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Huang Y, Zelmann R, Hadar P, Dezha-Peralta J, Richardson RM, Williams ZM, Cash SS, Keller CJ, Paulk AC. Theta-burst direct electrical stimulation remodels human brain networks. Nat Commun 2024; 15:6982. [PMID: 39143083 PMCID: PMC11324911 DOI: 10.1038/s41467-024-51443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
Theta-burst stimulation (TBS), a patterned brain stimulation technique that mimics rhythmic bursts of 3-8 Hz endogenous brain rhythms, has emerged as a promising therapeutic approach for treating a wide range of brain disorders, though the neural mechanism of TBS action remains poorly understood. We investigated the neural effects of TBS using intracranial EEG (iEEG) in 10 pre-surgical epilepsy participants undergoing intracranial monitoring. Here we show that individual bursts of direct electrical TBS at 29 frontal and temporal sites evoked strong neural responses spanning broad cortical regions. These responses exhibited dynamic local field potential voltage changes over the course of stimulation presentations, including either increasing or decreasing responses, suggestive of short-term plasticity. Stronger stimulation augmented the mean TBS response amplitude and spread with more recording sites demonstrating short-term plasticity. TBS responses were stimulation site-specific with stronger TBS responses observed in regions with strong baseline stimulation effective (cortico-cortical evoked potentials) and functional (low frequency phase locking) connectivity. Further, we could use these measures to predict stable and varying (e.g. short-term plasticity) TBS response locations. Future work may integrate pre-treatment connectivity alongside other biophysical factors to personalize stimulation parameters, thereby optimizing induction of neuroplasticity within disease-relevant brain networks.
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Affiliation(s)
- Yuhao Huang
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Hadar
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaquelin Dezha-Peralta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Palo Alto, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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2
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Solomon EA, Wang JB, Oya H, Howard MA, Trapp NT, Uitermarkt BD, Boes AD, Keller CJ. TMS provokes target-dependent intracranial rhythms across human cortical and subcortical sites. Brain Stimul 2024; 17:698-712. [PMID: 38821396 PMCID: PMC11313454 DOI: 10.1016/j.brs.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is believed to alter ongoing neural activity and cause circuit-level changes in brain function. While the electrophysiological effects of TMS have been extensively studied with scalp electroencephalography (EEG), this approach generally evaluates low-frequency neural activity at the cortical surface. However, TMS can be safely used in patients with intracranial electrodes (iEEG), allowing for direct assessment of deeper and more localized oscillatory responses across the frequency spectrum. OBJECTIVE/HYPOTHESIS Our study used iEEG to understand the effects of TMS on human neural activity in the spectral domain. We asked (1) which brain regions respond to cortically-targeted TMS, and in what frequency bands, (2) whether deeper brain structures exhibit oscillatory responses, and (3) whether the neural responses to TMS reflect evoked versus induced oscillations. METHODS We recruited 17 neurosurgical patients with indwelling electrodes and recorded neural activity while patients underwent repeated trials of single-pulse TMS at either the dorsolateral prefrontal cortex (DLPFC) or parietal cortex. iEEG signals were analyzed using spectral methods to understand the oscillatory responses to TMS. RESULTS Stimulation to DLPFC drove widespread low-frequency increases (3-8 Hz) in frontolimbic cortices and high-frequency decreases (30-110 Hz) in frontotemporal areas, including the hippocampus. Stimulation to parietal cortex specifically provoked low-frequency responses in the medial temporal lobe. While most low-frequency activity was consistent with phase-locked evoked responses, anterior frontal regions exhibited induced theta oscillations following DLPFC stimulation. CONCLUSIONS By combining TMS with intracranial EEG recordings, our results suggest that TMS is an effective means to perturb oscillatory neural activity in brain-wide networks, including deeper structures not directly accessed by stimulation itself.
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Affiliation(s)
- Ethan A Solomon
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, 94305, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, 94305, CA, USA.
| | - Jeffrey B Wang
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, 94305, CA, USA; Biophysics Graduate Program, Stanford University Medical Center, Stanford, 94305, CA, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Nicholas T Trapp
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA; Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Brandt D Uitermarkt
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA; Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA; Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Corey J Keller
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, 94305, CA, USA; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, 94305, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, 94305, CA, USA
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3
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Toenders YJ, van der Cruijsen R, Runze J, van de Groep S, Wierenga L, Crone EA. Mood variability during adolescent development and its relation to sleep and brain development. Sci Rep 2024; 14:8537. [PMID: 38609481 PMCID: PMC11014928 DOI: 10.1038/s41598-024-59227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Mood swings, or mood variability, are associated with negative mental health outcomes. Since adolescence is a time when mood disorder onset peaks, mood variability during this time is of significant interest. Understanding biological factors that might be associated with mood variability, such as sleep and structural brain development, could elucidate the mechanisms underlying mood and anxiety disorders. Data from the longitudinal Leiden self-concept study (N = 191) over 5 yearly timepoints was used to study the association between sleep, brain structure, and mood variability in healthy adolescents aged 11-21 at baseline in this pre-registered study. Sleep was measured both objectively, using actigraphy, as well as subjectively, using a daily diary self-report. Negative mood variability was defined as day-to-day negative mood swings over a period of 5 days after an MRI scan. It was found that negative mood variability peaked in mid-adolescence in females while it linearly increased in males, and average negative mood showed a similar pattern. Sleep duration (subjective and objective) generally decreased throughout adolescence, with a larger decrease in males. Mood variability was not associated with sleep, but average negative mood was associated with lower self-reported energy. In addition, higher thickness in the dorsolateral prefrontal cortex (dlPFC) compared to same-age peers, suggesting a delayed thinning process, was associated with higher negative mood variability in early and mid-adolescence. Together, this study provides an insight into the development of mood variability and its association with brain structure.
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Affiliation(s)
- Yara J Toenders
- Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Renske van der Cruijsen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jana Runze
- Clinical Child and Family Studies, VU University Amsterdam, Amsterdam, The Netherlands
| | - Suzanne van de Groep
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Lara Wierenga
- Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Eveline A Crone
- Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
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4
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Salehi N, Nahrgang S, Petershagen W, Dembek TA, Pedrosa D, Timmermann L, Weber I, Oehrn CR. Theta frequency deep brain stimulation in the subthalamic nucleus improves working memory in Parkinson's disease. Brain 2024; 147:1190-1196. [PMID: 38193320 DOI: 10.1093/brain/awad433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Most research in Parkinson's disease focuses on improving motor symptoms. Yet, up to 80% of patients present with non-motor symptoms that often have a large impact on patients' quality of life. Impairment in working memory, a fundamental cognitive process, is common in Parkinson's disease. While deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms in Parkinson's disease, its impact on cognitive functions is less well studied. Here, we examine the effect of DBS in the theta, beta, low and high gamma frequency on working memory in 20 Parkinson's disease patients with bilateral STN-DBS. A linear mixed effects model demonstrates that STN-DBS in the theta frequency improves working memory performance. This effect is frequency-specific and was absent for beta and gamma frequency stimulation. Further, this effect is specific to cognitive performance, as theta frequency DBS did not affect motor function. A non-parametric cluster-based permutation analysis of whole-brain normative structural connectivity shows that working memory enhancement by theta frequency stimulation is associated with higher connectivity between the stimulated subthalamic area and the right middle frontal gyrus. Again, this association is frequency- and task-specific. These findings highlight the potential of theta frequency STN-DBS as a targeted intervention to improve working memory in patients with Parkinson's disease.
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Affiliation(s)
- Narges Salehi
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Simone Nahrgang
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Wiebke Petershagen
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - David Pedrosa
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, 35032 Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, 35032 Marburg, Germany
| | - Immo Weber
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Carina R Oehrn
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, 35032 Marburg, Germany
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5
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Solomon EA, Wang JB, Oya H, Howard MA, Trapp NT, Uitermarkt BD, Boes AD, Keller CJ. TMS provokes target-dependent intracranial rhythms across human cortical and subcortical sites. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.09.552524. [PMID: 37645954 PMCID: PMC10461914 DOI: 10.1101/2023.08.09.552524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Transcranial magnetic stimulation (TMS) is increasingly deployed in the treatment of neuropsychiatric illness, under the presumption that stimulation of specific cortical targets can alter ongoing neural activity and cause circuit-level changes in brain function. While the electrophysiological effects of TMS have been extensively studied with scalp electroencephalography (EEG), this approach is most useful for evaluating low-frequency neural activity at the cortical surface. As such, little is known about how TMS perturbs rhythmic activity among deeper structures - such as the hippocampus and amygdala - and whether stimulation can alter higher-frequency oscillations. Recent work has established that TMS can be safely used in patients with intracranial electrodes (iEEG), allowing for direct neural recordings at sufficient spatiotemporal resolution to examine localized oscillatory responses across the frequency spectrum. To that end, we recruited 17 neurosurgical patients with indwelling electrodes and recorded neural activity while patients underwent repeated trials of single-pulse TMS at several cortical sites. Stimulation to the dorsolateral prefrontal cortex (DLPFC) drove widespread low-frequency increases (3-8Hz) in frontolimbic cortices, as well as high-frequency decreases (30-110Hz) in frontotemporal areas, including the hippocampus. Stimulation to parietal cortex specifically provoked low-frequency responses in the medial temporal lobe. While most low-frequency activity was consistent with brief evoked responses, anterior frontal regions exhibited induced theta oscillations following DLPFC stimulation. Taken together, we established that non-invasive stimulation can (1) provoke a mixture of low-frequency evoked power and induced theta oscillations and (2) suppress high-frequency activity in deeper brain structures not directly accessed by stimulation itself.
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Affiliation(s)
- Ethan A. Solomon
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto CA 94305
| | - Jeffrey B. Wang
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto CA 94305
- Biophysics Graduate Program, Stanford University Medical Center, Stanford, CA 94305
| | - Hiroyuki Oya
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
| | - Matthew A. Howard
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
| | - Nicholas T. Trapp
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
| | - Brandt D. Uitermarkt
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
| | - Aaron D. Boes
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242
| | - Corey J. Keller
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305
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6
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Sandoval-Pistorius SS, Hacker ML, Waters AC, Wang J, Provenza NR, de Hemptinne C, Johnson KA, Morrison MA, Cernera S. Advances in Deep Brain Stimulation: From Mechanisms to Applications. J Neurosci 2023; 43:7575-7586. [PMID: 37940596 PMCID: PMC10634582 DOI: 10.1523/jneurosci.1427-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 11/10/2023] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target brain regions for electrical stimulation delivery. Despite its safety and efficacy, DBS remains an underutilized therapy. Advances in the field of DBS, including in technology, mechanistic understanding, and applications have the potential to expand access and use of DBS, while also improving clinical outcomes. Developments in DBS technology, such as MRI compatibility and bidirectional DBS systems capable of sensing neural activity while providing therapeutic stimulation, have enabled advances in our understanding of DBS mechanisms and its application. In this review, we summarize recent work exploring DBS modulation of target networks. We also cover current work focusing on improved programming and the development of novel stimulation paradigms that go beyond current standards of DBS, many of which are enabled by sensing-enabled DBS systems and have the potential to expand access to DBS.
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Affiliation(s)
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Allison C Waters
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Kara A Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California 94143
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California 94143
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Najera RA, Mahavadi AK, Khan AU, Boddeti U, Del Bene VA, Walker HC, Bentley JN. Alternative patterns of deep brain stimulation in neurologic and neuropsychiatric disorders. Front Neuroinform 2023; 17:1156818. [PMID: 37415779 PMCID: PMC10320008 DOI: 10.3389/fninf.2023.1156818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
Deep brain stimulation (DBS) is a widely used clinical therapy that modulates neuronal firing in subcortical structures, eliciting downstream network effects. Its effectiveness is determined by electrode geometry and location as well as adjustable stimulation parameters including pulse width, interstimulus interval, frequency, and amplitude. These parameters are often determined empirically during clinical or intraoperative programming and can be altered to an almost unlimited number of combinations. Conventional high-frequency stimulation uses a continuous high-frequency square-wave pulse (typically 130-160 Hz), but other stimulation patterns may prove efficacious, such as continuous or bursting theta-frequencies, variable frequencies, and coordinated reset stimulation. Here we summarize the current landscape and potential clinical applications for novel stimulation patterns.
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Affiliation(s)
- Ricardo A. Najera
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anil K. Mahavadi
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anas U. Khan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victor A. Del Bene
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Harrison C. Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - J. Nicole Bentley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
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8
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Lu H, Li J, Zhang L, Meng L, Ning Y, Jiang T. Pinpointing the precise stimulation targets for brain rehabilitation in early-stage Parkinson's disease. BMC Neurosci 2023; 24:24. [PMID: 36991320 PMCID: PMC10061909 DOI: 10.1186/s12868-023-00791-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is increasingly used as a promising non-pharmacological treatment for Parkinson's disease (PD). Scalp-to-cortex distance (SCD), as a key technical parameter of TMS, plays a critical role in determining the locations of treatment targets and corresponding dosage. Due to the discrepancies in TMS protocols, the optimal targets and head models have yet to be established in PD patients. OBJECTIVE To investigate the SCDs of the most popular used targets in left dorsolateral prefrontal cortex (DLPFC) and quantify its impact on the TMS-induced electric fields (E-fields) in early-stage PD patients. METHODS Structural magnetic resonance imaging scans from PD patients (n = 47) and normal controls (n = 36) were drawn from the NEUROCON and Tao Wu datasets. SCD of left DLPFC was measured by Euclidean Distance in TMS Navigation system. The intensity and focality of SCD-dependent E-fields were examined and quantified using Finite Element Method. RESULTS Early-stage PD patients showed an increased SCDs, higher variances in the SCDs and SCD-dependent E-fields across the seven targets of left DLPFC than normal controls. The stimulation targets located on gyral crown had more focal and homogeneous E-fields. The SCD of left DLPFC had a better performance in differentiating early-stage PD patients than global cognition and other brain measures. CONCLUSION SCD and SCD-dependent E-fields could determine the optimal TMS treatment targets and may also be used as a novel marker to differentiate early-stage PD patients. Our findings have important implications for developing optimal TMS protocols and personalized dosimetry in real-world clinical practice.
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Affiliation(s)
- Hanna Lu
- G27, Multi-Centre, Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China.
- Centre for Neuromodulation and Rehabilitation, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Jing Li
- G27, Multi-Centre, Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China
| | - Li Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tianzi Jiang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Research Center for Augmented Intelligence, Zhejiang Lab, Hangzhou, 311100, China
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9
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Asp AJ, Chintaluru Y, Hillan S, Lujan JL. Targeted neuroplasticity in spatiotemporally patterned invasive neuromodulation therapies for improving clinical outcomes. Front Neuroinform 2023; 17:1150157. [PMID: 37035718 PMCID: PMC10080034 DOI: 10.3389/fninf.2023.1150157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Anders J. Asp
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Yaswanth Chintaluru
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Neurology and Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
| | - Sydney Hillan
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
- *Correspondence: J. Luis Lujan
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10
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Cole RC, Espinoza AI, Singh A, Berger JI, Cavanagh JF, Wessel JR, Greenlee JD, Narayanan NS. Novelty-induced frontal-STN networks in Parkinson's disease. Cereb Cortex 2022; 33:469-485. [PMID: 35297483 PMCID: PMC9837604 DOI: 10.1093/cercor/bhac078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 01/19/2023] Open
Abstract
Novelty detection is a primitive subcomponent of cognitive control that can be deficient in Parkinson's disease (PD) patients. Here, we studied the corticostriatal mechanisms underlying novelty-response deficits. In participants with PD, we recorded from cortical circuits with scalp-based electroencephalography (EEG) and from subcortical circuits using intraoperative neurophysiology during surgeries for implantation of deep brain stimulation (DBS) electrodes. We report three major results. First, novel auditory stimuli triggered midfrontal low-frequency rhythms; of these, 1-4 Hz "delta" rhythms were linked to novelty-associated slowing, whereas 4-7 Hz "theta" rhythms were specifically attenuated in PD. Second, 32% of subthalamic nucleus (STN) neurons were response-modulated; nearly all (94%) of these were also modulated by novel stimuli. Third, response-modulated STN neurons were coherent with midfrontal 1-4 Hz activity. These findings link scalp-based measurements of neural activity with neuronal activity in the STN. Our results provide insight into midfrontal cognitive control mechanisms and how purported hyperdirect frontobasal ganglia circuits evaluate new information.
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Affiliation(s)
- Rachel C Cole
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, United States
| | - Arturo I Espinoza
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, United States
| | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, 414 E. Clark St. Vermillion, 57069, SD, United States
| | - Joel I Berger
- Department of Neurosurgery, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, United States
| | - James F Cavanagh
- Department of Psychology, University of New Mexico, 2001 Redondo S Dr, Albuquerque, NM 87106, United States
| | - Jan R Wessel
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, United States.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, United States.,Carver College of Medicine, Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, United States
| | - Jeremy D Greenlee
- Department of Neurosurgery, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, United States.,Carver College of Medicine, Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, United States
| | - Nandakumar S Narayanan
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, United States.,Carver College of Medicine, Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, United States
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Cheng B, Zhu T, Zhao W, Sun L, Shen Y, Xiao W, Zhang S. Effect of Theta Burst Stimulation-Patterned rTMS on Motor and Nonmotor Dysfunction of Parkinson's Disease: A Systematic Review and Metaanalysis. Front Neurol 2022; 12:762100. [PMID: 35095722 PMCID: PMC8790062 DOI: 10.3389/fneur.2021.762100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/10/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Theta burst stimulation (TBS), a type of patterned repetitive transcranial magnetic stimulation (rTMS), has several advantages, such as short time of single treatment and low stimulation intensity compared with traditional rTMS. Since the efficacy of TBS on the symptoms of Parkinson's disease (PD) was inconsistent among different studies, we systematically searched these studies and quantitatively analyzed the therapeutic effect of TBS for patients with PD. Methods: We followed the recommended PRISMA guidelines for systematic reviews. Studies from PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov from January 1, 2005 of each database to September 30, 2021 were analyzed. We also manually retrieved studies of reference. Results: Eight eligible studies with 189 participants (received real TBS and/or sham TBS) were included. This metaanalysis found that TBS did not significantly improve Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score in the “on” medicine state (SMD = −0.06; 95% CI, −0.37 to 0.25; p = 0.69; I2 = 0%), while, it brought significant improvement of UPDRS-III scores in the “off” medicine state (SMD = −0.37; 95% CI, −0.65 to −0.09; p < 0.01; I2 = 19%). Subgroup analysis found that merely continuous TBS (cTBS) over the supplementary motor area (SMA) brought significant improvement of UPDRS-III score (SMD = −0.63; 95% CI, −1.02 to −0.25; p < 0.01). TBS had insignificant effectiveness for upper limb movement disorder both in the “on” and “off” medicine status (SMD = −0.07; 95% CI, −0.36 to 0.22; p = 0.64; I2 = 0%; SMD = −0.21; 95% CI, −0.57 to 0.15; p = 0.26; I2 = 0%; respectively). TBS significantly improved slowing of gait in the “off” medicine status (SMD = −0.37; 95% CI, −0.71 to −0.03; p = 0.03; I2 = 0%). Subgroup analysis suggested that only intermittent TBS (iTBS) over the primary motor cortex (M1) + dorsolateral prefrontal cortex (DLPFC) had significant difference (SMD = −0.57; 95% CI, −1.13 to −0.01; p = 0.04). Additionally, iTBS over the M1+ DLPFC had a short-term (within 2 weeks) therapeutic effect on PD depression (MD = −2.93; 95% CI, −5.52 to −0.33; p = 0.03). Conclusion: Our study demonstrated that cTBS over the SMA could significantly improve the UPDRS-III score for PD patients in the “off,” not in the “on,” medicine state. TBS could not bring significant improvement of upper limb movement dysfunction. ITBS over the M1+DLPFC could significantly improve the slowing of gait in the “off” medicine status. Additionally, iTBS over the M1+DLPFC has a short-term (within 2 weeks) therapeutic effect on PD depression. Further RCTs of a large sample, and excellent design are needed to confirm our conclusions.
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Affiliation(s)
- Bo Cheng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Tao Zhu
- Department of Preventive Medicine, North Sichuan Medical College (University), Nanchong, China
| | - Wenhao Zhao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Ling Sun
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Yao Shen
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Wei Xiao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Shushan Zhang
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
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12
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de Hemptinne C, Chen W, Racine CA, Seritan AL, Miller AM, Yaroshinsky MS, Wang SS, Gilron R, Little S, Bledsoe I, San Luciano M, Katz M, Chang EF, Dawes HE, Ostrem JL, Starr PA. Prefrontal Physiomarkers of Anxiety and Depression in Parkinson's Disease. Front Neurosci 2021; 15:748165. [PMID: 34744613 PMCID: PMC8568318 DOI: 10.3389/fnins.2021.748165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: Anxiety and depression are prominent non-motor symptoms of Parkinson’s disease (PD), but their pathophysiology remains unclear. We sought to understand their neurophysiological correlates from chronic invasive recordings of the prefrontal cortex (PFC). Methods: We studied four patients undergoing deep brain stimulation (DBS) for their motor signs, who had comorbid mild to moderate anxiety and/or depressive symptoms. In addition to their basal ganglia leads, we placed a permanent prefrontal subdural 4-contact lead. These electrodes were attached to an investigational pulse generator with the capability to sense and store field potential signals, as well as deliver therapeutic neurostimulation. At regular intervals over 3–5 months, participants paired brief invasive neural recordings with self-ratings of symptoms related to depression and anxiety. Results: Mean age was 61 ± 7 years, mean disease duration was 11 ± 8 years and a mean Unified Parkinson’s Disease Rating Scale, with part III (UPDRS-III) off medication score of 37 ± 13. Mean Beck Depression Inventory (BDI) score was 14 ± 5 and Beck Anxiety Index was 16.5 ± 5. Prefrontal cortex spectral power in the beta band correlated with patient self-ratings of symptoms of depression and anxiety, with r-values between 0.31 and 0.48. Mood scores showed negative correlation with beta spectral power in lateral locations, and positive correlation with beta spectral power in a mesial recording location, consistent with the dichotomous organization of reward networks in PFC. Interpretation: These findings suggest a physiological basis for anxiety and depression in PD, which may be useful in the development of neurostimulation paradigms for these non-motor disease features.
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Affiliation(s)
- Coralie de Hemptinne
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Witney Chen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Caroline A Racine
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Andreea L Seritan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew M Miller
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Maria S Yaroshinsky
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Sarah S Wang
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Roee Gilron
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Ian Bledsoe
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Maya Katz
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Heather E Dawes
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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13
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Herrero JL, Smith A, Mishra A, Markowitz N, Mehta AD, Bickel S. Inducing neuroplasticity through intracranial θ-burst stimulation in the human sensorimotor cortex. J Neurophysiol 2021; 126:1723-1739. [PMID: 34644179 PMCID: PMC8782667 DOI: 10.1152/jn.00320.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023] Open
Abstract
The progress of therapeutic neuromodulation greatly depends on improving stimulation parameters to most efficiently induce neuroplasticity effects. Intermittent θ-burst stimulation (iTBS), a form of electrical stimulation that mimics natural brain activity patterns, has proved to efficiently induce such effects in animal studies and rhythmic transcranial magnetic stimulation studies in humans. However, little is known about the potential neuroplasticity effects of iTBS applied through intracranial electrodes in humans. This study characterizes the physiological effects of intracranial iTBS in humans and compare them with α-frequency stimulation, another frequently used neuromodulatory pattern. We applied these two stimulation patterns to well-defined regions in the sensorimotor cortex, which elicited contralateral hand muscle contractions during clinical mapping, in patients with epilepsy implanted with intracranial electrodes. Treatment effects were evaluated using oscillatory coherence across areas connected to the treatment site, as defined with corticocortical-evoked potentials. Our results show that iTBS increases coherence in the β-frequency band within the sensorimotor network indicating a potential neuroplasticity effect. The effect is specific to the sensorimotor system, the β band, and the stimulation pattern and outlasted the stimulation period by ∼3 min. The effect occurred in four out of seven subjects depending on the buildup of the effect during iTBS treatment and other patterns of oscillatory activity related to ceiling effects within the β band and to preexistent coherence within the α band. By characterizing the neurophysiological effects of iTBS within well-defined cortical networks, we hope to provide an electrophysiological framework that allows clinicians/researchers to optimize brain stimulation protocols which may have translational value.NEW & NOTEWORTHY θ-Burst stimulation (TBS) protocols in transcranial magnetic stimulation studies have shown improved treatment efficacy in a variety of neuropsychiatric disorders. The optimal protocol to induce neuroplasticity in invasive direct electrical stimulation approaches is not known. We report that intracranial TBS applied in human sensorimotor cortex increases local coherence of preexistent β rhythms. The effect is specific to the stimulation frequency and the stimulated network and outlasts the stimulation period by ∼3 min.
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Affiliation(s)
- Jose L Herrero
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Alexander Smith
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Akash Mishra
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Noah Markowitz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Ashesh D Mehta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Stephan Bickel
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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14
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Solomon EA, Sperling MR, Sharan AD, Wanda PA, Levy DF, Lyalenko A, Pedisich I, Rizzuto DS, Kahana MJ. Theta-burst stimulation entrains frequency-specific oscillatory responses. Brain Stimul 2021; 14:1271-1284. [PMID: 34428553 PMCID: PMC9161680 DOI: 10.1016/j.brs.2021.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Brain stimulation has emerged as a powerful tool in human neuroscience, becoming integral to next-generation psychiatric and neurologic therapeutics. Theta-burst stimulation (TBS), in which electrical pulses are delivered in rhythmic bouts of 3-8 Hz, seeks to recapitulate neural activity seen endogenously during cognitive tasks. A growing literature suggests that TBS can be used to alter or enhance cognitive processes, but little is known about how these stimulation events influence underlying neural activity. OBJECTIVE Our study sought to investigate the effect of direct electrical TBS on mesoscale neural activity in humans by asking (1) whether TBS evokes persistent theta oscillations in cortical areas, (2) whether these oscillations occur at the stimulated frequency, and (3) whether stimulation events propagate in a manner consistent with underlying functional and structural brain architecture. METHODS We recruited 20 neurosurgical epilepsy patients with indwelling electrodes and delivered direct cortical TBS at varying locations and frequencies. Simultaneous iEEG was recorded from non-stimulated electrodes and analyzed to understand how TBS influences mesoscale neural activity. RESULTS We found that TBS rapidly evoked theta rhythms in widespread brain regions, preferentially at the stimulation frequency, and that these oscillations persisted for hundreds of milliseconds post stimulation offset. Furthermore, the functional connectivity between recording and stimulation sites predicted the strength of theta response, suggesting that underlying brain architecture guides the flow of stimulation through the brain. CONCLUSIONS By demonstrating that cortical TBS induces frequency-specific oscillatory responses, our results suggest this technology can be used to directly and predictably influence the activity of cognitively-relevant brain networks.
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Affiliation(s)
- Ethan A Solomon
- University of Pennsylvania, Perelman School of Medicine, Philadelphia PA 19104, USA; University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA.
| | - Michael R Sperling
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia PA 19107, USA
| | - Ashwini D Sharan
- Thomas Jefferson University Hospital, Department of Neurosurgery, Philadelphia PA 19107, USA
| | - Paul A Wanda
- University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA
| | - Deborah F Levy
- University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA
| | - Anastasia Lyalenko
- University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA
| | - Isaac Pedisich
- University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA
| | - Daniel S Rizzuto
- University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA; Nia Therapeutics Inc., Bala Cynwyd, PA 19004, USA
| | - Michael J Kahana
- University of Pennsylvania, Department of Psychology, Philadelphia PA 19104, USA.
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15
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Electrical stimulation of the nucleus basalis of meynert: a systematic review of preclinical and clinical data. Sci Rep 2021; 11:11751. [PMID: 34083732 PMCID: PMC8175342 DOI: 10.1038/s41598-021-91391-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/24/2021] [Indexed: 12/09/2022] Open
Abstract
Deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM) has been clinically investigated in Alzheimer’s disease (AD) and Lewy body dementia (LBD). However, the clinical effects are highly variable, which questions the suggested basic principles underlying these clinical trials. Therefore, preclinical and clinical data on the design of NBM stimulation experiments and its effects on behavioral and neurophysiological aspects are systematically reviewed here. Animal studies have shown that electrical stimulation of the NBM enhanced cognition, increased the release of acetylcholine, enhanced cerebral blood flow, released several neuroprotective factors, and facilitates plasticity of cortical and subcortical receptive fields. However, the translation of these outcomes to current clinical practice is hampered by the fact that mainly animals with an intact NBM were used, whereas most animals were stimulated unilaterally, with different stimulation paradigms for only restricted timeframes. Future animal research has to refine the NBM stimulation methods, using partially lesioned NBM nuclei, to better resemble the clinical situation in AD, and LBD. More preclinical data on the effect of stimulation of lesioned NBM should be present, before DBS of the NBM in human is explored further.
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16
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Kim HK, Blumberger DM, Daskalakis ZJ. Neurophysiological Biomarkers in Schizophrenia-P50, Mismatch Negativity, and TMS-EMG and TMS-EEG. Front Psychiatry 2020; 11:795. [PMID: 32848953 PMCID: PMC7426515 DOI: 10.3389/fpsyt.2020.00795] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022] Open
Abstract
Impaired early auditory processing is a well characterized finding in schizophrenia that is theorized to contribute to clinical symptoms, cognitive impairment, and social dysfunction in patients. Two neurophysiological measures of early auditory processing, P50 gating ("P50") and mismatch negativity (MMN), which measure sensory gating and detection of change in auditory stimuli, respectively, are consistently shown to be impaired in patients with schizophrenia. Transcranial magnetic stimulation (TMS) may also be a potential method by which sensory processing can be assessed, since TMS paradigms can be used to measure GABAB-mediated cortical inhibition that is linked with sensory gating. In this review, we examine the potential of P50, MMN and two TMS paradigms, cortical silent period (CSP) and long-interval intracortical inhibition (LICI), as endophenotypes as well as their ability to be used as predictive markers for interventions targeted at cognitive and psychosocial functioning. Studies consistently support a link between MMN, P50, and cognitive dysfunction, with robust evidence for a link between MMN and psychosocial functioning in schizophrenia as well. Importantly, studies have demonstrated that MMN can be used to predict performance in social and cognitive training tasks. A growing body of studies also supports the potential of MMN to be used as an endophenotype, and future studies are needed to determine if MMN can be used as an endophenotype specifically in schizophrenia. P50, however, has weaker evidence supporting its use as an endophenotype. While CSP and LICI are not as extensively investigated, growing evidence is supporting their potential to be used as an endophenotype in schizophrenia. Future studies that assess the ability of P50, MMN, and TMS neurophysiological measures to predict performance in cognitive and social training programs may identify markers that inform clinical decisions in the treatment of neurocognitive impairments in schizophrenia.
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Affiliation(s)
- Helena K Kim
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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