicated mice. While investigating mechanisms, we found that cinnamic acid induced the activation of peroxisome proliferator-activated receptor α (PPARα), but not PPARβ, in primary mouse astrocytes. Cinnamic acid mediated protection of the nigrostriatal system and locomotor activities in WT and PPARβ (-/-), but not PPARα (-/-) mice from MPTP intoxication suggests that cinnamic acid requires the involvement of PPARα in protecting dopaminergic neurons in this model of PD. This study delineates a new function of cinnamic acid in protecting dopaminergic neurons via PPARα that could be beneficial for PD.
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Affiliation(s)
- Tim Prorok
- Division of Research and Development, Jesse Brown Veterans Affairs Medical Center, Chicago, USA.,Department of Neurological Sciences, Rush University Medical Center, 1735 West Harrison St, Suite 310, Chicago, IL, 60612, USA
| | - Malabendu Jana
- Division of Research and Development, Jesse Brown Veterans Affairs Medical Center, Chicago, USA.,Department of Neurological Sciences, Rush University Medical Center, 1735 West Harrison St, Suite 310, Chicago, IL, 60612, USA
| | - Dhruv Patel
- Division of Research and Development, Jesse Brown Veterans Affairs Medical Center, Chicago, USA.,Department of Neurological Sciences, Rush University Medical Center, 1735 West Harrison St, Suite 310, Chicago, IL, 60612, USA
| | - Kalipada Pahan
- Division of Research and Development, Jesse Brown Veterans Affairs Medical Center, Chicago, USA. .,Department of Neurological Sciences, Rush University Medical Center, 1735 West Harrison St, Suite 310, Chicago, IL, 60612, USA.
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Tu PH, Liu ZH, Chen CC, Lin WY, Bowes AL, Lu CS, Lee ST. Indirect Targeting of Subthalamic Deep Brain Stimulation Guided by Stereotactic Computed Tomography and Microelectrode Recordings in Patients With Parkinson's Disease. Front Hum Neurosci 2018; 12:470. [PMID: 30568585 PMCID: PMC6290336 DOI: 10.3389/fnhum.2018.00470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/08/2018] [Indexed: 01/17/2023] Open
Abstract
Objective: Magnetic resonance imaging fusion techniques guided by frame-based stereotactic computed tomography and microelectrode recordings are widely used to target the subthalamic nucleus. However, MRI is not always available. The aim of this study was to determine whether the indirect targeting of the subthalamic nucleus for deep brain stimulation using frame-based stereotactic computed tomography and microelectrode recording guidance in patients with advanced idiopathic Parkinson’s disease was an effective and safe treatment and to determine the factors that contributed to outcome. Methods: Thirty-four consecutive patients with Parkinson’s disease who were treated from 2010 to 2012 were enrolled in this retrospective cohort study. The patients were assessed with the Unified Parkinson’s Disease Rating Scale-part III (UPDRS-III) and other clinical profiles peri- and post-operatively. The horizontal and vertical distances between the midpoint of the head frame and the brain midline at the septum pellucidum level and the upper edge of the bilateral lens, respectively, on a thin-section brain computed tomography scan were defined as the horizontal and vertical deviations, respectively. Results: After the deep brain stimulation surgery, the patients’ UPDRS-III scores improved 48 ± 2.8% (range, 20–81%) compared to the patients’ baseline off-levodopa scores. No surgery-associated complications were found. The mean recorded length difference of the subthalamic nucleus between the initial and final single microelectrode recording trajectories was 5.37 ± 0.16 mm (range, 3.99–7.50). Multiple linear regression analyses revealed that the increased lengths of the vertical (regression coefficient [B]: -0.0626; 95% confidence interval [CI]: -0.113 to -0.013) and horizontal deviations (B: -0.0497; 95% CI: -0.083 to -0.017) were associated with less improvement in the patients’ UPDRS scores. Conclusion: These results showed that the indirect targeting of the subthalamic nucleus for deep brain stimulation using frame-based stereotactic computed tomography and microelectrode recording guidance in patients with advanced idiopathic Parkinson’s disease was effective and safe. Greater symmetry of the head frame fixation resulted in better outcomes of the deep brain stimulation of the subthalamic nucleus in patients with Parkinson’s disease, especially when the horizontal deviation was 2 mm or less and the vertical deviation was 1 mm or less.
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Affiliation(s)
- Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Linkou, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Linkou, Taiwan
| | - Chiung Chu Chen
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Linkou, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Wey Yil Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Linkou, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.,Department of Neurology, Landseed Hospital, Taoyuan, Taiwan
| | - Amy L Bowes
- Royal Free London NHS Foundation Trust, Royal Free Hospital, London, United Kingdom
| | - Chin Song Lu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Linkou, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Linkou, Taiwan
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Bhaskar Y, Lim LW, Mitra R. Enriched Environment Facilitates Anxiolytic Efficacy Driven by Deep-Brain Stimulation of Medial Prefrontal Cortex. Front Behav Neurosci 2018; 12:204. [PMID: 30356891 PMCID: PMC6190853 DOI: 10.3389/fnbeh.2018.00204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/17/2018] [Indexed: 12/29/2022] Open
Abstract
Deep brain stimulation (DBS) is a widely used treatment for neurodegenerative disorders like Parkinson’s disease. Recently, several studies have used preclinical animal models to suggest that DBS has a potential to improve emotional symptoms in mental disorders such as treatment-resistant depression and post-traumatic stress disorder. An important difference between neurodegenerative and emotional disorders is the crucial role of environment in the ontogeny of the latter. Thus, it is important to understand the effects of DBS in the context of environmental variation. In this study, we show that DBS of ventromedial prefrontal cortex reduces anxiety in rats when it is coupled with simultaneous exposure to an enriched environment (EE). In contrast, effects of DBS on anxiety-like behaviors remained equivocal when animals were housed in standard laboratory conditions. These results suggest that the ability of DBS to treat anxiety and related phenotypes can be significantly enhanced by EE opportunities.
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Affiliation(s)
- Yamini Bhaskar
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Lee Wei Lim
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Rupshi Mitra
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
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Oses M, Ordás CM, Feliz C, Val JD, Ayerbe J, García-Ruiz PJ. Disease-modifying anti-rheumatic drugs as a risk factor for delayed DBS implant infection. Parkinsonism Relat Disord 2018; 55:143-144. [DOI: 10.1016/j.parkreldis.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 11/15/2022]
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Foki T, Hitzl D, Pirker W, Novak K, Pusswald G, Lehrner J. Individual cognitive change after DBS-surgery in Parkinson's disease patients using Reliable Change Index Methodology. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2018; 32:149-158. [PMID: 29767379 PMCID: PMC6132487 DOI: 10.1007/s40211-018-0271-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/23/2018] [Indexed: 11/24/2022]
Abstract
Long-term therapy of Parkinson's disease (PD) with levodopa (L-DOPA) is associated with a high risk of developing motor fluctuations and dyskinesia. Deep brain stimulation (DBS) in PD patients of the subthalamic nucleus can improve these motor complications. Although the positive effect on motor symptoms has been proven, postoperative cognitive decline has been documented. To tackle the impact of PD-DBS on cognition, 18 DBS patients were compared to 25 best medically treated Parkinson's patients, 24 Mild Cognitive Impairment (MCI) patients and 12 healthy controls using the Neuropsychological Test Battery Vienna-long (NTBV-long) for cognitive outcome 12 months after first examination. Reliable change index methodology was used. Overall, there was cognitive change in individual patients, but the change was very heterogeneous with gains and losses. Further research is needed to identify the mechanisms that lead to improvement or deterioration of cognitive functions in individual cases.
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Affiliation(s)
- Thomas Foki
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Daniela Hitzl
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
- Department of Neurology, Wilhelminenspital Wien, Vienna, Austria
| | - Klaus Novak
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria.
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Santaniello S, Gale JT, Sarma SV. Systems approaches to optimizing deep brain stimulation therapies in Parkinson's disease. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2018; 10:e1421. [PMID: 29558564 PMCID: PMC6148418 DOI: 10.1002/wsbm.1421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 01/17/2023]
Abstract
Over the last 30 years, deep brain stimulation (DBS) has been used to treat chronic neurological diseases like dystonia, obsessive-compulsive disorders, essential tremor, Parkinson's disease, and more recently, dementias, depression, cognitive disorders, and epilepsy. Despite its wide use, DBS presents numerous challenges for both clinicians and engineers. One challenge is the design of novel, more efficient DBS therapies, which are hampered by the lack of complete understanding about the cellular mechanisms of therapeutic DBS. Another challenge is the existence of redundancy in clinical outcomes, that is, different DBS programs can result in similar clinical benefits but very little information (e.g., predictive models, longitudinal data, metrics, etc.) is available to select one program over another. Finally, there is high variability in patients' responses to DBS, which forces clinicians to carefully adjust the stimulation settings to each patient via lengthy programming sessions. Researchers in neural engineering and systems biology have been tackling these challenges over the past few years with the specific goal of developing novel DBS therapies, design methodologies, and computational tools that optimize the therapeutic effects of DBS in each patient. Furthermore, efforts are being made to automatically adapt the DBS treatment to the fluctuations of disease symptoms. A review of the quantitative approaches currently available for the treatment of Parkinson's disease is presented here with an emphasis on the contributions that systems theoretical approaches have provided to understand the global dynamics of complex neuronal circuits in the brain under DBS. This article is categorized under: Translational, Genomic, and Systems Medicine > Therapeutic Methods Analytical and Computational Methods > Computational Methods Analytical and Computational Methods > Dynamical Methods Physiology > Mammalian Physiology in Health and Disease.
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Affiliation(s)
- Sabato Santaniello
- Biomedical Engineering Department and CT Institute for the Brain and Cognitive Sciences, University of Connecticut; ORCID-ID: 0000-0002-2133-9471
| | - John T. Gale
- Department of Neurosurgery, Emory University School of Medicine
| | - Sridevi V. Sarma
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University
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Moore BD, Aron AR, Tandon N. Closed-loop intracranial stimulation alters movement timing in humans. Brain Stimul 2018; 11:886-895. [PMID: 29598890 DOI: 10.1016/j.brs.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/20/2018] [Accepted: 03/06/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND A prime objective driving the recent development of human neural prosthetics is to stimulate neural circuits in a manner time-locked to ongoing brain activity. The human supplementary motor area (SMA) is a particularly useful target for this objective because it displays characteristic neural activity just prior to voluntary movement. OBJECTIVE Here, we tested a method that detected activity in the human SMA related to impending movement and then delivered cortical stimulation with intracranial electrodes to influence the timing of movement. METHODS We conducted experiments in nine patients with electrodes implanted for epilepsy localization: five patients with SMA electrodes and four control patients with electrodes outside the SMA. In the first experiment, electrocorticographic (ECoG) recordings were used to localize the electrode of interest during a task involving bimanual finger movements. In the second experiment, a real-time sense-and-stimulate (SAS) system was implemented that delivered an electrical stimulus when pre-movement gamma power exceeded a threshold. RESULTS Stimulation based on real-time detection of this supra-threshold activity resulted in significant slowing of motor behavior in all of the cases where stimulation was carried out in the SMA patients but in none of the patients where stimulation was performed at the control site. CONCLUSIONS The neurophysiological correlates of impending movement can be used to trigger a closed loop stimulation device and influence ongoing motor behavior in a manner imperceptible to the subject. This is the first report of a human closed loop system designed to alter movement using direct cortical recordings and direct stimulation.
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Affiliation(s)
- Bartlett D Moore
- Vivian L Smith Department of Neurosurgery, McGovern Medical School, Houston, TX, 77030, USA
| | - Adam R Aron
- Department of Psychology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Nitin Tandon
- Vivian L Smith Department of Neurosurgery, McGovern Medical School, Houston, TX, 77030, USA; Mischer Neurosciences Institute, Memorial Hermann Hospital, Texas Medical Center, Houston, TX, 77030, USA.
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Huang C, Chu H, Zhang Y, Wang X. Deep Brain Stimulation to Alleviate Freezing of Gait and Cognitive Dysfunction in Parkinson's Disease: Update on Current Research and Future Perspectives. Front Neurosci 2018; 12:29. [PMID: 29503606 PMCID: PMC5821065 DOI: 10.3389/fnins.2018.00029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 01/10/2023] Open
Abstract
Freezing of gait (FOG) is a gait disorder featured by recurrent episodes of temporary gait halting and mainly found in advanced Parkinson's disease (PD). FOG has a severe impact on the quality of life of patients with PD. The pathogenesis of FOG is unclear and considered to be related to several brain areas and neural circuits. Its close connection with cognitive disorder has been proposed and some researchers explain the pathogenesis using the cognitive model theory. FOG occurs concurrently with cognitive disorder in some PD patients, who are poorly responsive to medication therapy. Deep brain stimulation (DBS) proves effective for FOG in PD patients. Cognitive impairment plays a role in the formation of FOG. Therefore, if DBS works by improving the cognitive function, both two challenging conditions can be ameliorated by DBS. We reviewed the clinical studies related to DBS for FOG in PD patients over the past decade. In spite of the varying stimulation parameters used in different studies, DBS of either subthalamic nucleus (STN) or pedunculopontine nucleus (PPN) alone or in combination can improve the symptoms of FOG. Moreover, the treatment efficacy can last for 1–2 years and DBS is generally safe. Although few studies have been conducted concerning the use of DBS for cognitive disorder in FOG patients, the existing studies seem to indicate that PPN is a potential therapeutic target to both FOG and cognitive disorder. However, most of the studies have a small sample size and involve sporadic cases, so it remains uncertain which nucleus is the optimal target of stimulation. Prospective clinical trials with a larger sample size are needed to systematically assess the efficacy of DBS for FOG and cognitive disorder.
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Affiliation(s)
- Chuyi Huang
- Department of Neurology, Shanghai TongRen Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
| | - Heling Chu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Zhang
- Department of Neurology, Shanghai TongRen Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
| | - Xiaoping Wang
- Department of Neurology, Shanghai TongRen Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
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Carradori S, Ortuso F, Petzer A, Bagetta D, De Monte C, Secci D, De Vita D, Guglielmi P, Zengin G, Aktumsek A, Alcaro S, Petzer JP. Design, synthesis and biochemical evaluation of novel multi-target inhibitors as potential anti-Parkinson agents. Eur J Med Chem 2018; 143:1543-1552. [DOI: 10.1016/j.ejmech.2017.10.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 01/04/2023]
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