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Ricciardi L, Apps M, Little S. Uncovering the neurophysiology of mood, motivation and behavioral symptoms in Parkinson's disease through intracranial recordings. NPJ Parkinsons Dis 2023; 9:136. [PMID: 37735477 PMCID: PMC10514046 DOI: 10.1038/s41531-023-00567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 08/07/2023] [Indexed: 09/23/2023] Open
Abstract
Neuropsychiatric mood and motivation symptoms (depression, anxiety, apathy, impulse control disorders) in Parkinson's disease (PD) are highly disabling, difficult to treat and exacerbated by current medications and deep brain stimulation therapies. High-resolution intracranial recording techniques have the potential to undercover the network dysfunction and cognitive processes that drive these symptoms, towards a principled re-tuning of circuits. We highlight intracranial recording as a valuable tool for mapping and desegregating neural networks and their contribution to mood, motivation and behavioral symptoms, via the ability to dissect multiplexed overlapping spatial and temporal neural components. This technique can be powerfully combined with behavioral paradigms and emerging computational techniques to model underlying latent behavioral states. We review the literature of intracranial recording studies investigating mood, motivation and behavioral symptomatology with reference to 1) emotional processing, 2) executive control 3) subjective valuation (reward & cost evaluation) 4) motor control and 5) learning and updating. This reveals associations between different frequency specific network activities and underlying cognitive processes of reward decision making and action control. If validated, these signals represent potential computational biomarkers of motivational and behavioural states and could lead to principled therapy development for mood, motivation and behavioral symptoms in PD.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Matthew Apps
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
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2
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Identifying Patients with Epilepsy Having Depression/Anxiety Disorder Using Common Spatial Patterns of Functional EEG Networks. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lee DJ, Drummond NM, Saha U, De Vloo P, Dallapiazza RF, Gramer R, Al-Ozzi TM, Lam J, Loh A, Elias GJB, Boutet A, Germann J, Hodaie M, Fasano A, Munhoz RP, Hutchison W, Cohn M, Chen R, Kalia SK, Lozano AM. Acute low frequency dorsal subthalamic nucleus stimulation improves verbal fluency in Parkinson's disease. Brain Stimul 2021; 14:754-760. [PMID: 33940243 DOI: 10.1016/j.brs.2021.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a common neurodegenerative disorder that results in movement-related dysfunction and has variable cognitive impairment. Deep brain stimulation (DBS) of the dorsal subthalamic nucleus (STN) has been shown to be effective in improving motor symptoms; however, cognitive impairment is often unchanged, and in some cases, worsened particularly on tasks of verbal fluency. Traditional DBS strategies use high frequency gamma stimulation for motor symptoms (∼130 Hz), but there is evidence that low frequency theta oscillations (5-12 Hz) are important in cognition. METHODS We tested the effects of stimulation frequency and location on verbal fluency among patients who underwent STN DBS implantation with externalized leads. During baseline cognitive testing, STN field potentials were recorded and the individual patients' peak theta frequency power was identified during each cognitive task. Patients repeated cognitive testing at five different stimulation settings: no stimulation, dorsal contact gamma (130 Hz), ventral contact gamma, dorsal theta (peak baseline theta) and ventral theta (peak baseline theta) frequency stimulation. RESULTS Acute left dorsal peak theta frequency STN stimulation improves overall verbal fluency compared to no stimulation and to either dorsal or ventral gamma stimulation. Stratifying by type of verbal fluency probes, verbal fluency in episodic categories was improved with dorsal theta stimulation compared to all other conditions, while there were no differences between stimulation conditions in non-episodic probe conditions. CONCLUSION Here, we provide evidence that dorsal STN theta stimulation may improve verbal fluency, suggesting a potential possibility of integrating theta stimulation into current DBS paradigms to improve cognitive outcomes.
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Affiliation(s)
- Darrin J Lee
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Department of Neurological Surgery, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA, 90033, USA; USC Neurorestoration Center, Keck School of Medicine of USC, 1333 San Pablo Street, McKibben Hall B51, Los Angeles, CA, 90033, USA.
| | - Neil M Drummond
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada
| | - Utpal Saha
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; USC Neurorestoration Center, Keck School of Medicine of USC, 1333 San Pablo Street, McKibben Hall B51, Los Angeles, CA, 90033, USA
| | - Philippe De Vloo
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Department of Neurosurgery, University Hospitals Leuven - KU Leuven, Herestraat 49, 3000, Leuven, Vlaams-Brabant, Belgium
| | - Robert F Dallapiazza
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Robert Gramer
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Tameem M Al-Ozzi
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Jordan Lam
- Department of Neurological Surgery, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA, 90033, USA; USC Neurorestoration Center, Keck School of Medicine of USC, 1333 San Pablo Street, McKibben Hall B51, Los Angeles, CA, 90033, USA
| | - Aaron Loh
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada
| | - Gavin J B Elias
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada
| | - Alexandre Boutet
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jurgen Germann
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada
| | - Mojgan Hodaie
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - William Hutchison
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Melanie Cohn
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Department of Psychology, University of Toronto, Toronto, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Andres M Lozano
- Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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Upadhyayula PS, Rennert RC, Martin JR, Yue JK, Yang J, Gillis-Buck EM, Sidhu N, Cheung CK, Lee AT, Hoshide RR, Ciacci JD. Basal impulses: findings from the last twenty years on impulsivity and reward pathways using deep brain stimulation. J Neurosurg Sci 2020; 64:544-551. [PMID: 32972108 DOI: 10.23736/s0390-5616.20.04906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an important treatment modality for movement disorders. Its role in tasks and processes of higher cortical function continues to increase in importance and relevance. This systematic review investigates the impact of DBS on measures of impulsivity. EVIDENCE ACQUISITION A total of 45 studies were collated from PubMed (30 prospective, 8 animal, 4 questionnaire-based, and 3 computational models), excluding case reports and review articles. Two areas extensively studied are the subthalamic nucleus (STN) and nucleus accumbens (NAc). EVIDENCE SYNTHESIS While both are part of the basal ganglia, the STN and NAc have extensive connections to the prefrontal cortex, cingulate cortex, and limbic system. Therefore, understanding cause and treatment of impulsivity requires understanding motor pathways, learning, memory, and emotional processing. DBS of the STN and NAc shell can increase objective measures of impulsivity, as measured by reaction times or reward-based learning, independent from patient insight. The ability for DBS to treat impulse control disorders, and also cause and/or worsen impulsivity in Parkinson's disease, may be explained by the affected closely-related neuroanatomical areas with discrete and sometimes opposing functions. CONCLUSIONS As newer, more refined DBS technology emerges, large-scale prospective studies specifically aimed at treatment of impulsivity disorders are needed.
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Affiliation(s)
- Pavan S Upadhyayula
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joel R Martin
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jason Yang
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Eva M Gillis-Buck
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nikki Sidhu
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Christopher K Cheung
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anthony T Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Reid R Hoshide
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joseph D Ciacci
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA -
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5
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Drummond NM, Chen R. Deep brain stimulation and recordings: Insights into the contributions of subthalamic nucleus in cognition. Neuroimage 2020; 222:117300. [PMID: 32828919 DOI: 10.1016/j.neuroimage.2020.117300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022] Open
Abstract
Recent progress in targeted interrogation of basal ganglia structures and networks with deep brain stimulation in humans has provided insights into the complex functions the subthalamic nucleus (STN). Beyond the traditional role of the STN in modulating motor function, recognition of its role in cognition was initially fueled by side effects seen with STN DBS and later revealed with behavioral and electrophysiological studies. Anatomical, clinical, and electrophysiological data converge on the view that the STN is a pivotal node linking cognitive and motor processes. The goal of this review is to synthesize the literature to date that used DBS to examine the contributions of the STN to motor and non-motor cognitive functions and control. Multiple modalities of research have provided us with an enhanced understanding of the STN and reveal that it is critically involved in motor and non-motor inhibition, decision-making, motivation and emotion. Understanding the role of the STN in cognition can enhance the therapeutic efficacy and selectivity not only for existing applications of DBS, but also in the development of therapeutic strategies to stimulate aberrant circuits to treat non-motor symptoms of Parkinson's disease and other disorders.
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Affiliation(s)
- Neil M Drummond
- Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada.
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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Al‐Ozzi TM, Botero-Posada LF, Lopez Rios AL, Hutchison WD. Single unit and beta oscillatory activities in subthalamic nucleus are modulated during visual choice preference. Eur J Neurosci 2020; 53:2220-2233. [DOI: 10.1111/ejn.14750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Tameem M. Al‐Ozzi
- Department of Physiology University of Toronto Toronto ON Canada
- Department of Surgery University of Toronto Toronto ON Canada
- Krembil Research Institute Toronto ON Canada
| | - Luis F. Botero-Posada
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
| | - Adriana L. Lopez Rios
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
| | - William D. Hutchison
- Department of Physiology University of Toronto Toronto ON Canada
- Department of Surgery University of Toronto Toronto ON Canada
- Krembil Research Institute Toronto ON Canada
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
- Division of Neurosurgery Toronto Western Hospital – University Health Network Toronto ON Canada
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Dalley JW, Ersche KD. Neural circuitry and mechanisms of waiting impulsivity: relevance to addiction. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180145. [PMID: 30966923 DOI: 10.1098/rstb.2018.0145] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Impatience-the failure to wait or tolerate delayed rewards (e.g. food, drug and monetary incentives)-is a common behavioural tendency in humans. However, when rigidly and rapidly expressed with limited regard for future, often negative consequences, impatient or impulsive actions underlie and confer susceptibility for such diverse brain disorders as drug addiction, attention-deficit hyperactivity disorder (ADHD) and major depressive disorder. Consequently, 'waiting' impulsivity has emerged as a candidate endophenotype to inform translational research on underlying neurobiological mechanisms and biomarker discovery for many of the so-called impulse-control disorders. Indeed, as reviewed in this article, this research enterprise has revealed a number of unexpected targets and mechanisms for intervention. However, in the context of drug addiction, impulsive decisions that maximize short-term gains (e.g. acute drug consumption) over longer-term punishment (e.g. unemployment, homelessness, personal harm) defines one aspect of impulsivity, which may or may not be related to rapid, unrestrained actions over shorter timescales. We discuss the relevance of this distinction in impulsivity subtypes for drug addiction with reference to translational research in humans and other animals. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.
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Affiliation(s)
- Jeffrey W Dalley
- 1 Department of Psychology, University of Cambridge , Cambridge CB2 3EB , UK.,2 Department of Psychiatry, University of Cambridge , Cambridge CB2 0SZ , UK
| | - Karen D Ersche
- 1 Department of Psychology, University of Cambridge , Cambridge CB2 3EB , UK
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Zavala B, Jang A, Trotta M, Lungu CI, Brown P, Zaghloul KA. Cognitive control involves theta power within trials and beta power across trials in the prefrontal-subthalamic network. Brain 2019; 141:3361-3376. [PMID: 30358821 DOI: 10.1093/brain/awy266] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/12/2018] [Indexed: 11/13/2022] Open
Abstract
There is increasing evidence that the medial prefrontal cortex participates in conflict and feedback monitoring while the subthalamic nucleus adjusts actions. Yet how these two structures coordinate their activity during cognitive control remains poorly understood. We recorded from the human prefrontal cortex and the subthalamic nucleus simultaneously while participants (n = 22) performed a novel task involving high conflict trials, complete response inhibition trials, and trial-to-trial behavioural adaptations to conflict and errors. Overall, we found that within-trial adaptions to both conflict and complete response inhibition involved changes in the theta band while across-trial behavioural adaptations to both conflict and errors involved changes in the beta band (P < 0.05). Yet the role each region's theta and beta oscillations played during the task differed significantly between the two sites. Trials that involved either within-trial conflict or complete response inhibition were associated with increased theta phase synchrony between the medial prefrontal cortex and the subthalamic nucleus (P < 0.05). Despite increased synchrony, however, increases in prefrontal theta power were associated with response inhibition, while increases in subthalamic theta power were associated with response execution (P < 0.05). In the beta band, post-response increases in prefrontal beta power were suppressed when the completed trial contained either conflict or an erroneous response (P < 0.05). Subthalamic beta power, on the other hand, was only modified during the subsequent trial that followed a conflict or error trial. Notably, these adaptation trials exhibited slower response times (P < 0.05), suggesting that both brain regions contribute to across-trial adaptations but do so at different stages of the adaptation process. Taken together, our data shed light on the mechanisms underlying within-trial and across-trial cognitive control and how disruption of this network can negatively impact cognition. More broadly, however, our data also demonstrate that the specific role of a brain region, rather than the frequency being utilized, governs the behavioural correlates of oscillatory activity.
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Affiliation(s)
- Baltazar Zavala
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Jang
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Michael Trotta
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Codrin I Lungu
- Division of Clinical Research, NINDS, National Institutes of Health, Rockville, MD, USA
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford and Nuffield Department of Clinical Neurology, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
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Winter L, Alam M, Heissler HE, Saryyeva A, Milakara D, Jin X, Heitland I, Schwabe K, Krauss JK, Kahl KG. Neurobiological Mechanisms of Metacognitive Therapy - An Experimental Paradigm. Front Psychol 2019; 10:660. [PMID: 31019477 PMCID: PMC6458268 DOI: 10.3389/fpsyg.2019.00660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/11/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The neurobiological mechanisms underlying the clinical effects of psychotherapy are scarcely understood. In particular, the modifying effects of psychotherapy on neuronal activity are largely unknown. We here present data from an innovative experimental paradigm using the example of a patient with treatment resistant obsessive-compulsive disorder (trOCD) who underwent implantation of bilateral electrodes for deep brain stimulation (DBS). The aim of the paradigm was to examine the short term effect of metacognitive therapy (MCT) on neuronal local field potentials (LFP) before and after 5 MCT sessions. METHODS DBS electrodes were implanted bilaterally with stereotactic guidance in the bed nucleus of the stria terminalis/ internal capsule (BNST/IC). The period between implantation of the electrodes and the pacemaker was used for the experimental paradigm. DBS electrodes were externalized via extension cables, yielding the opportunity to record LFP directly from the BNST/IC. The experimental paradigm was designed as follows: (a) baseline recording of LFP from the BNST/IC, (b) application of 5 MCT sessions over 3 days, (c) post-MCT recording from the BNST/IC. The Obsessive-Compulsive Disorder- scale (OCD-S) was used to evaluate OCD symptoms. RESULTS OCD symptoms decreased after MCT. These reductions were accompanied by a decrease of the relative power of theta band activity, while alpha, beta, and gamma band activity was significantly increased after MCT. Further, analysis of BNST/IC LFP and frontal cortex EEG coherence showed that MCT decreased theta frequency band synchronization. DISCUSSION Implantation of DBS electrodes for treating psychiatric disorders offers the opportunity to gather data from neuronal circuits, and to compare effects of therapeutic interventions. Here, we demonstrate direct effects of MCT on neuronal oscillatory behavior, which may give possible cues for the neurobiological changes associated with psychotherapy.
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Affiliation(s)
- Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Mesbah Alam
- Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Hans E. Heissler
- Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Denny Milakara
- Center for Stroke Research Berlin, Charité – Berlin University of Medicine, Berlin, Germany
| | - Xingxing Jin
- Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Joachim K. Krauss
- Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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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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11
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Bonnevie T, Zaghloul KA. The Subthalamic Nucleus: Unravelling New Roles and Mechanisms in the Control of Action. Neuroscientist 2018; 25:48-64. [PMID: 29557710 DOI: 10.1177/1073858418763594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
How do we decide what we do? This is the essence of action control, the process of selecting the most appropriate response among multiple possible choices. Suboptimal action control can involve a failure to initiate or adapt actions, or conversely it can involve making actions impulsively. There has been an increasing focus on the specific role of the subthalamic nucleus (STN) in action control. This has been fueled by the clinical relevance of this basal ganglia nucleus as a target for deep brain stimulation (DBS), primarily in Parkinson's disease but also in obsessive-compulsive disorder. The context of DBS has opened windows to study STN function in ways that link neuroscientific and clinical fields closely together, contributing to an exceptionally high level of two-way translation. In this review, we first outline the role of the STN in both motor and nonmotor action control, and then discuss how these functions might be implemented by neuronal activity in the STN. Gaining a better understanding of these topics will not only provide important insights into the neurophysiology of action control but also the pathophysiological mechanisms relevant for several brain disorders and their therapies.
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Affiliation(s)
- Tora Bonnevie
- 1 Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,2 Neuroclinic, Trondheim University Hospital, Trondheim, Norway.,3 Kavli Institute for Systems Neuroscience, NTNU, Trondheim, Norway
| | - Kareem A Zaghloul
- 4 Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
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