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Nambu A, Chiken S, Sano H, Hatanaka N, Obeso JA. [Dynamic activity model of movement disorders: a unified view to understand their pathophysiology]. Rinsho Shinkeigaku 2024; 64:390-397. [PMID: 38811203 DOI: 10.5692/clinicalneurol.cn-001957] [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] [Indexed: 05/31/2024]
Abstract
Malfunction of the basal ganglia leads to movement disorders such as Parkinson's disease, dystonia, Huntington's disease, dyskinesia, and hemiballism, but their underlying pathophysiology is still subject to debate. To understand their pathophysiology in a unified manner, we propose the "dynamic activity model", on the basis of alterations of cortically induced responses in individual nuclei of the basal ganglia. In the normal state, electric stimulation in the motor cortex, mimicking cortical activity during initiation of voluntary movements, evokes a triphasic response consisting of early excitation, inhibition, and late excitation in the output stations of the basal ganglia of monkeys, rodents, and humans. Among three components, cortically induced inhibition, which is mediated by the direct pathway, releases an appropriate movement at an appropriate time by disinhibiting thalamic and cortical activity, whereas early and late excitation, which is mediated by the hyperdirect and indirect pathways, resets on-going cortical activity and stops movements, respectively. Cortically induced triphasic response patterns are systematically altered in various movement disorder models and could well explain the pathophysiology of their motor symptoms. In monkey and mouse models of Parkinson's disease, cortically induced inhibition is reduced and prevents the release of movements, resulting in akinesia/bradykinesia. On the other hand, in a mouse model of dystonia, cortically induced inhibition is enhanced and releases unintended movements, inducing involuntary muscle contractions. Moreover, after blocking the subthalamic nucleus activity in a monkey model of Parkinson's disease, cortically induced inhibition is recovered and enables voluntary movements, explaining the underlying mechanism of stereotactic surgery to ameliorate parkinsonian motor signs. The "dynamic activity model" gives us a more comprehensive view of the pathophysiology underlying motor symptoms of movement disorders and clues for their novel therapies.
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Affiliation(s)
- Atsushi Nambu
- Division of System Neurophysiology, National Institute for Physiological Sciences
| | - Satomi Chiken
- Division of System Neurophysiology, National Institute for Physiological Sciences
- Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies)
| | - Hiromi Sano
- Division of Behavioral Neuropharmacology, International Center for Brain Science, Fujita Health University
| | - Nobuhiko Hatanaka
- Division of System Neurophysiology, National Institute for Physiological Sciences
- Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies)
- School of Dentistry, Aichi Gakuin University
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III
- University CEU-San Pablo
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Steiner LA, Crompton D, Sumarac S, Vetkas A, Germann J, Scherer M, Justich M, Boutet A, Popovic MR, Hodaie M, Kalia SK, Fasano A, Hutchison Wd WD, Lozano AM, Lankarany M, Kühn AA, Milosevic L. Neural signatures of indirect pathway activity during subthalamic stimulation in Parkinson's disease. Nat Commun 2024; 15:3130. [PMID: 38605039 PMCID: PMC11009243 DOI: 10.1038/s41467-024-47552-6] [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: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) produces an electrophysiological signature called evoked resonant neural activity (ERNA); a high-frequency oscillation that has been linked to treatment efficacy. However, the single-neuron and synaptic bases of ERNA are unsubstantiated. This study proposes that ERNA is a subcortical neuronal circuit signature of DBS-mediated engagement of the basal ganglia indirect pathway network. In people with Parkinson's disease, we: (i) showed that each peak of the ERNA waveform is associated with temporally-locked neuronal inhibition in the STN; (ii) characterized the temporal dynamics of ERNA; (iii) identified a putative mesocircuit architecture, embedded with empirically-derived synaptic dynamics, that is necessary for the emergence of ERNA in silico; (iv) localized ERNA to the dorsal STN in electrophysiological and normative anatomical space; (v) used patient-wise hotspot locations to assess spatial relevance of ERNA with respect to DBS outcome; and (vi) characterized the local fiber activation profile associated with the derived group-level ERNA hotspot.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
- Berlin Institute of Health (BIH), Berlin, 10178, Germany
| | - David Crompton
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Srdjan Sumarac
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Artur Vetkas
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Jürgen Germann
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Maximilian Scherer
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Maria Justich
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, M5G 1×6, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - William D Hutchison Wd
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Milad Lankarany
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada.
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada.
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Zhu L, Meng H, Zhang W, Xie W, Sun H, Hou S. The pathogenesis of blepharospasm. Front Neurol 2024; 14:1336348. [PMID: 38274886 PMCID: PMC10808626 DOI: 10.3389/fneur.2023.1336348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Blepharospasm is a focal dystonia characterized by involuntary tetanic contractions of the orbicularis oculi muscle, which can lead to functional blindness and loss of independent living ability in severe cases. It usually occurs in adults, with a higher incidence rate in women than in men. The etiology and pathogenesis of this disease have not been elucidated to date, but it is traditionally believed to be related to the basal ganglia. Studies have also shown that this is related to the decreased activity of inhibitory neurons in the cerebral cortex caused by environmental factors and genetic predisposition. Increasingly, studies have focused on the imbalance in the regulation of neurotransmitters, including dopamine, serotonin, and acetylcholine, in blepharospasm. The onset of the disease is insidious, and the misdiagnosis rate is high based on history and clinical manifestations. This article reviews the etiology, epidemiological features, and pathogenesis of blepharospasm, to improve understanding of the disease by neurologists and ophthalmologists.
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Affiliation(s)
- Lixia Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wuqiong Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Xie
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Huaiyu Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shuai Hou
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Xu W, Wang J, Li XN, Liang J, Song L, Wu Y, Liu Z, Sun B, Li WG. Neuronal and synaptic adaptations underlying the benefits of deep brain stimulation for Parkinson's disease. Transl Neurodegener 2023; 12:55. [PMID: 38037124 PMCID: PMC10688037 DOI: 10.1186/s40035-023-00390-w] [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: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established and effective treatment for patients with advanced Parkinson's disease (PD), yet its underlying mechanisms remain enigmatic. Optogenetics, primarily conducted in animal models, provides a unique approach that allows cell type- and projection-specific modulation that mirrors the frequency-dependent stimulus effects of DBS. Opto-DBS research in animal models plays a pivotal role in unraveling the neuronal and synaptic adaptations that contribute to the efficacy of DBS in PD treatment. DBS-induced neuronal responses rely on a complex interplay between the distributions of presynaptic inputs, frequency-dependent synaptic depression, and the intrinsic excitability of postsynaptic neurons. This orchestration leads to conversion of firing patterns, enabling both antidromic and orthodromic modulation of neural circuits. Understanding these mechanisms is vital for decoding position- and programming-dependent effects of DBS. Furthermore, patterned stimulation is emerging as a promising strategy yielding long-lasting therapeutic benefits. Research on the neuronal and synaptic adaptations to DBS may pave the way for the development of more enduring and precise modulation patterns. Advanced technologies, such as adaptive DBS or directional electrodes, can also be integrated for circuit-specific neuromodulation. These insights hold the potential to greatly improve the effectiveness of DBS and advance PD treatment to new levels.
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Affiliation(s)
- Wenying Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xin-Ni Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Jingxue Liang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Wei-Guang Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China.
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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Stavropoulos I, Pak HL, Alarcon G, Valentin A. Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus. Brain Sci 2023; 13:1527. [PMID: 38002487 PMCID: PMC10670094 DOI: 10.3390/brainsci13111527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Status epilepticus (SE) is a life-threatening condition and medical emergency which can have lifelong consequences, including neuronal death and alteration of neuronal networks, resulting in long-term neurologic and cognitive deficits in children. When standard pharmacological treatment for SE is not successful in controlling seizures, the condition evolves to refractory SE (rSE) and finally to super-refractory SE (srSE) if it exceeds 24 h despite using anaesthetics. In this systematic review, we present literature data on the potential uses of clinical neuromodulation techniques for the management of srSE in children, including electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation. The evaluation of these techniques is limited by the small number of published paediatric cases (n = 25, one with two techniques) in peer-reviewed articles (n = 18). Although neuromodulation strategies have not been tested through randomised, prospective controlled clinical trials, this review presents the existing data and the potential benefits of neuromodulation therapy, suggesting that these techniques, when available, could be considered at earlier stages within the course of srSE intending to prevent long-term neurologic complications. Clinical trials aiming to establish whether early intervention can prevent long-term sequelae are necessary in order to establish the potential clinical value of neuromodulation techniques for the treatment of srSE in children.
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Affiliation(s)
- Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King’s College Hospital, London SE5 9RS, UK;
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Ho Lim Pak
- Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK;
| | - Gonzalo Alarcon
- Royal Manchester Children’s Hospital, Manchester M13 9WL, UK;
- Alder Hey Children’s Hospital, Liverpool L12 2AP, UK
| | - Antonio Valentin
- Department of Clinical Neurophysiology, King’s College Hospital, London SE5 9RS, UK;
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- Alder Hey Children’s Hospital, Liverpool L12 2AP, UK
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Abdelnaim MA, Lang-Hambauer V, Hebel T, Schoisswohl S, Schecklmann M, Deuter D, Schlaier J, Langguth B. Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions. Front Psychiatry 2023; 14:1242566. [PMID: 37779611 PMCID: PMC10533930 DOI: 10.3389/fpsyt.2023.1242566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Obsessive-compulsive disorder (OCD) affects 2-3% of the global population, causing distress in many functioning levels. Standard treatments only lead to a partial recovery, and about 10% of the patients remain treatment-resistant. Deep brain stimulation offers a treatment option for severe, therapy-refractory OCD, with a reported response of about 60%. We report a comprehensive clinical, demographic, and treatment data for patients who were treated with DBS in our institution. Methods We offered DBS to patients with severe chronic treatment resistant OCD. Severity was defined as marked impairment in functioning and treatment resistance was defined as non-response to adequate trials of medications and psychotherapy. Between 2020 and 2022, 11 patients were implanted bilaterally in the bed nucleus of stria terminalis (BNST). Patients were evaluated with YBOCS, MADRS, GAF, CGI, and WHOQOL-BREF. We performed the ratings at baseline (before surgery), after implantation before the start of the stimulation, after reaching satisfactory stimulation parameters, and at follow-up visits 3, 6, 9, and 12 months after optimized stimulation. Results One patient has retracted his consent to publish the results of his treatment, thus we are reporting the results of 10 patients (5 males, 5 females, mean age: 37 years). Out of our 10 patients, 6 have shown a clear response indicated by a YBOCS-reduction between 42 and 100 percent at last follow-up. One further patient experienced a subjectively dramatic effect on OCD symptoms, but opted afterwards to stop the stimulation. The other 3 patients showed a slight, non-significant improvement of YBOCS between 8.8 and 21.9%. The overall mean YBOCS decreased from 28.3 at baseline to 13.3 (53% reduction) at the last follow-up. The improvement of the OCD symptoms was also accompanied by an improvement of depressive symptoms, global functioning, and quality of life. Conclusion Our results suggest that BNST-DBS can be effective for treatment-resistant OCD patients, as indicated by a reduction in symptoms and an overall improvement in functioning. Despite the need for additional research to define the patients' selection criteria, the most appropriate anatomical target, and the most effective stimulation parameters, improved patient access for this therapy should be established.
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Affiliation(s)
- Mohamed A. Abdelnaim
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
- Center for Deep Brain Stimulation, University Regensburg, Regensburg, Germany
| | - Verena Lang-Hambauer
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
- Center for Deep Brain Stimulation, University Regensburg, Regensburg, Germany
| | - Tobias Hebel
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
- Department of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Daniel Deuter
- Center for Deep Brain Stimulation, University Regensburg, Regensburg, Germany
- Department of Neurosurgery, University Regensburg, Regensburg, Germany
| | - Juergen Schlaier
- Center for Deep Brain Stimulation, University Regensburg, Regensburg, Germany
- Department of Neurosurgery, University Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
- Center for Deep Brain Stimulation, University Regensburg, Regensburg, Germany
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Stavropoulos I, Khaw JH, Valentin A. Neuromodulation in new-onset refractory status epilepticus. Front Neurol 2023; 14:1195844. [PMID: 37388544 PMCID: PMC10301751 DOI: 10.3389/fneur.2023.1195844] [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: 03/29/2023] [Accepted: 05/17/2023] [Indexed: 07/01/2023] Open
Abstract
Background New-onset refractory status epilepticus (NORSE) and its subset of febrile infection-related epilepsy syndrome (FIRES) are devastating clinical presentations with high rates of mortality and morbidity. The recently published consensus on the treatment of these conditions includes anesthetics, antiseizure drugs, antivirals, antibiotics, and immune therapies. Despite the internationally accepted treatment, the outcome remains poor for a significant percentage of patients. Methods We conducted a systematic review of the use of neuromodulation techniques in the treatment of the acute phase of NORSE/FIRES using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Our search strategy brought up 74 articles of which 15 met our inclusion criteria. A total of 20 patients were treated with neuromodulation. Thirteen cases represented FIRES and in 17 cases the NORSE remained cryptogenic. Ten had electroconvulsive therapy (ECT), seven had vagal nerve stimulation (VNS), and four had deep brain stimulation (DBS); one patient had initially VNS and later DBS. Eight patients were female and nine were children. In 17 out of 20 patients, the status epilepticus was resolved after neuromodulation, while three patients died. Conclusion NORSE can have a catastrophic course and the first treatment goal should be the fastest possible termination of status epilepticus. The data presented are limited by the small number of published cases and the variability of neuromodulation protocols used. However, they show some potential clinical benefits of early neuromodulation therapy, suggesting that these techniques could be considered within the course of FIRES/NORSE.
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Affiliation(s)
- Ioannis Stavropoulos
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
| | - Jin Han Khaw
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
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Passera B, Harquel S, Chauvin A, Gérard P, Lai L, Moro E, Meoni S, Fraix V, David O, Raffin E. Multi-scale and cross-dimensional TMS mapping: A proof of principle in patients with Parkinson's disease and deep brain stimulation. Front Neurosci 2023; 17:1004763. [PMID: 37214390 PMCID: PMC10192635 DOI: 10.3389/fnins.2023.1004763] [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: 07/27/2022] [Accepted: 03/29/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Transcranial magnetic stimulation (TMS) mapping has become a critical tool for exploratory studies of the human corticomotor (M1) organization. Here, we propose to gather existing cutting-edge TMS-EMG and TMS-EEG approaches into a combined multi-dimensional TMS mapping that considers local and whole-brain excitability changes as well as state and time-specific changes in cortical activity. We applied this multi-dimensional TMS mapping approach to patients with Parkinson's disease (PD) with Deep brain stimulation (DBS) of the sub-thalamic nucleus (STN) ON and OFF. Our goal was to identifying one or several TMS mapping-derived markers that could provide unprecedent new insights onto the mechanisms of DBS in movement disorders. Methods Six PD patients (1 female, mean age: 62.5 yo [59-65]) implanted with DBS-STN for 1 year, underwent a robotized sulcus-shaped TMS motor mapping to measure changes in muscle-specific corticomotor representations and a movement initiation task to probe state-dependent modulations of corticospinal excitability in the ON (using clinically relevant DBS parameters) and OFF DBS states. Cortical excitability and evoked dynamics of three cortical areas involved in the neural control of voluntary movements (M1, pre-supplementary motor area - preSMA and inferior frontal gyrus - IFG) were then mapped using TMS-EEG coupling in the ON and OFF state. Lastly, we investigated the timing and nature of the STN-to-M1 inputs using a paired pulse DBS-TMS-EEG protocol. Results In our sample of patients, DBS appeared to induce fast within-area somatotopic re-arrangements of motor finger representations in M1, as revealed by mediolateral shifts of corticomuscle representations. STN-DBS improved reaction times while up-regulating corticospinal excitability, especially during endogenous motor preparation. Evoked dynamics revealed marked increases in inhibitory circuits in the IFG and M1 with DBS ON. Finally, inhibitory conditioning effects of STN single pulses on corticomotor activity were found at timings relevant for the activation of inhibitory GABAergic receptors (4 and 20 ms). Conclusion Taken together, these results suggest a predominant role of some markers in explaining beneficial DBS effects, such as a context-dependent modulation of corticospinal excitability and the recruitment of distinct inhibitory circuits, involving long-range projections from higher level motor centers and local GABAergic neuronal populations. These combined measures might help to identify discriminative features of DBS mechanisms towards deep clinical phenotyping of DBS effects in Parkinson's Disease and in other pathological conditions.
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Affiliation(s)
- Brice Passera
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Sylvain Harquel
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
- CNRS, INSERM, IRMaGe, Grenoble, France
- Defitech Chair in Clinical Neuroengineering, Neuro-X Institute and Brain Mind Institute, EPFL, Geneva, Switzerland
| | - Alan Chauvin
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
| | - Pauline Gérard
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
| | - Lisa Lai
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Elena Moro
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Sara Meoni
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Valerie Fraix
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Olivier David
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
- Aix Marseille Univ, Inserm, U1106, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Estelle Raffin
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
- Defitech Chair in Clinical Neuroengineering, Neuro-X Institute and Brain Mind Institute, EPFL, Geneva, Switzerland
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9
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A Protocol to Investigate Deep Brain Stimulation for Refractory Tinnitus: From Rat Model to the Set-Up of a Human Pilot Study. Audiol Res 2022; 13:49-63. [PMID: 36648926 PMCID: PMC9844413 DOI: 10.3390/audiolres13010005] [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: 10/27/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic tinnitus can have an immense impact on quality of life. Despite recent treatment advances, many tinnitus patients remain refractory to them. Preclinical and clinical evidence suggests that deep brain stimulation (DBS) is a promising treatment to suppress tinnitus. In rats, it has been shown in multiple regions of the auditory pathway that DBS can have an alleviating effect on tinnitus. The thalamic medial geniculate body (MGB) takes a key position in the tinnitus network, shows pathophysiological hallmarks of tinnitus, and is readily accessible using stereotaxy. Here, a protocol is described to evaluate the safety and test the therapeutic effects of DBS in the MGB in severe tinnitus sufferers. METHODS Bilateral DBS of the MGB will be applied in a future study in six patients with severe and refractory tinnitus. A double-blinded, randomized 2 × 2 crossover design (stimulation ON and OFF) will be applied, followed by a period of six months of open-label follow-up. The primary focus is to assess safety and feasibility (acceptability). Secondary outcomes assess a potential treatment effect and include tinnitus severity measured by the Tinnitus Functional Index (TFI), tinnitus loudness and distress, hearing, cognitive and psychological functions, quality of life, and neurophysiological characteristics. DISCUSSION This protocol carefully balances risks and benefits and takes ethical considerations into account. This study will explore the safety and feasibility of DBS in severe refractory tinnitus, through extensive assessment of clinical and neurophysiological outcome measures. Additionally, important insights into the underlying mechanism of tinnitus and hearing function might be revealed. TRIAL REGISTRATION ClinicalTrials.gov NCT03976908 (6 June 2019).
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10
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David FJ, Rivera YM, Entezar TK, Arora R, Drane QH, Munoz MJ, Rosenow JM, Sani SB, Pal GD, Verhagen-Metman L, Corcos DM. Encoding type, medication, and deep brain stimulation differentially affect memory-guided sequential reaching movements in Parkinson's disease. Front Neurol 2022; 13:980935. [PMID: 36324383 PMCID: PMC9618698 DOI: 10.3389/fneur.2022.980935] [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: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Memory-guided movements, vital to daily activities, are especially impaired in Parkinson's disease (PD). However, studies examining the effects of how information is encoded in memory and the effects of common treatments of PD, such as medication and subthalamic nucleus deep brain stimulation (STN-DBS), on memory-guided movements are uncommon and their findings are equivocal. We designed two memory-guided sequential reaching tasks, peripheral-vision or proprioception encoded, to investigate the effects of encoding type (peripheral-vision vs. proprioception), medication (on- vs. off-), STN-DBS (on- vs. off-, while off-medication), and compared STN-DBS vs. medication on reaching amplitude, error, and velocity. We collected data from 16 (analyzed n = 7) participants with PD, pre- and post-STN-DBS surgery, and 17 (analyzed n = 14) healthy controls. We had four important findings. First, encoding type differentially affected reaching performance: peripheral-vision reaches were faster and more accurate. Also, encoding type differentially affected reaching deficits in PD compared to healthy controls: peripheral-vision reaches manifested larger deficits in amplitude. Second, the effect of medication depended on encoding type: medication had no effect on amplitude, but reduced error for both encoding types, and increased velocity only during peripheral-vision encoding. Third, the effect of STN-DBS depended on encoding type: STN-DBS increased amplitude for both encoding types, increased error during proprioception encoding, and increased velocity for both encoding types. Fourth, STN-DBS was superior to medication with respect to increasing amplitude and velocity, whereas medication was superior to STN-DBS with respect to reducing error. We discuss our findings in the context of the previous literature and consider mechanisms for the differential effects of medication and STN-DBS.
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Affiliation(s)
- Fabian J. David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yessenia M. Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tara K. Entezar
- School of Integrative Biology, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States
| | - Rishabh Arora
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Quentin H. Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Miranda J. Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sepehr B. Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Gian D. Pal
- Department of Neurology, Rutgers University, New Brunswick, NJ, United States
| | - Leonard Verhagen-Metman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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11
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Yu H, Meng Z, Li H, Liu C, Wang J. Intensity-Varied Closed-Loop Noise Stimulation for Oscillation Suppression in the Parkinsonian State. IEEE TRANSACTIONS ON CYBERNETICS 2022; 52:9861-9870. [PMID: 34398769 DOI: 10.1109/tcyb.2021.3079100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This work explores the effectiveness of the intensity-varied closed-loop noise stimulation on the oscillation suppression in the Parkinsonian state. Deep brain stimulation (DBS) is the standard therapy for Parkinson's disease (PD), but its effects need to be improved. The noise stimulation has compelling results in alleviating the PD state. However, in the open-loop control scheme, the noise stimulation parameters cannot be self-adjusted to adapt to the amplitude of the synchronized neuronal activities in real time. Thus, based on the delayed-feedback control algorithm, an intensity-varied closed-loop noise stimulation strategy is proposed. Based on a computational model of the basal ganglia (BG) that can present the intrinsic properties of the BG neurons and their interactions with the thalamic neurons, the proposed stimulation strategy is tested. Simulation results show that the noise stimulation suppresses the pathological beta (12-35 Hz) oscillations without any new rhythms in other bands compared with traditional high-frequency DBS. The intensity-varied closed-loop noise stimulation has a more profound role in removing the pathological beta oscillations and improving the thalamic reliability than open-loop noise stimulation, especially for different PD states. And the closed-loop noise stimulation enlarges the parameter space of the delayed-feedback control algorithm due to the randomness of noise signals. We also provide a theoretical analysis of the effective parameter domain of the delayed-feedback control algorithm by simplifying the BG model to an oscillator model. This exploration may guide a new approach to treating PD by optimizing the noise-induced improvement of the BG dysfunction.
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12
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Steiner LA, Kühn AA, Geiger JR, Alle H, Popovic MR, Kalia SK, Hodaie M, Lozano AM, Hutchison WD, Milosevic L. Persistent synaptic inhibition of the subthalamic nucleus by high frequency stimulation. Brain Stimul 2022; 15:1223-1232. [PMID: 36058524 DOI: 10.1016/j.brs.2022.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/10/2022] [Accepted: 08/25/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) provides symptomatic relief in a growing number of neurological indications, but local synaptic dynamics in response to electrical stimulation that may relate to its mechanism of action have not been fully characterized. OBJECTIVE The objectives of this study were to (1) study local synaptic dynamics during high frequency extracellular stimulation of the subthalamic nucleus (STN), and (2) compare STN synaptic dynamics with those of the neighboring substantia nigra pars reticulata (SNr). METHODS Two microelectrodes were advanced into the STN and SNr of patients undergoing DBS surgery for Parkinson's disease (PD). Neuronal firing and evoked field potentials (fEPs) were recorded with one microelectrode during stimulation from an adjacent microelectrode. RESULTS Inhibitory fEPs could be discerned within the STN and their amplitudes predicted bidirectional effects on neuronal firing (p = .013). There were no differences between STN and SNr inhibitory fEP dynamics at low stimulation frequencies (p > .999). However, inhibitory neuronal responses were sustained over time in STN during high frequency stimulation but not in SNr (p < .001) where depression of inhibitory input was coupled with a return of neuronal firing (p = .003). INTERPRETATION Persistent inhibitory input to the STN suggests a local synaptic mechanism for the suppression of subthalamic firing during high frequency stimulation. Moreover, differences in the resiliency versus vulnerability of inhibitory inputs to the STN and SNr suggest a projection source- and frequency-specificity for this mechanism. The feasibility of targeting electrophysiologically-identified neural structures may provide insight into how DBS achieves frequency-specific modulation of neuronal projections.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Canada; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Berlin Institute of Health (BIH), Germany; Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Jörg Rp Geiger
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Henrik Alle
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Milos R Popovic
- KITE Research Institute, University Health Network, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Canada; KITE Research Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - William D Hutchison
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada; Department of Physiology, University of Toronto, Canada
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Canada; KITE Research Institute, University Health Network, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
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13
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Single-neuron bursts encode pathological oscillations in subcortical nuclei of patients with Parkinson's disease and essential tremor. Proc Natl Acad Sci U S A 2022; 119:e2205881119. [PMID: 36018837 PMCID: PMC9436336 DOI: 10.1073/pnas.2205881119] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Deep brain stimulation procedures offer an invaluable opportunity to study disease through intracranial recordings from awake patients. Here, we address the relationship between single-neuron and aggregate-level (local field potential; LFP) activities in the subthalamic nucleus (STN) and thalamic ventral intermediate nucleus (Vim) of patients with Parkinson's disease (n = 19) and essential tremor (n = 16), respectively. Both disorders have been characterized by pathologically elevated LFP oscillations, as well as an increased tendency for neuronal bursting. Our findings suggest that periodic single-neuron bursts encode both pathophysiological beta (13 to 33 Hz; STN) and tremor (4 to 10 Hz; Vim) LFP oscillations, evidenced by strong time-frequency and phase-coupling relationships between the bursting and LFP signals. Spiking activity occurring outside of bursts had no relationship to the LFP. In STN, bursting activity most commonly preceded the LFP oscillation, suggesting that neuronal bursting generated within STN may give rise to an aggregate-level LFP oscillation. In Vim, LFP oscillations most commonly preceded bursting activity, suggesting that neuronal firing may be entrained by periodic afferent inputs. In both STN and Vim, the phase-coupling relationship between LFP and high-frequency oscillation (HFO) signals closely resembled the relationships between the LFP and single-neuron bursting. This suggests that periodic single-neuron bursting is likely representative of a higher spatial and temporal resolution readout of periodic increases in the amplitude of HFOs, which themselves may be a higher resolution readout of aggregate-level LFP oscillations. Overall, our results may reconcile "rate" and "oscillation" models of Parkinson's disease and shed light on the single-neuron basis and origin of pathophysiological oscillations in movement disorders.
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14
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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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15
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Horisawa S, Kohara K, Ebise H, Nishitani M, Kawamata T, Taira T. Efficacy and Safety of Zolpidem for Focal Dystonia After Neurosurgical Treatments: A Retrospective Cohort Study. Front Neurol 2022; 13:837023. [PMID: 35592470 PMCID: PMC9111172 DOI: 10.3389/fneur.2022.837023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Although there are several reports of the significant efficacy of zolpidem for treating dystonia, zolpidem is still considered an anecdotal treatment. Here, we evaluated the efficacy and safety of zolpidem for treating residual dystonia in patients who previously received various neurosurgical treatments majorly including deep brain stimulation and radiofrequency ablation. We retrospectively reviewed medical records from January 2021 to September 2021 to identify patients with dystonia who had been prescribed zolpidem after undergoing neurosurgery. Twenty patients were enrolled in this study, including those with blepharospasm (two), tongue dystonia (four), mouth dystonia (one), spasmodic dysphonia (two), cervical dystonia (six), focal hand dystonia (three), hemidystonia (two), blepharospasm with cervical dystonia (one), and mouth dystonia with cervical dystonia (one). Single doses of zolpidem ranged between 2.5 and 10 mg, while daily dosages ranged from 10 to 30 mg. The zolpidem dose prescribed was 5–10 mg, with single and daily doses of 7 ± 2.9 and 14.5 ± 6.0 mg, respectively. With zolpidem administration, the participants' Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale score significantly improved from 8.1 ± 6.7 to 3.7 ± 2.5 (50.6% improvement, p < 0.0001). Improvements in arm dystonia, blepharospasm, and spasmodic dysphonia were observed using the Arm Dystonia Disability Scale, Jankovic Rating Scale, and Voice Handicap Index, respectively. No improvements were observed in cervical dystonia on the Toronto Western Spasmodic Torticollis Rating Scale. Drowsiness, including three cases each of mild and moderate drowsiness, was the most frequent adverse effect (30%), which persisted for 2–3 h. Transient amnesia and rapid eye movement sleep behavior disorder occurred in two patients and one patient, respectively. Although our findings suggest that zolpidem can be a valuable treatment option for patients with residual dystonia after neurosurgical treatments, the beneficial effects for cervical dystonia were limited.
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16
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Luo G, Cameron BD, Wang L, Yu H, Neimat JS, Hedera P, Phibbs F, Bradley EB, Cmelak AJ, Kirschner AN. Targeting for stereotactic radiosurgical thalamotomy based on tremor treatment response. J Neurosurg 2022; 136:1387-1394. [PMID: 34715657 DOI: 10.3171/2021.7.jns21160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) treats severe, medically refractory essential tremor and tremor-dominant Parkinson disease. However, the optimal target for SRS treatment within the thalamic ventral intermediate nucleus (VIM) is not clearly defined. This work evaluates the precision of the physician-selected VIM target, and determines the optimal SRS target within the VIM by correlation between early responders and nonresponders. METHODS Early responders and nonresponders were assessed retrospectively by Elements Basal Ganglia Atlas autocontouring of the VIM on the pre-SRS-treatment 1-mm slice thickness T1-weighted MRI and correlating the center of the post-SRS-treatment lesion. Using pre- and posttreatment diffusion tensor imaging, the fiber tracking package in the Elements software generated tremor-related tracts from autosegmented motor cortex, thalamus, red nucleus, and dentate nucleus. Autocontouring of the VIM was successful for all patients. RESULTS Among 23 patients, physician-directed SRS targets had a medial-lateral target range from +2.5 mm to -2.0 mm from the VIM center. Relative to the VIM center, the SRS isocenter target was 0.7-0.9 mm lateral for 6 early responders and 0.9-1.1 mm medial for 4 nonresponders (p = 0.019), and without differences in the other dimensions: 0.2 mm posterior and 0.6 mm superior. Dose-volume histogram analyses for the VIM had no significant differences between responders and nonresponders between 20 Gy and 140 Gy, mean or maximum dose, and dose to small volumes. Tractography data was obtained for 4 patients. CONCLUSIONS For tremor control in early responders, the Elements Basal Ganglia Atlas autocontour for the VIM provides the optimal SRS target location that is 0.7-0.9 mm lateral to the VIM center.
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Affiliation(s)
| | | | | | - Hong Yu
- 3Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph S Neimat
- 4Department of Neurological Surgery, University of Louisville, Kentucky; and
| | - Peter Hedera
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fenna Phibbs
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elise B Bradley
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
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17
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Berggren M, Głowacki ED, Simon DT, Stavrinidou E, Tybrandt K. In Vivo Organic Bioelectronics for Neuromodulation. Chem Rev 2022; 122:4826-4846. [PMID: 35050623 PMCID: PMC8874920 DOI: 10.1021/acs.chemrev.1c00390] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 01/27/2023]
Abstract
The nervous system poses a grand challenge for integration with modern electronics and the subsequent advances in neurobiology, neuroprosthetics, and therapy which would become possible upon such integration. Due to its extreme complexity, multifaceted signaling pathways, and ∼1 kHz operating frequency, modern complementary metal oxide semiconductor (CMOS) based electronics appear to be the only technology platform at hand for such integration. However, conventional CMOS-based electronics rely exclusively on electronic signaling and therefore require an additional technology platform to translate electronic signals into the language of neurobiology. Organic electronics are just such a technology platform, capable of converting electronic addressing into a variety of signals matching the endogenous signaling of the nervous system while simultaneously possessing favorable material similarities with nervous tissue. In this review, we introduce a variety of organic material platforms and signaling modalities specifically designed for this role as "translator", focusing especially on recent implementation in in vivo neuromodulation. We hope that this review serves both as an informational resource and as an encouragement and challenge to the field.
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Affiliation(s)
- Magnus Berggren
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Eric D. Głowacki
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
- Bioelectronics
Materials and Devices, Central European
Institute of Technology, Brno University of Technology, Purkyňova 656/123, 612 00 Brno, Czech
Republic
| | - Daniel T. Simon
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Eleni Stavrinidou
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Klas Tybrandt
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
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18
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Stavropoulos I, Pak HL, Valentin A. Neuromodulation in Super-refractory Status Epilepticus. J Clin Neurophysiol 2021; 38:494-502. [PMID: 34261110 DOI: 10.1097/wnp.0000000000000710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Status epilepticus (SE) is a severe condition that needs immediate pharmacological treatment to tackle brain damage and related side effects. In approximately 20% of cases, the standard treatment for SE does not control seizures, and the condition evolves to refractory SE. If refractory status epilepticus lasts more than 24 hours despite the use of anesthetic treatment, the condition is redefined as super-refractory SE (srSE). sRSE is a destructive condition, potentially to cause severe brain damage. In this review, we discuss the clinical neuromodulation techniques for controlling srSE when conventional treatments have failed: electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation. Data show that neuromodulation therapies can abort srSE in >80% of patients. However, no randomized, prospective, and controlled trials have been completed, and data are provided only by retrospective small case series and case reports with obvious inclination to publication bias. There is a need for further investigation into the use of neuromodulation techniques as an early treatment of srSE and to address whether an earlier intervention can prevent long-term complications.
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Affiliation(s)
- Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; and
| | - Ho Lim Pak
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Antonio Valentin
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; and
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Chiken S, Takada M, Nambu A. Altered Dynamic Information Flow through the Cortico-Basal Ganglia Pathways Mediates Parkinson's Disease Symptoms. Cereb Cortex 2021; 31:5363-5380. [PMID: 34268560 PMCID: PMC8568006 DOI: 10.1093/cercor/bhab164] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disorder caused by dopamine deficiency. To elucidate network-level changes through the cortico-basal ganglia pathways in PD, we recorded neuronal activity in PD monkeys treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. We applied electrical stimulation to the motor cortices and examined responses in the internal (GPi) and external (GPe) segments of the globus pallidus, the output and relay nuclei of the basal ganglia, respectively. In the normal state, cortical stimulation induced a triphasic response composed of early excitation, inhibition, and late excitation in the GPi and GPe. In the PD state, cortically evoked inhibition in the GPi mediated by the cortico-striato-GPi “direct” pathway was largely diminished, whereas late excitation in the GPe mediated by the cortico-striato-GPe-subthalamo (STN)-GPe pathway was elongated. l-DOPA treatment ameliorated PD signs, particularly akinesia/bradykinesia, and normalized cortically evoked responses in both the GPi and GPe. STN blockade by muscimol injection ameliorated the motor deficit and unmasked cortically evoked inhibition in the GPi. These results suggest that information flow through the direct pathway responsible for the initiation of movements is largely reduced in PD and fails to release movements, resulting in akinesia/bradykinesia. Restoration of the information flow through the direct pathway recovers execution of voluntary movements.
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Affiliation(s)
- Satomi Chiken
- Division of System Neurophysiology, National Institute for Physiological Sciences and Department of Physiological Sciences, SOKENDAI, Myodaiji, Okazaki 444-8585, Japan
| | - Masahiko Takada
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama 484-8506, Japan
| | - Atsushi Nambu
- Division of System Neurophysiology, National Institute for Physiological Sciences and Department of Physiological Sciences, SOKENDAI, Myodaiji, Okazaki 444-8585, Japan
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20
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Koketsu D, Chiken S, Hisatsune T, Miyachi S, Nambu A. Elimination of the Cortico-Subthalamic Hyperdirect Pathway Induces Motor Hyperactivity in Mice. J Neurosci 2021; 41:5502-5510. [PMID: 34001630 PMCID: PMC8221597 DOI: 10.1523/jneurosci.1330-20.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022] Open
Abstract
The substantia nigra pars reticulata (SNr) is the output station of the basal ganglia and receives cortical inputs by way of the following three basal ganglia pathways: the cortico-subthalamo (STN)-SNr hyperdirect, the cortico-striato-SNr direct, and the cortico-striato-external pallido-STN-SNr indirect pathways. Compared with the classical direct and indirect pathways via the striatum, the functions of the hyperdirect pathway remain to be fully elucidated. Here we used a photodynamic technique to selectively eliminate the cortico-STN projection in male mice and observed neuronal activity and motor behaviors in awake conditions. After cortico-STN elimination, cortically evoked early excitation in the SNr was diminished, while the cortically evoked inhibition and late excitation, which are delivered through the direct and indirect pathways, respectively, were unchanged. In addition, locomotor activity was significantly increased after bilateral cortico-STN elimination, and apomorphine-induced ipsilateral rotations were observed after unilateral cortico-STN elimination, suggesting that cortical activity was increased. These results are compatible with the notion that the cortico-STN-SNr hyperdirect pathway quickly conveys cortical excitation to the output station of the basal ganglia, resets or suppresses the cortical activity related to ongoing movements, and prepares for the forthcoming movement.SIGNIFICANCE STATEMENT The basal ganglia play a pivotal role in the control of voluntary movements, and their malfunctions lead to movement disorders, such as Parkinson's disease and dystonia. Understanding their functions is important to find better treatments for such diseases. Here we used a photodynamic technique to selectively eliminate the projection from the motor cortex to the subthalamic nucleus, the input station of the basal ganglia, and found greatly reduced early excitatory signals from the cortex to the output station of the basal ganglia and motor hyperactivity. These results suggest that the neuronal signals through the cortico-subthalamic hyperdirect pathway reset or suppress ongoing movements and that blockade of this pathway may be beneficial for Parkinson's disease, which is characterized by oversuppression of movements.
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Affiliation(s)
- Daisuke Koketsu
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki 444-8585, Japan
| | - Satomi Chiken
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki 444-8585, Japan
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki 444-8585, Japan
| | - Tatsuhiro Hisatsune
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, University of Tokyo, Kashiwa 277-8562, Japan
| | - Shigehiro Miyachi
- Cognitive Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama 484-8506, Japan
| | - Atsushi Nambu
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki 444-8585, Japan
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki 444-8585, Japan
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21
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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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22
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Milosevic L, Kalia SK, Hodaie M, Lozano AM, Popovic MR, Hutchison WD, Lankarany M. A theoretical framework for the site-specific and frequency-dependent neuronal effects of deep brain stimulation. Brain Stimul 2021; 14:807-821. [PMID: 33991712 DOI: 10.1016/j.brs.2021.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Deep brain stimulation is an established therapy for several neurological disorders; however, its effects on neuronal activity vary across brain regions and depend on stimulation settings. Understanding these variable responses can aid in the development of physiologically-informed stimulation paradigms in existing or prospective indications. OBJECTIVE Provide experimental and computational insights into the brain-region-specific and frequency-dependent effects of extracellular stimulation on neuronal activity. METHODS In patients with movement disorders, single-neuron recordings were acquired from the subthalamic nucleus, substantia nigra pars reticulata, ventral intermediate nucleus, or reticular thalamus during microstimulation across various frequencies (1-100 Hz) to assess single-pulse and frequency-response functions. Moreover, a biophysically-realistic computational framework was developed which generated postsynaptic responses under the assumption that electrical stimuli simultaneously activated all convergent presynaptic inputs to stimulation target neurons. The framework took into consideration the relative distributions of excitatory/inhibitory afferent inputs to model site-specific responses, which were in turn embedded within a model of short-term synaptic plasticity to account for stimulation frequency-dependence. RESULTS We demonstrated microstimulation-evoked excitatory neuronal responses in thalamic structures (which have predominantly excitatory inputs) and inhibitory responses in basal ganglia structures (predominantly inhibitory inputs); however, higher stimulation frequencies led to a loss of site-specificity and convergence towards neuronal suppression. The model confirmed that site-specific responses could be simulated by accounting for local neuroanatomical/microcircuit properties, while suppression of neuronal activity during high-frequency stimulation was mediated by short-term synaptic depression. CONCLUSIONS Brain-region-specific and frequency-dependant neuronal responses could be simulated by considering neuroanatomical (local microcircuitry) and neurophysiological (short-term plasticity) properties.
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Affiliation(s)
- Luka Milosevic
- Krembil Brain Institute, University Health Network, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Canada.
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Toronto, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Toronto, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Toronto, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Canada
| | - William D Hutchison
- CRANIA, University Health Network and University of Toronto, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada
| | - Milad Lankarany
- Krembil Brain Institute, University Health Network, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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23
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Horisawa S, Miyao S, Hori T, Kohara K, Kawamata T, Taira T. Comorbid seizure reduction after pallidothalamic tractotomy for movement disorders: Revival of Jinnai's Forel-H-tomy. Epilepsia Open 2021; 6:225-229. [PMID: 33681665 PMCID: PMC7918322 DOI: 10.1002/epi4.12467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
Forel-H-tomy for intractable epilepsy was introduced by Dennosuke Jinnai in the 1960s. Recently, Forel-H-tomy was renamed to "pallidothalamic tractotomy" and revived for the treatment of Parkinson's disease and dystonia. Two of our patients with movement disorders and comorbid epilepsy experienced significant seizure reduction after pallidothalamic tractotomy, demonstrating the efficacy of this method. The first was a 29-year-old woman who had temporal lobe epilepsy with focal impaired awareness seizure once every three months and an aura 10-20 times daily, even with four antiseizure medicines. For the treatment of hand dyskinesia, she underwent left pallidothalamic tractotomy and her right-hand dyskinesia significantly improved. Fourteen months later, she had experienced no focal impaired awareness seizure and the aura decreased to one to three times per month. The second case was that of a 15-year-old boy diagnosed with progressive myoclonic epilepsy, who developed generalized tonic-clonic seizure, which manifested once every month, despite treatment with five antiseizure medicines. After surgery, myoclonic movements in his right hand slightly improved. A one-year follow-up revealed that he had not experienced a generalized tonic-clonic seizure. The lesion locations in the two cases were close to the vicinity of Jinnai's Forel-H-tomy. Forel's field H deserves reconsideration as a treatment target for intractable epilepsy.
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Affiliation(s)
- Shiro Horisawa
- Department of NeurosurgeryTokyo Women’s Medical UniversityTokyoJapan
| | - Satoru Miyao
- Department of NeurosurgeryTokyo Women’s Medical UniversityTokyoJapan
| | - Tomokatsu Hori
- Department of NeurosurgeryMoriyama Neurological Center HospitalTokyoJapan
| | - Kotaro Kohara
- Department of NeurosurgeryTokyo Women’s Medical UniversityTokyoJapan
| | - Takakazu Kawamata
- Department of NeurosurgeryTokyo Women’s Medical UniversityTokyoJapan
| | - Takaomi Taira
- Department of NeurosurgeryTokyo Women’s Medical UniversityTokyoJapan
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24
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Stefani A, Cerroni R, Pierantozzi M, D’Angelo V, Grandi L, Spanetta M, Galati S. Deep brain stimulation in Parkinson’s disease patients and routine 6‐OHDA rodent models: Synergies and pitfalls. Eur J Neurosci 2020; 53:2322-2343. [DOI: 10.1111/ejn.14950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandro Stefani
- Department of System Medicine Faculty of Medicine and Surgery University of Rome “Tor Vergata” Rome Italy
| | - Rocco Cerroni
- Department of System Medicine Faculty of Medicine and Surgery University of Rome “Tor Vergata” Rome Italy
| | - Mariangela Pierantozzi
- Department of System Medicine Faculty of Medicine and Surgery University of Rome “Tor Vergata” Rome Italy
| | - Vincenza D’Angelo
- Department of System Medicine Faculty of Medicine and Surgery University of Rome “Tor Vergata” Rome Italy
| | - Laura Grandi
- Center for Movement Disorders Neurocenter of Southern Switzerland Lugano Switzerland
| | - Matteo Spanetta
- Department of System Medicine Faculty of Medicine and Surgery University of Rome “Tor Vergata” Rome Italy
| | - Salvatore Galati
- Center for Movement Disorders Neurocenter of Southern Switzerland Lugano Switzerland
- Faculty of Biomedical Sciences Università della Svizzera Italiana Lugano Switzerland
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25
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Lee EJ, Oh JS, Moon H, Kim MJ, Kim MS, Chung SJ, Kim JS, Jeon SR. Parkinson Disease-Related Pattern of Glucose Metabolism Associated With the Potential for Motor Improvement After Deep Brain Stimulation. Neurosurgery 2020; 86:492-499. [PMID: 31215629 DOI: 10.1093/neuros/nyz206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/24/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Motor dysfunctions in Parkinson disease (PD) patients are not completely normalized by deep brain stimulation (DBS), and there is an obvious difference in the degree of symptom improvement after DBS for each patient. OBJECTIVE To test our hypothesis that each patient has their own restoration capacity for motor improvement after DBS, and to investigate whether regional cerebral glucose metabolism in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans is associated with the capacity for off-medication motor improvement (MIoff) after DBS. METHODS The MIoff (%) was calculated using the Unified Parkinson's Disease Rating Scale part III in 27 PD patients undergoing DBS in the globus pallidus interna. The standardized uptake value ratios (SUVRs) on FDG-PET were quantitatively measured, and the areas where the SUVR correlated with the MIoff (%) were identified. Also, the areas where the SUVR was significantly different between the 2 MIoff groups (≥60% vs <60%) were determined. RESULTS Ten patients achieved MIoff > 60% at 12 mo after DBS. In general, the MIoff (%) was positively correlated with preoperative SUVR in the temporo-parieto-occipital lobes, while it was inversely correlated with the metabolism in the primary motor cortex. The patients in the MIoff < 60% group showed a significant decrease in SUVR in the parieto-occipital lobes, while parieto-occipital metabolism in those with MIoff ≥ 60% was relatively preserved (Mann-Whitney U test, P = .03). CONCLUSION Our findings suggest that the parieto-occipital lobes may be implicated more generally in the prognosis of motor improvement after DBS in advanced PD than other regions.
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Affiliation(s)
- Eun Jung Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jungsu S Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyojeong Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,System Medical Device Team, Advanced Technology Department, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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26
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Marks WA, Acord S, Bailey L, Honeycutt J. Neuromodulation in Childhood Onset Dystonia: Evolving Role of Deep Brain Stimulation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00258-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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27
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Hansen AL, Krell-Roesch J, Kirlin KA, Limback-Stokin MM, Roesler K, Velgos SN, Lyons MK, Geda YE, Mehta SH. Deep Brain Stimulation and Cognitive Outcomes Among Patients With Parkinson's Disease: A Historical Cohort Study. J Neuropsychiatry Clin Neurosci 2020; 31:196-200. [PMID: 30791806 DOI: 10.1176/appi.neuropsych.18050118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment for motor symptoms of Parkinson's disease; however, there is conflicting literature about the effect of DBS on cognitive function. The authors conducted a historical cohort study involving patients with Parkinson's disease who underwent DBS of the globus pallidus pars interna (GPi; N=12) or subthalamic nucleus (STN; N=17). METHODS The authors investigated differences in four neuropsychological test scores at 6 months post-DBS (follow-up) as compared with baseline (i.e., Boston Naming Test, WAIS Verbal Comprehension Index [WAIS-VCI], Working Memory Index [WAIS-WMI], and Processing Speed Index [WAIS-PSI]). RESULTS GPi DBS patients showed no difference between baseline and follow-up on any neuropsychological test. STN DBS patients had lower scores indicating decreased performance at follow-up as compared with baseline on WAIS-PSI (mean [SD], 91.47 [10.42] versus 81.65 [12.03]; p=0.03). There was a significant (p=0.008) difference between the change in baseline to follow-up scores on the WAIS-VCI for the STN DBS and GPi DBS groups (i.e., STN DBS patients scored lower at the 6-month follow-up compared with baseline, whereas GPi DBS patients scored higher). CONCLUSIONS GPi may be a preferred target for DBS in patients with Parkinson's disease when considering cognitive outcomes.
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Affiliation(s)
- Allison L Hansen
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Janina Krell-Roesch
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Kristin A Kirlin
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Martin M Limback-Stokin
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Kimberly Roesler
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Stefanie N Velgos
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Mark K Lyons
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Yonas E Geda
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
| | - Shyamal H Mehta
- The Translational Neuroscience and Aging Laboratory, Mayo Clinic, Phoenix, Ariz. (Krell-Roesch, Velgos, Geda); the Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, Ariz. (Kirlin, Geda); the Department of Neurological Surgery, Phoenix, Ariz. (Lyons); and the Department of Neurology, Mayo Clinic, Phoenix, Ariz. (Geda, Mehta)
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28
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Cho S, Hachmann JT, Balzekas I, In MH, Andres-Beck LG, Lee KH, Min HK, Jo HJ. Resting-state functional connectivity modulates the BOLD activation induced by nucleus accumbens stimulation in the swine brain. Brain Behav 2019; 9:e01431. [PMID: 31697455 PMCID: PMC6908867 DOI: 10.1002/brb3.1431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION While the clinical efficacy of deep brain stimulation (DBS) the treatment of motor-related symptoms is well established, the mechanism of action of the resulting cognitive and behavioral effects has been elusive. METHODS By combining functional magnetic resonance imaging (fMRI) and DBS, we investigated the pattern of blood-oxygenation-level-dependent (BOLD) signal changes induced by stimulating the nucleus accumbens in a large animal model. RESULTS We found that diffused BOLD activation across multiple functional networks, including the prefrontal, limbic, and thalamic regions during the stimulation, resulted in a significant change in inter-regional functional connectivity. More importantly, the magnitude of the modulation was closely related to the strength of the inter-regional resting-state functional connectivity. CONCLUSIONS Nucleus accumbens stimulation affects the functional activity in networks that underlie cognition and behavior. Our study provides an insight into the nature of the functional connectivity, which mediates activation effect via brain networks.
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Affiliation(s)
- Shinho Cho
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota at Twin Cities, Minneapolis, MN, USA
| | - Jan T Hachmann
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurologic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Irena Balzekas
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Myung-Ho In
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Lindsey G Andres-Beck
- Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Hang Joon Jo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Physiology, College of Medicine, Hanyang University, Seoul, South Korea
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29
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Chang CW, Lo YC, Lin SH, Yang SH, Lin HC, Lin TC, Li SJ, Hsieh CCJ, Ro V, Chung YJ, Chang YC, Lee CW, Kuo CH, Chen SY, Chen YY. Modulation of Theta-Band Local Field Potential Oscillations Across Brain Networks With Central Thalamic Deep Brain Stimulation to Enhance Spatial Working Memory. Front Neurosci 2019; 13:1269. [PMID: 32038122 PMCID: PMC6988804 DOI: 10.3389/fnins.2019.01269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/08/2019] [Indexed: 01/06/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established technique for the treatment of movement and psychiatric disorders through the modulation of neural oscillatory activity and synaptic plasticity. The central thalamus (CT) has been indicated as a potential target for stimulation to enhance memory. However, the mechanisms underlying local field potential (LFP) oscillations and memory enhancement by CT-DBS remain unknown. In this study, we used CT-DBS to investigate the mechanisms underlying the changes in oscillatory communication between the CT and hippocampus, both of which are involved in spatial working memory. Local field potentials (LFPs) were recorded from microelectrode array implanted in the CT, dentate gyrus, cornu ammonis (CA) region 1, and CA region 3. Functional connectivity (FC) strength was assessed by LFP-LFP coherence calculations for these brain regions. In addition, a T-maze behavioral task using a rat model was performed to assess the performance of spatial working memory. In DBS group, our results revealed that theta oscillations significantly increased in the CT and hippocampus compared with that in sham controls. As indicated by coherence, the FC between the CT and hippocampus significantly increased in the theta band after CT-DBS. Moreover, Western blotting showed that the protein expressions of the dopamine D1 and α4-nicotinic acetylcholine receptors were enhanced, whereas that of the dopamine D2 receptor decreased in the DBS group. In conclusion, the use of CT-DBS resulted in elevated theta oscillations, increased FC between the CT and hippocampus, and altered synaptic plasticity in the hippocampus, suggesting that CT-DBS is an effective approach for improving spatial working memory.
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Affiliation(s)
- Ching-Wen Chang
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Yu-Chun Lo
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Huang Lin
- Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien City, Taiwan.,Department of Neurology, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Shih-Hung Yang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ching Lin
- Department and Institute of Physiology, National Yang Ming University, Taipei, Taiwan
| | - Ting-Chun Lin
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Ssu-Ju Li
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Christine Chin-Jung Hsieh
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan.,Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang Ming University, Academia Sinica, Taipei, Taiwan
| | - Vina Ro
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Yueh-Jung Chung
- Department and Institute of Physiology, National Yang Ming University, Taipei, Taiwan
| | - Yun-Chi Chang
- Department and Institute of Physiology, National Yang Ming University, Taipei, Taiwan
| | - Chi-Wei Lee
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan.,Department of Neurosurgery, Taipei Veterans General Hospital, Neurological Institute, Taipei, Taiwan.,Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Shin-Yuan Chen
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien City, Taiwan.,Department of Surgery, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - You-Yin Chen
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan.,The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang Ming University, Academia Sinica, Taipei, Taiwan
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30
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van Zwieten G, Jahanshahi A, van Erp ML, Temel Y, Stokroos RJ, Janssen MLF, Smit JV. Alleviation of Tinnitus With High-Frequency Stimulation of the Dorsal Cochlear Nucleus: A Rodent Study. Trends Hear 2019; 23:2331216519835080. [PMID: 30868944 PMCID: PMC6419256 DOI: 10.1177/2331216519835080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Deep brain stimulation of the central auditory pathway is emerging as a promising treatment modality for tinnitus. Within this pathway, the dorsal cochlear nucleus (DCN) plays a key role in the pathophysiology of tinnitus and is believed to be a tinnitus generator. We hypothesized that high-frequency stimulation (HFS) of the DCN would influence tinnitus-related abnormal neuronal activity within the auditory pathway and hereby suppress tinnitus. To this end, we assessed the effect of HFS of the DCN in a noise-induced rat model of tinnitus. The presence of tinnitus was verified using the gap prepulse inhibition of the acoustic startle response paradigm. Hearing thresholds were determined before and after noise trauma by measuring the auditory brainstem responses. In addition, changes in neuronal activity induced by noise trauma and HFS were assessed using c-Fos immunohistochemistry in related structures. Results showed tinnitus development after noise trauma and hearing loss ipsilateral to the side exposed to noise trauma. During HFS of the DCN, tinnitus was suppressed. There was no change in c-Fos expression within the central auditory pathway after HFS. These findings suggest that DCN-HFS changes patterns of activity and results in information lesioning within the network and hereby blocking the relay of abnormal tinnitus-related neuronal activity.
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Affiliation(s)
- Gusta van Zwieten
- 1 Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,2 School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Ali Jahanshahi
- 3 Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marlieke L van Erp
- 2 School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Yasin Temel
- 2 School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,3 Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J Stokroos
- 4 Department of Ear Nose Throat/Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcus L F Janssen
- 2 School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,5 Department of Neurophysiology and Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jasper V Smit
- 1 Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,2 School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
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31
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Chen P, Li X. Study on Effect of Striatal mGluR2/3 in Alleviating Motor Dysfunction in Rat PD Model Treated by Exercise Therapy. Front Aging Neurosci 2019; 11:255. [PMID: 31632264 PMCID: PMC6783497 DOI: 10.3389/fnagi.2019.00255] [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: 06/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Exercise therapy has been widely applied in clinical rehabilitation as an important practical and side effect-free adjuvant therapy, with a significant effect in alleviating motor dysfunction of patients with Parkinson's disease (PD) or animal PD models. This study focuses on the effect of exercise therapy in reducing the concentration of extracellular glutamate (Glu) in the striatum in a rat PD model by upregulating the expression of group II metabotropic Glu receptor (mGluR2/3), so as to alleviate motor dysfunction in the rat PD model. Methods: Neurotoxin 6-hydroxydopamine (6-OHDA) was injected into the right medial forebrain bundle (MFB) of the rats to establish the semi-lateral cerebral damage PD model. The sham-operated group was given an equal amount of normal saline at the same site and taken as the control group. The apomorphine (APO)-induced rotational behavior test combined with immunohistochemical staining with tyrosine hydroxylase (TH) in the substantia nigra (SNc) and striatum was performed to assess the reliability of the model. The exercise group was given treadmill exercise intervention for 4 weeks (11 m/min, 30 min/day, 5 days/week) 1 week after the operation. The open field test (OFT) was performed to assess the locomotor activity of the rats; the Western blot technique was used to detect SNc TH and striatal mGluR2/3 protein expressions; real-time polymerase chain reaction (RT-PCR) was applied to detect striatal mGluR2 and mGluR3 mRNA expressions; the microdialysis-high-performance liquid chromatography (HPLC) method was adopted to detect the concentration of extracellular Glu in striatal neurons. Results: Compared with the control group, the number of rotations of each model group at the first week was significantly increased (P < 0.01); compared with the PD group, the number of rotations of the PD + exercise group at the third week and the fifth week was significantly decreased (P < 0.05, P < 0.01). Compared with the control group, the total movement distance, the total movement time, and the mean velocity of each model group at the first week were significantly reduced (P < 0.05); compared with the PD group, the total movement distance, the total movement time, and the mean velocity of the PD + exercise group at the third week and the fifth week were significantly increased (P < 0.01). Compared with the control group, the count of immunopositive cells and protein expression of SNc TH, and the content of immunopositive fiber terminals in the striatal TH of each model group significantly declined (P < 0.01). Compared with the PD group, the striatal mGluR2/3 protein expression of the PD + exercise group significantly rose (P < 0.01). Compared with the control group, the concentration of extracellular Glu in striatal neurons of each model group at the first week significantly grew (P < 0.05); compared with the PD group, the concentration of extracellular Glu in striatal neurons of the PD + exercise group at the third week and the fifth week was significantly decreased (P < 0.01); compared with the PD + exercise group, the concentration of extracellular Glu in striatal neurons of the group injected with mGluR2/3 antagonist (RS)-1-amino-5-phosphonoindan-1-carboxylic acid (APICA) into the striatum at the third week and the fifth week was significantly increased (P < 0.05, P < 0.01). Compared with the control group, the striatal mGluR2/3 protein expression of the PD group was significantly downregulated (P < 0.01); compared with the PD group, the striatal mGluR2/3 protein expression of the PD + exercise group was significantly upregulated (P < 0.05); compared with the control group, the striatal mGluR3 mRNA expression of the PD group was significantly downregulated (P < 0.01); compared with the PD group, the striatal mGluR3 mRNA expression of the PD + exercise group was significantly upregulated (P < 0.01); 6-OHDA damage and exercise intervention had no significant effect on the striatal mGluR2 mRNA expression (P > 0.05). Compared with the PD + exercise group, the total movement distance, the total movement time, and the mean velocity of the PD + exercise + APICA group were significantly decreased (P < 0.05); compared with the PD group, the PD + exercise + APICA group had no significant change in the total movement distance, the total movement time, and the mean velocity (P > 0.05). Conclusion: These data collectively demonstrate that the mGluR2/3-mediated glutamatergic transmission in the striatum is sensitive to dopamine (DA) depletion and may serve as a target of exercise intervention for mediating the therapeutic effect of exercise intervention in a rat model of PD.
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Affiliation(s)
- Ping Chen
- College of Sport Science, JiShou Univerity, JiShou, China
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaodong Li
- College of Sport Science, JiShou Univerity, JiShou, China
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Liu C, Wang J, Deng B, Li H, Fietkiewicz C, Loparo KA. Noise-Induced Improvement of the Parkinsonian State: A Computational Study. IEEE TRANSACTIONS ON CYBERNETICS 2019; 49:3655-3664. [PMID: 29994689 DOI: 10.1109/tcyb.2018.2845359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The benefit of noise in improving the basal ganglia (BG) dysfunctions, especially Parkinsonian state, is explored in this paper. High frequency (≥ 100 Hz) deep brain stimulation (DBS), as a clinical effective stimulation method, has compelling and fantastic results in alleviating the motor symptoms of Parkinson's disease (PD). However, the mechanism of DBS is still unclear. And the selection of the DBS waveform parameters faces great challenges to further optimize the stimulation effects and to reduce its energy expenditure. Considering that the desynchronization of the BG neuronal activities is benefited from the forced high frequency regular spikes driven by standard high frequency DBS, we expect to explore a novel stimulation method that has capability of restoring the BG physiological firing patterns without introducing artificial high-frequency fires. In this paper, a colored noise stimulation is used as a neuromodulation method to disrupt the firing patterns of the pathological neuronal activities. A computational model of the BG that exhibits the intrinsic properties of the BG neurons and their interactions with the thalamic (Th) cells is employed. Based on the model, we investigate the effects of noise stimulation and explore the impacts of the noise stimulation parameters on both relay reliability of the Th neurons and energy expenditure of the stimulation. By comparison, it can be found that noise stimulation does not entrain the network to an artificial high-frequency firing state, but induces the pathological increased synchronous activities back to a normal physiological level. Moreover, besides the capability of restoring the neuronal state, the benefits of the noise also include its balanced waveform to avert potential tissue or electrode damage and its ability to reduce the energy expenditure to 50% less than that of the standard DBS, when the noise stimulation has low frequency (≤ 100 Hz) and appropriate intensity. Thus, the exploration of the optimal noise-induced improvement of the BG dysfunction is of great significance in treating symptoms of neurological disorders such as PD.
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Bilateral subthalamic nucleus deep brain stimulation increases fixational saccades during movement preparation: evidence for impaired preparatory set. Exp Brain Res 2019; 237:2841-2851. [PMID: 31455999 DOI: 10.1007/s00221-019-05636-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
People with Parkinson's disease (PD) exhibit an increase in fixational saccades during the preparatory period prior to target onset in the antisaccade task and this increase is related to an increase in prosaccade errors in the antisaccade task. It was previously shown that bilateral, but not unilateral, subthalamic nucleus deep brain stimulation (STN DBS) in people with PD further increases the prosaccade error rate on the antisaccade task. We investigated whether bilateral STN DBS also increases the number of fixational saccades in the preparatory period of the antisaccade task and if this increase in the number of fixational saccades is related to prosaccade errors. We found that: (1) there were a greater number of fixational saccades during the preparatory period of the antisaccade task during bilateral STN DBS compared to no STN DBS (p < 0.001), unilateral STN DBS (p < 0.001), and healthy controls (p = 0.02), and (2) the increase in the number of fixational saccades increased the probability of a prosaccade error for the antisaccade task during bilateral STN DBS (p = 0.005). This association between number of fixational saccades and probability of a prosaccade error was similar across no STN DBS, unilateral stimulation, and healthy controls. In addition, we found that the proportion of express prosaccade errors and prosaccade error latency were similar across stimulation conditions. We propose that bilateral STN DBS disrupts the integrated activity of cortico-basal ganglia-collicular processes underlying antisaccade preparation and that this disruption manifests as an increase in both fixational saccades and prosaccade error rate.
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34
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Ye H, Kaszuba S. Neuromodulation with electromagnetic stimulation for seizure suppression: From electrode to magnetic coil. IBRO Rep 2019; 7:26-33. [PMID: 31360792 PMCID: PMC6639724 DOI: 10.1016/j.ibror.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022] Open
Abstract
Non-invasive brain tissue stimulation with a magnetic coil provides several irreplaceable advantages over that with an implanted electrode, in altering neural activities under pathological situations. We reviewed clinical cases that utilized time-varying magnetic fields for the treatment of epilepsy, and the safety issues related to this practice. Animal models have been developed to foster understanding of the cellular/molecular mechanisms underlying magnetic control of epileptic activity. These mechanisms include (but are not limited to) (1) direct membrane polarization by the magnetic field, (2) depolarization blockade by the deactivation of ion channels, (3) alteration in synaptic transmission, and (4) interruption of ephaptic interaction and cellular synchronization. Clinical translation of this technology could be improved through the advancement of magnetic design, optimization of stimulation protocols, and evaluation of the long-term safety. Cellular and molecular studies focusing on the mechanisms of magnetic stimulation are of great value in facilitating this translation.
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Key Words
- 4-AP, 4-aminopyridine
- Animal models
- CD50, convulsant dose
- Cellular mechanisms
- DBS, deep brain stimulation
- EEG, electroencephalography
- ELF-MF, extremely low frequency magnetic fields
- EcoG, electrocorticography
- Epilepsy
- GABA, gamma-aminobutyric acid
- HFS, high frequency stimulation
- KA, kainic acid
- LD50, lethal dose
- LTD, long-term depression
- LTP, long-term potential
- MEG, magnetoencephalography
- MRI, magnetic resonance imaging
- Magnetic stimulation
- NMDAR, N-methyl-d-aspartate receptor
- PTZ, pentylenetetrazol
- REM, rapid eye movement
- SMF, static magnetic field
- TES, transcranial electrical stimulation
- TLE, temporal lobe epilepsy
- TMS, transcranial magnetic stimulation
- rTMS, repetitive transcranial magnetic stimulation
- tDCS, transcranial direct-current stimulation
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Affiliation(s)
- Hui Ye
- Department of Biology, Loyola University Chicago, Chicago, 1032 W. Sheridan Rd., IL, 60660, United States
| | - Stephanie Kaszuba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL, 60064, United States
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35
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Reyes-Garcés N, Diwan M, Boyacı E, Gómez-Ríos GA, Bojko B, Nobrega JN, Bambico FR, Hamani C, Pawliszyn J. In Vivo Brain Sampling Using a Microextraction Probe Reveals Metabolic Changes in Rodents after Deep Brain Stimulation. Anal Chem 2019; 91:9875-9884. [DOI: 10.1021/acs.analchem.9b01540] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nathaly Reyes-Garcés
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - Mustansir Diwan
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Ezel Boyacı
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - German A. Gómez-Ríos
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - Barbara Bojko
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - José N. Nobrega
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Francis R. Bambico
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Clement Hamani
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Janusz Pawliszyn
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
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36
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Schor JS, Nelson AB. Multiple stimulation parameters influence efficacy of deep brain stimulation in parkinsonian mice. J Clin Invest 2019; 129:3833-3838. [PMID: 31194696 DOI: 10.1172/jci122390] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Deep brain stimulation (DBS) is used to treat multiple neuropsychiatric disorders, including Parkinson's Disease (PD). Despite widespread clinical use, its therapeutic mechanisms are unknown. Here, we developed a mouse model of subthalamic nucleus (STN) DBS for PD, to permit investigation using cell type-specific tools available in mice. We found that electrical STN DBS relieved bradykinesia, as measured by movement velocity. In addition, our model recapitulated several hallmarks of human STN DBS, including rapid onset and offset, frequency dependence, dyskinesia at higher stimulation intensity, and associations between electrode location, therapeutic benefit, and side effects. We used this model to assess whether high frequency stimulation is necessary for effective STN DBS, or if low frequency stimulation can be effective when paired with compensatory adjustments in other parameters. We found that low frequency stimulation, paired with greater pulse width and amplitude, relieved bradykinesia. Moreover, a composite metric incorporating pulse width, amplitude, and frequency predicted therapeutic efficacy better than frequency alone. We found a similar relationship between this composite metric and movement speed in a retrospective analysis of human data, suggesting correlations observed in the mouse model may extend to human patients. Together, these data establish a mouse model for elucidating mechanisms of DBS.
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Affiliation(s)
- Jonathan S Schor
- Neuroscience Program.,Kavli Institute for Fundamental Neuroscience.,Weill Institute for Neuroscience, and
| | - Alexandra B Nelson
- Neuroscience Program.,Kavli Institute for Fundamental Neuroscience.,Weill Institute for Neuroscience, and.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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37
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Zangiabadi N, Ladino LD, Sina F, Orozco-Hernández JP, Carter A, Téllez-Zenteno JF. Deep Brain Stimulation and Drug-Resistant Epilepsy: A Review of the Literature. Front Neurol 2019; 10:601. [PMID: 31244761 PMCID: PMC6563690 DOI: 10.3389/fneur.2019.00601] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction: Deep brain stimulation is a safe and effective neurointerventional technique for the treatment of movement disorders. Electrical stimulation of subcortical structures may exert a control on seizure generators initiating epileptic activities. The aim of this review is to present the targets of the deep brain stimulation for the treatment of drug-resistant epilepsy. Methods: We performed a structured review of the literature from 1980 to 2018 using Medline and PubMed. Articles assessing the impact of deep brain stimulation on seizure frequency in patients with DRE were selected. Meta-analyses, randomized controlled trials, and observational studies were included. Results: To date, deep brain stimulation of various neural targets has been investigated in animal experiments and humans. This article presents the use of stimulation of the anterior and centromedian nucleus of the thalamus, hippocampus, basal ganglia, cerebellum and hypothalamus. Anterior thalamic stimulation has demonstrated efficacy and there is evidence to recommend it as the target of choice. Conclusion: Deep brain stimulation for seizures may be an option in patients with drug-resistant epilepsy. Anterior thalamic nucleus stimulation could be recommended over other targets.
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Affiliation(s)
- Nasser Zangiabadi
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, Neuroclinica, University of Antioquia, Medellín, Colombia
| | - Farzad Sina
- Department of Neurology, Rasool Akram Hospital, IUMS, Tehran, Iran
| | - Juan Pablo Orozco-Hernández
- Departamento de Investigación Clínica, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira-Clínica Comfamiliar, Pereira, Colombia
| | - Alexandra Carter
- Saskatchewan Epilepsy Program, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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38
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Alexander L, Clarke HF, Roberts AC. A Focus on the Functions of Area 25. Brain Sci 2019; 9:E129. [PMID: 31163643 PMCID: PMC6627335 DOI: 10.3390/brainsci9060129] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/27/2022] Open
Abstract
Subcallosal area 25 is one of the least understood regions of the anterior cingulate cortex, but activity in this area is emerging as a crucial correlate of mood and affective disorder symptomatology. The cortical and subcortical connectivity of area 25 suggests it may act as an interface between the bioregulatory and emotional states that are aberrant in disorders such as depression. However, evidence for such a role is limited because of uncertainty over the functional homologue of area 25 in rodents, which hinders cross-species translation. This emphasizes the need for causal manipulations in monkeys in which area 25, and the prefrontal and cingulate regions in which it is embedded, resemble those of humans more than rodents. In this review, we consider physiological and behavioral evidence from non-pathological and pathological studies in humans and from manipulations of area 25 in monkeys and its putative homologue, the infralimbic cortex (IL), in rodents. We highlight the similarities between area 25 function in monkeys and IL function in rodents with respect to the regulation of reward-driven responses, but also the apparent inconsistencies in the regulation of threat responses, not only between the rodent and monkey literatures, but also within the rodent literature. Overall, we provide evidence for a causal role of area 25 in both the enhanced negative affect and decreased positive affect that is characteristic of affective disorders, and the cardiovascular and endocrine perturbations that accompany these mood changes. We end with a brief consideration of how future studies should be tailored to best translate these findings into the clinic.
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Affiliation(s)
- Laith Alexander
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, UK.
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK.
| | - Hannah F Clarke
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, UK.
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK.
| | - Angela C Roberts
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, UK.
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK.
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39
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Hell F, Palleis C, Mehrkens JH, Koeglsperger T, Bötzel K. Deep Brain Stimulation Programming 2.0: Future Perspectives for Target Identification and Adaptive Closed Loop Stimulation. Front Neurol 2019; 10:314. [PMID: 31001196 PMCID: PMC6456744 DOI: 10.3389/fneur.2019.00314] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
Deep brain stimulation has developed into an established treatment for movement disorders and is being actively investigated for numerous other neurological as well as psychiatric disorders. An accurate electrode placement in the target area and the effective programming of DBS devices are considered the most important factors for the individual outcome. Recent research in humans highlights the relevance of widespread networks connected to specific DBS targets. Improving the targeting of anatomical and functional networks involved in the generation of pathological neural activity will improve the clinical DBS effect and limit side-effects. Here, we offer a comprehensive overview over the latest research on target structures and targeting strategies in DBS. In addition, we provide a detailed synopsis of novel technologies that will support DBS programming and parameter selection in the future, with a particular focus on closed-loop stimulation and associated biofeedback signals.
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Affiliation(s)
- Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilians University, Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Jan H. Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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40
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Kelley R, Flouty O, Emmons EB, Kim Y, Kingyon J, Wessel JR, Oya H, Greenlee JD, Narayanan NS. A human prefrontal-subthalamic circuit for cognitive control. Brain 2019; 141:205-216. [PMID: 29190362 DOI: 10.1093/brain/awx300] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022] Open
Abstract
The subthalamic nucleus is a key site controlling motor function in humans. Deep brain stimulation of the subthalamic nucleus can improve movements in patients with Parkinson's disease; however, for unclear reasons, it can also have cognitive effects. Here, we show that the human subthalamic nucleus is monosynaptically connected with cognitive brain areas such as the prefrontal cortex. Single neurons and field potentials in the subthalamic nucleus are modulated during cognitive processing and are coherent with 4-Hz oscillations in medial prefrontal cortex. These data predict that low-frequency deep brain stimulation may alleviate cognitive deficits in Parkinson's disease patients. In line with this idea, we found that novel 4-Hz deep brain stimulation of the subthalamic nucleus improved cognitive performance. These data support a role for the human hyperdirect pathway in cognitive control, which could have relevance for brain-stimulation therapies aimed at cognitive symptoms of human brain disease.awx300media15660002226001.
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Affiliation(s)
- Ryan Kelley
- Medical Scientist Training Program, University of Iowa, Iowa City, IA 52242, USA.,Program in Neuroscience, University of Iowa, Iowa City, IA 52242, USA
| | - Oliver Flouty
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA
| | - Eric B Emmons
- Program in Neuroscience, University of Iowa, Iowa City, IA 52242, USA
| | - Youngcho Kim
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - Johnathan Kingyon
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Jan R Wessel
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA
| | - Jeremy D Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA
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41
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Connectivity and Dynamics Underlying Synaptic Control of the Subthalamic Nucleus. J Neurosci 2019; 39:2470-2481. [PMID: 30700533 DOI: 10.1523/jneurosci.1642-18.2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/29/2018] [Accepted: 01/24/2019] [Indexed: 12/16/2022] Open
Abstract
Adaptive motor control critically depends on the interconnected nuclei of the basal ganglia in the CNS. A pivotal element of the basal ganglia is the subthalamic nucleus (STN), which serves as a therapeutic target for deep brain stimulation (DBS) in movement disorders, such as Parkinson's disease. The functional connectivity of the STN at the microcircuit level, however, still requires rigorous investigation. Here we combine multiple simultaneous whole-cell recordings with extracellular stimulation and post hoc neuroanatomical analysis to investigate intrinsic and afferent connectivity and synaptic properties of the STN in acute brain slices obtained from rats of both sexes. Our data reveal an absence of intrinsic connectivity and an afferent innervation with low divergence, suggesting that STN neurons operate as independent processing elements driven by upstream structures. Hence, synchrony in the STN, a hallmark of motor processing, exclusively depends on the interactions and dynamics of GABAergic and glutamatergic afferents. Importantly, these inputs are subject to differential short-term depression when stimulated at high, DBS-like frequencies, shifting the balance of excitation and inhibition toward inhibition. Thus, we present a mechanism for fast yet transient decoupling of the STN from synchronizing afferent control. Together, our study provides new insights into the microcircuit organization of the STN by identifying its neurons as parallel processing units and thus sets new constraints for future computational models of the basal ganglia. The observed differential short-term plasticity of afferent inputs further offers a basis to better understand and optimize DBS algorithms.SIGNIFICANCE STATEMENT The subthalamic nucleus (STN) is a pivotal element of the basal ganglia and serves as target for deep brain stimulation, but information on the functional connectivity of its neurons is limited. To investigate the STN microcircuitry, we combined multiple simultaneous patch-clamp recordings and neuroanatomical analysis. Our results provide new insights into the synaptic organization of the STN identifying its neurons as parallel processing units and thus set new constraints for future computational models of the basal ganglia. We further find that synaptic dynamics of afferent inputs result in a rapid yet transient decoupling of the STN when stimulated at high frequencies. These results offer a better understanding of deep brain stimulation mechanisms, promoting the development of optimized algorithms.
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Abstract
BACKGROUND Dystonia is a painful and disabling disorder, characterised by painful, involuntary posturing of the affected body region(s). Deep brain stimulation is an intervention typically reserved for severe and drug-refractory cases, although uncertainty exists regarding its efficacy, safety, and tolerability. OBJECTIVES To compare the efficacy, safety, and tolerability of deep brain stimulation (DBS) versus placebo, sham intervention, or best medical care, including botulinum toxin and resective or lesional surgery, in adults with dystonia. SEARCH METHODS We identified studies by searching the CENTRAL, MEDLINE, Embase, three other databases, four clinical trial registries, four grey literature databases, and reference lists of included articles. We ran the last search of all elements of the search strategy, with no language restrictions, on 29 May 2018. SELECTION CRITERIA Double-blind, parallel, randomised, controlled trials (RCTs) comparing DBS with sham stimulation, best medical care, or placebo in adults with dystonia. DATA COLLECTION AND ANALYSIS Two independent review authors assessed records, selected included studies, extracted data onto a standardised (or prespecified) data extraction form, and evaluated the risk of bias. We resolved disagreements by consensus or by consulting a third review author. We conducted meta-analyses using a random-effects model, to estimate pooled effects and corresponding 95% confidence intervals (95% CI). We assessed the quality of the evidence with GRADE methods. The primary efficacy outcome was symptom improvement on any validated symptomatic rating scale, and the primary safety outcome was adverse events. MAIN RESULTS We included two RCTs, enrolling a total of 102 participants. Both trials evaluated the effect of DBS on the internal globus pallidus nucleus, and assessed outcomes after three and six months of stimulation. One of the studies included participants with generalised and segmental dystonia; the other included participants with focal (cervical) dystonia. We assessed both studies at high risk for performance and for-profit bias. One study was retrospectively registered with a clinical trial register, we judged the second at high risk of detection bias.Low-quality evidence suggests that DBS of the internal globus pallidus nucleus may improve overall cervical dystonia-related symptoms (mean difference (MD) 9.8 units, 95% CI 3.52 to 16.08 units; 1 RCT, 59 participants), cervical dystonia-related functional capacity (MD 3.8 units, 95% CI 1.41 to 6.19; 1 RCT, 61 participants), and mood at three months (MD 3.1 units, 95% CI 0.73 to 5.47; 1 RCT, 61 participants).Low-quality evidence suggests that In people with cervical dystonia, DBS may slightly improve the overall clinical status (MD 2.3 units, 95% CI 1.15 to 3.45; 1 RCT, 61 participants). We are uncertain whether DBS improves quality of life in cervical dystonia (MD 3 units, 95% CI -7.71 to 13.71; 1 RCT, 57 participants; very low-quality evidence), or emotional state (MD 2.4 units, 95% CI -6.2 to 11.00; 1 RCT, 56 participants; very low-quality evidence).Low-quality evidence suggests that DBS of the internal globus pallidus nucleus may improve generalised or segmental dystonia-related symptoms (MD 14.4 units, 95% CI 8.0 to 20.8; 1 RCT, 40 participants), overall clinical status (MD 3.5 units, 95% CI 2.33 to 4.67; 1 RCT, 37 participants), physical functioning-related quality of life (MD 6.3 units, 95% CI 1.06 to 11.54; 1 RCT, 33 participants), and overall dystonia-related functional capacity at three months (MD 3.1 units, 95% CI 1.71 to 4.48; 1 RCT, 39 participants). We are uncertain whether DBS improves physical functioning-related quality of life (MD 5.0 units, 95% CI -2.14 to 12.14, 1 RCT, 33 participants; very low-quality evidence), or mental health-related quality of life (MD -4.6 units, 95% CI -11.26 to 2.06; 1 RCT, 30 participants; very low-quality evidence) in generalised or segmental dystonia.We pooled outcomes related to safety and tolerability, since both trials used the same intervention and comparison. We found very low-quality evidence of inconclusive results for risk of adverse events (relative risk (RR) 1.58, 95% 0.98 to 2.54; 2 RCTs, 102 participants), and tolerability (RR 1.86, 95% CI 0.16 to 21.57; 2 RCTs,102 participants). AUTHORS' CONCLUSIONS DBS of the internal globus pallidus nucleus may reduce symptom severity and improve functional capacity in adults with cervical, segmental or generalised moderate to severe dystonia (low-quality evidence), and may improve quality of life in adults with generalised or segmental dystonia (low-quality evidence). We are uncertain whether the procedure improves quality of life in cervical dystonia (very low-quality evidence). We are also uncertain about the safety and tolerability of the procedure in adults with either cervical and generalised, or segmental dystonia (very-low quality evidence).We could draw no conclusions for other populations with dystonia (i.e. children and adolescents, and adults with other types of dystonia), or for other DBS protocols (i.e. other target nuclei or stimulation paradigms). Further research is needed to establish the long-term efficacy and safety of DBS of the internal globus pallidus nucleus.
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Affiliation(s)
- Filipe B Rodrigues
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina de Lisboa, Avenida Professor Egas Moniz, Lisboa, Portugal, 1649-028
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Casquero-Veiga M, García-García D, Pascau J, Desco M, Soto-Montenegro ML. Stimulating the nucleus accumbens in obesity: A positron emission tomography study after deep brain stimulation in a rodent model. PLoS One 2018; 13:e0204740. [PMID: 30261068 PMCID: PMC6160153 DOI: 10.1371/journal.pone.0204740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/13/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The nucleus accumbens (NAcc) has been suggested as a possible target for deep brain stimulation (DBS) in the treatment of obesity. Our hypothesis was that NAcc-DBS would modulate brain regions related to reward and food intake regulation, consequently reducing the food intake and, finally, the weight gain. Therefore, we examined changes in brain glucose metabolism, weight gain and food intake after NAcc-DBS in a rat model of obesity. PROCEDURES Electrodes were bilaterally implanted in 2 groups of obese Zucker rats targeting the NAcc. One group received stimulation one hour daily during 15 days, while the other remained as control. Weight and daily consumption of food and water were everyday registered the days of stimulation, and twice per week during the following month. Positron emission tomography (PET) studies with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) were performed 1 day after the end of DBS. PET data was assessed by statistical parametric mapping (SPM12) software and region of interest (ROI) analyses. RESULTS NAcc-DBS lead to increased metabolism in the cingulate-retrosplenial-parietal association cortices, and decreased metabolism in the NAcc, thalamic and pretectal nuclei. Furthermore, ROIs analyses confirmed these results by showing a significant striatal and thalamic hypometabolism, and a cortical hypermetabolic region. However, NAcc-DBS did not induce a decrease in either weight gain or food intake. CONCLUSIONS NAcc-DBS led to changes in the metabolism of regions associated with cognitive and reward systems, whose impairment has been described in obesity.
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Affiliation(s)
| | | | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María Luisa Soto-Montenegro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
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Wu HF, Chen YJ, Chu MC, Hsu YT, Lu TY, Chen IT, Chen PS, Lin HC. Deep Brain Stimulation Modified Autism-Like Deficits via the Serotonin System in a Valproic Acid-Induced Rat Model. Int J Mol Sci 2018; 19:ijms19092840. [PMID: 30235871 PMCID: PMC6164279 DOI: 10.3390/ijms19092840] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 01/30/2023] Open
Abstract
Deep brain stimulation (DBS) is known to be a promising treatment for resistant depression, which acts via the serotonin (5-hydroxytryptamine, 5-HT) system in the infralimbic prefrontal cortex (ILPFC). Previous study revealed that dysfunction of brain 5-HT homeostasis is related to a valproate (VPA)-induced rat autism spectrum disorder (ASD) model. Whether ILPFC DBS rescues deficits in VPA-induced offspring through the 5-HT system is not known. Using VPA-induced offspring, we therefore explored the effect of DBS in autistic phenotypes and further investigated the underlying mechanism. Using combined behavioral and molecular approaches, we observed that applying DBS and 5-HT1A receptor agonist treatment with 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) reversed sociability deficits, anxiety and hyperactivity in the VPA-exposed offspring. We then administered the selective 5-HT1A receptor antagonist N-[2-[4-(2-Methoxyphenyl)-1-piperazinyl]ethyl]-N-2-pyridinylcyclohexanecarboxamide maleate (WAY 100635), following which the effect of DBS in terms of improving autistic behaviors was blocked in the VPA-exposed offspring. Furthermore, we found that both 8-OH-DPAT and DBS treatment rescued autistic behaviors by decreasing the expressions of NR2B subunit of N-methyl-D-aspartate receptors (NMDARs) and the β₃ subunit of γ-aminobutyric acid type A receptors (GABAAR) in the PFC region. These results provided the first evidence of characteristic behavioral changes in VPA-induced offspring caused by DBS via the 5-HT system in the ILPFC.
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Affiliation(s)
- Han-Fang Wu
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Yi-Ju Chen
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Ming-Chia Chu
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Ya-Ting Hsu
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Ting-Yi Lu
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - I-Tuan Chen
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.
- Addiction Research Center, National Cheng Kung University, Tainan 70101, Taiwan.
| | - Hui-Ching Lin
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei 11221, Taiwan.
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan.
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Pautrat A, Rolland M, Barthelemy M, Baunez C, Sinniger V, Piallat B, Savasta M, Overton PG, David O, Coizet V. Revealing a novel nociceptive network that links the subthalamic nucleus to pain processing. eLife 2018; 7:36607. [PMID: 30149836 PMCID: PMC6136891 DOI: 10.7554/elife.36607] [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: 03/13/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022] Open
Abstract
Pain is a prevalent symptom of Parkinson's disease, and is effectively treated by deep brain stimulation of the subthalamic nucleus (STN). However, the link between pain and the STN remains unclear. In the present work, using in vivo electrophysiology in rats, we report that STN neurons exhibit complex tonic and phasic responses to noxious stimuli. We also show that nociception is altered following lesions of the STN, and characterize the role of the superior colliculus and the parabrachial nucleus in the transmission of nociceptive information to the STN, physiologically from both structures and anatomically in the case of the parabrachial nucleus. We show that STN nociceptive responses are abnormal in a rat model of PD, suggesting their dependence on the integrity of the nigrostriatal dopaminergic system. The STN-linked nociceptive network that we reveal is likely to be of considerable clinical importance in neurological diseases involving a dysfunction of the basal ganglia.
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Affiliation(s)
- Arnaud Pautrat
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Marta Rolland
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Margaux Barthelemy
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Christelle Baunez
- Institut de Neurosciences de la Timone, Aix-Marseille Université, Marseille, France
| | - Valérie Sinniger
- Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France.,Service d'Hépato-Gastroentérologie, CHU Grenoble Alpes, Grenoble, France
| | - Brigitte Piallat
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Marc Savasta
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Paul G Overton
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Olivier David
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Veronique Coizet
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
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Muthuraman M, Koirala N, Ciolac D, Pintea B, Glaser M, Groppa S, Tamás G, Groppa S. Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease. Front Neurol 2018; 9:711. [PMID: 30210436 PMCID: PMC6119713 DOI: 10.3389/fneur.2018.00711] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stanislav Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Lio G, Thobois S, Ballanger B, Lau B, Boulinguez P. Removing deep brain stimulation artifacts from the electroencephalogram: Issues, recommendations and an open-source toolbox. Clin Neurophysiol 2018; 129:2170-2185. [PMID: 30144660 DOI: 10.1016/j.clinph.2018.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 07/23/2018] [Accepted: 07/28/2018] [Indexed: 12/30/2022]
Abstract
A major question for deep brain stimulation (DBS) research is understanding how DBS of one target area modulates activity in different parts of the brain. EEG gives privileged access to brain dynamics, but its use with implanted patients is limited since DBS adds significant high-amplitude electrical artifacts that can completely obscure neural activity measured using EEG. Here, we systematically review and discuss the methods available for removing DBS artifacts. These include simple techniques such as oversampling, antialiasing analog filtering and digital low-pass filtering, which are necessary but typically not sufficient to fully remove DBS artifacts when each is used in isolation. We also cover more advanced methods, including techniques tracking outliers in the frequency-domain, which can be effective, but are rarely used. The reason for that is twofold: First, it requires advanced skills in signal processing since no user friendly tool for removing DBS artifacts is currently available. Second, it involves fine-tuning to avoid over-aggressive filtering. We highlight an open-source toolbox incorporating most artifact removal methods, allowing users to combine different strategies.
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Affiliation(s)
- Guillaume Lio
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, Centre de Neuroscience Cognitive, Bron, France
| | - Stéphane Thobois
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, Centre de Neuroscience Cognitive, Bron, France; Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, Bron, France
| | - Bénédicte Ballanger
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Brian Lau
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, F-75013 Paris, France
| | - Philippe Boulinguez
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France.
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Chen SC, Chu PY, Hsieh TH, Li YT, Peng CW. Feasibility of deep brain stimulation for controlling the lower urinary tract functions: An animal study. Clin Neurophysiol 2017; 128:2438-2449. [PMID: 29096218 DOI: 10.1016/j.clinph.2017.09.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/17/2017] [Accepted: 09/16/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the feasibility of deep brain stimulation (DBS) and compare the potential of four DBS targets in rats for regulating bladder activity: the periaqueductal gray (PAG), locus coeruleus (LC), rostral pontine reticular nucleus (PnO), and pedunculopontine tegmental nucleus (PPTg). METHODS A bipolar stimulating electrode was implanted. The effects of DBS on the inhibition and activation of micturition reflexes were investigated by using isovolumetric intravesical pressure recordings. RESULTS PAG DBS at 2-2.5 V, PnO DBS at 2-2.5 V, and PPTg DBS at 1.75-2.5 V nearly completely inhibited reflexive isovolumetric bladder contractions. By contrast, LC DBS at 1.75 and 2 V slightly augmented reflexive isovolumetric bladder contractions in rats. DBSs on PnO and PPTg at higher intensities (2.5-5 V) demonstrated a higher success rate and larger contraction area evocation in activating bladder contractions in a partially filled bladder. DBS targeting the PPTg was most efficient in suppressing reflexive isovolumetric bladder contractions. CONCLUSION PPTg DBS demonstrated stable results and high potency for controlling bladder contractions. PPTg might be a promising DBS target for developing new neuromodulatory approaches for the treatment of bladder dysfunctions. SIGNIFICANCE DBS could be a potential approach to manage bladder function under various conditions.
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Affiliation(s)
- Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Yi Chu
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsun Hsieh
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Graduate Institute of Neural Regenerative Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ting Li
- Instrument Technology Research Center, National Applied Research Laboratories, Hsinchu, Taiwan
| | - Chih-Wei Peng
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
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Smit JV, Jahanshahi A, Janssen ML, Stokroos RJ, Temel Y. Hearing assessment during deep brain stimulation of the central nucleus of the inferior colliculus and dentate cerebellar nucleus in rat. PeerJ 2017; 5:e3892. [PMID: 29018625 PMCID: PMC5633028 DOI: 10.7717/peerj.3892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/15/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently it has been shown in animal studies that deep brain stimulation (DBS) of auditory structures was able to reduce tinnitus-like behavior. However, the question arises whether hearing might be impaired when interfering in auditory-related network loops with DBS. METHODS The auditory brainstem response (ABR) was measured in rats during high frequency stimulation (HFS) and low frequency stimulation (LFS) in the central nucleus of the inferior colliculus (CIC, n = 5) or dentate cerebellar nucleus (DCBN, n = 5). Besides hearing thresholds using ABR, relative measures of latency and amplitude can be extracted from the ABR. In this study ABR thresholds, interpeak latencies (I-III, III-V, I-V) and V/I amplitude ratio were measured during off-stimulation state and during LFS and HFS. RESULTS In both the CIC and the CNBN groups, no significant differences were observed for all outcome measures. DISCUSSION DBS in both the CIC and the CNBN did not have adverse effects on hearing measurements. These findings suggest that DBS does not hamper physiological processing in the auditory circuitry.
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Affiliation(s)
- Jasper V. Smit
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ali Jahanshahi
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L.F. Janssen
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J. Stokroos
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
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