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Farokhniaee A, Palmisano C, Del Vecchio Del Vecchio J, Pezzoli G, Volkmann J, Isaias IU. Gait-related beta-gamma phase amplitude coupling in the subthalamic nucleus of parkinsonian patients. Sci Rep 2024; 14:6674. [PMID: 38509158 PMCID: PMC10954750 DOI: 10.1038/s41598-024-57252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Analysis of coupling between the phases and amplitudes of neural oscillations has gained increasing attention as an important mechanism for large-scale brain network dynamics. In Parkinson's disease (PD), preliminary evidence indicates abnormal beta-phase coupling to gamma-amplitude in different brain areas, including the subthalamic nucleus (STN). We analyzed bilateral STN local field potentials (LFPs) in eight subjects with PD chronically implanted with deep brain stimulation electrodes during upright quiet standing and unperturbed walking. Phase-amplitude coupling (PAC) was computed using the Kullback-Liebler method, based on the modulation index. Neurophysiological recordings were correlated with clinical and kinematic measurements and individual molecular brain imaging studies ([123I]FP-CIT and single-photon emission computed tomography). We showed a dopamine-related increase in subthalamic beta-gamma PAC from standing to walking. Patients with poor PAC modulation and low PAC during walking spent significantly more time in the stance and double support phase of the gait cycle. Our results provide new insights into the subthalamic contribution to human gait and suggest cross-frequency coupling as a gateway mechanism to convey patient-specific information of motor control for human locomotion.
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Affiliation(s)
- AmirAli Farokhniaee
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy.
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Gianni Pezzoli
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Ioannis U Isaias
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Sobanska A, Czerwosz L, Sulek A, Rola R, Stepniak I, Rakowicz M. Quantitative Evaluation of Stance as a Sensitive Biomarker of Postural Ataxia Development in Preclinical SCA1 Mutation Carriers. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01679-w. [PMID: 38492164 DOI: 10.1007/s12311-024-01679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
The aim of this study was to determine the time between the first detection of postural control impairments and the evident manifestation of ataxia in preclinical SCA1 individuals. Twenty five preclinical SCA1 mutation carriers: 13 with estimated disease onset ≤ 6 years (SCA1 +) aged 27.8 ± 8.1 years; 12 with expected disease onset > 6 years (SCA1-) aged 26.6 ± 3.1 years and 26 age and sex matched healthy controls (HCs) underwent static posturography during 5 years of observation. The movements of the centre of feet pressure (COP) during quiet standing with eyes open (EO) and closed (EC) were quantified by calculating the mean radius (R), developed surface area (A) and mean COP movement velocity (V). Ataxia was evaluated by use of the Scale for Assessment and Rating of Ataxia (SARA).SCA1 + exhibited significantly worse quality of stance with EC vs. SCA1- (p < 0.05 for V) and HCs (p < 0.001) even 5 to 6 years before estimated disease onset. There were no statistically significant differences between SCA1- and HCs. A slow increase in Cohen's d effect size was observed for VEO up to the clinical manifestation of ataxia. VEO and AEC recorded in preclinical SCA1 individuals correlated slightly but statistically significantly with SARA (r = 0.47).The study confirms that static posturography detects COP sway changes in SCA1 preclinical gene carriers even 5 to 6 years before estimated disease onset. The quantitative evaluation of stance in preclinical SCA is a sensitive biomarker for the monitoring of the disease progression and may be useful in clinical trials.
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Affiliation(s)
- Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Leszek Czerwosz
- Laboratory of Respiration Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Sulek
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Rafal Rola
- Department of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Iwona Stepniak
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Maria Rakowicz
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Palmisano C, Farinelli V, Camuncoli F, Favata A, Pezzoli G, Frigo CA, Isaias IU. Dynamic evaluation of spine kinematics in individuals with Parkinson's disease and freezing of gait. Gait Posture 2024; 108:199-207. [PMID: 37993298 DOI: 10.1016/j.gaitpost.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Freezing of gait (FoG) is an episodic failure of gait exposing people with Parkinson's disease (PD) to a high risk of falling. Despite growing evidence of the interconnection between impaired trunk control and FoG, a detailed description of spinal kinematics during walking is still lacking in this population. RESEARCH QUESTION Do spinal alterations impact gait performance in individuals with PD and FoG? METHODS We analyzed kinematic data of 47 PD participants suffering (PD-FOG, N = 24) or not suffering from FoG (PD-NFOG, N = 23) and 15 healthy controls (HCO) during quiet standing and unperturbed walking. We estimated the main spinal variables (i.e., spinal length, lordosis and kyphosis angles, trunk inclination), the pelvis angles, and the shoulder-pelvis angles during gait and standing. We studied differences across conditions and groups and the relationships between postural and gait parameters using linear regression methods. RESULTS During standing and walking, both PD groups showed increased trunk inclination and decreased lordosis angle with respect to HCO, as well as a decreased range in variation of kyphosis angle, pelvic obliquity, and shoulder-pelvis angles. Only PD-FOG participants showed reduced range of lordosis angle and spinal length compared to HCO. PD-FOG individuals were also not able to straighten their spine during walking compared to standing. Stride length and velocity were decreased in both patient groups compared to HCO, while swing duration was reduced only in the PD-FOG group. In individuals with FoG, trunk inclination and lordosis angle showed moderate but significant positive correlations with all gait alterations. SIGNIFICANCE Spine alterations impacted gait performance in individuals with PD suffering from FoG. Excessive trunk inclination and poor mastering of the lordosis spinal region may create an unfavourable postural precondition for forward walking. Physical therapy should target combined spinal and stepping alterations in these individuals.
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Affiliation(s)
- C Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
| | - V Farinelli
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milano, Italy
| | - F Camuncoli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - A Favata
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - G Pezzoli
- Parkinson Institute Milan, ASST G. Pini-CTO, Milano, Italy
| | - C A Frigo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - I U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, Milano, Italy
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Marchese SM, Palesi F, Nigri A, Bruzzone MG, Pantaleoni C, Gandini Wheeler-Kingshott CAM, D’Arrigo S, D’Angelo E, Cavallari P. Structural and connectivity parameters reveal spared connectivity in young patients with non-progressive compared to slow-progressive cerebellar ataxia. Front Neurol 2023; 14:1279616. [PMID: 37965172 PMCID: PMC10642782 DOI: 10.3389/fneur.2023.1279616] [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: 08/21/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Within Pediatric Cerebellar Ataxias (PCAs), patients with non-progressive ataxia (NonP) surprisingly show postural motor behavior comparable to that of healthy controls, differently to slow-progressive ataxia patients (SlowP). This difference may depend on the building of compensatory strategies of the intact areas in NonP brain network. Methods Eleven PCAs patients were recruited: five with NonP and six with SlowP. We assessed volumetric and axonal bundles alterations with a multimodal approach to investigate whether eventual spared connectivity between basal ganglia and cerebellum explains the different postural motor behavior of NonP and SlowP patients. Results Cerebellar lobules were smaller in SlowP patients. NonP patients showed a lower number of streamlines in the cerebello-thalamo-cortical tracts but a generalized higher integrity of white matter tracts connecting the cortex and the basal ganglia with the cerebellum. Discussion This work reveals that the axonal bundles connecting the cerebellum with basal ganglia and cortex demonstrate a higher integrity in NonP patients. This evidence highlights the importance of the cerebellum-basal ganglia connectivity to explain the different postural motor behavior of NonP and SlowP patients and support the possible compensatory role of basal ganglia in patients with stable cerebellar malformation.
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Affiliation(s)
- Silvia Maria Marchese
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milan, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Digital Neuroscience, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Nigri
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Chiara Pantaleoni
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Digital Neuroscience, IRCCS Mondino Foundation, Pavia, Italy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Stefano D’Arrigo
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Digital Neuroscience, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Cavallari
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milan, Italy
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5
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Marchese SM, Esposti R, Farinelli V, Ciaccio C, De Laurentiis A, D’Arrigo S, Cavallari P. Pediatric Slow-Progressive, but Not Non-Progressive Cerebellar Ataxia Delays Intra-Limb Anticipatory Postural Adjustments in the Upper Arm. Brain Sci 2023; 13:brainsci13040620. [PMID: 37190585 DOI: 10.3390/brainsci13040620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
We recently investigated the role of the cerebellum during development, reporting that children with genetic slow-progressive ataxia (SlowP) show worse postural control during quiet stance and gait initiation compared to healthy children (H). Instead, children with genetic non-progressive ataxia (NonP) recalled the behavior of H. This may derive from compensatory networks, which are hindered by disease progression in SlowP while free to develop in NonP. In the aim of extending our findings to intra-limb postural control, we recorded, in 10 NonP, 10 SlowP and 10 H young patients, Anticipatory Postural Adjustments (APAs) in the proximal muscles of the upper-limb and preceding brisk index finger flexions. No significant differences in APA timing occurred between NonP and H, while APAs in SlowP were delayed. Indeed, the excitatory APA in Triceps Brachii was always present but significantly delayed with respect to both H and NonP. Moreover, the inhibitory APAs in the Biceps Brachii and Anterior Deltoid, which are normally followed by a late excitation, could not be detected in most SlowP children, as if inhibition was delayed to the extent where there was overlap with a late excitation. In conclusion, disease progression seems to be detrimental for intra-limb posture, supporting the idea that inter- and intra-limb postures seemingly share the same control mechanism.
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Affiliation(s)
- Silvia Maria Marchese
- Human Physiology Section of the DePT, Università degli Studi di Milano, 20133 Milan, Italy
| | - Roberto Esposti
- Human Physiology Section of the DePT, Università degli Studi di Milano, 20133 Milan, Italy
| | - Veronica Farinelli
- Human Physiology Section of the DePT, Università degli Studi di Milano, 20133 Milan, Italy
| | - Claudia Ciaccio
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, 20133 Milan, Italy
| | - Arianna De Laurentiis
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, 20133 Milan, Italy
| | - Stefano D’Arrigo
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, 20133 Milan, Italy
| | - Paolo Cavallari
- Human Physiology Section of the DePT, Università degli Studi di Milano, 20133 Milan, Italy
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Pozzi NG, Palmisano C, Reich MM, Capetian P, Pacchetti C, Volkmann J, Isaias IU. Troubleshooting Gait Disturbances in Parkinson's Disease With Deep Brain Stimulation. Front Hum Neurosci 2022; 16:806513. [PMID: 35652005 PMCID: PMC9148971 DOI: 10.3389/fnhum.2022.806513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson's disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management.
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Affiliation(s)
- Nicoló G. Pozzi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Martin M. Reich
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Philip Capetian
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Claudio Pacchetti
- Parkinson’s Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Gaetano Pini-CTO, Milan, Italy
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Consensus Paper: Ataxic Gait. CEREBELLUM (LONDON, ENGLAND) 2022; 22:394-430. [PMID: 35414041 DOI: 10.1007/s12311-022-01373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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Affiliation(s)
- Pierre Cabaraux
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Université Versailles Saint-Quentin, Versailles, France.,Service de NeuroImagerie, Centre Hospitalier National des 15-20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.,Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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8
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Palmisano C, Kullmann P, Hanafi I, Verrecchia M, Latoschik ME, Canessa A, Fischbach M, Isaias IU. A Fully-Immersive Virtual Reality Setup to Study Gait Modulation. Front Hum Neurosci 2022; 16:783452. [PMID: 35399359 PMCID: PMC8983870 DOI: 10.3389/fnhum.2022.783452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: Gait adaptation to environmental challenges is fundamental for independent and safe community ambulation. The possibility of precisely studying gait modulation using standardized protocols of gait analysis closely resembling everyday life scenarios is still an unmet need. Methods: We have developed a fully-immersive virtual reality (VR) environment where subjects have to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. We collected kinematic data of 12 healthy young subjects walking in real world (RW) and in the VR environment, both with (VR/A+) and without (VR/A-) the VA perturbation. The VR environment closely resembled the RW scenario of the gait laboratory. To ensure standardization of the obstacle presentation the starting time speed and trajectory of the VA were defined using the kinematics of the participant as detected online during each walking trial. Results: We did not observe kinematic differences between walking in RW and VR/A-, suggesting that our VR environment per se might not induce significant changes in the locomotor pattern. When facing the VA all subjects consistently reduced stride length and velocity while increasing stride duration. Trunk inclination and mediolateral trajectory deviation also facilitated avoidance of the obstacle. Conclusions: This proof-of-concept study shows that our VR/A+ paradigm effectively induced a timely gait modulation in a standardized immersive and realistic scenario. This protocol could be a powerful research tool to study gait modulation and its derangements in relation to aging and clinical conditions.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- *Correspondence: Chiara Palmisano
| | - Peter Kullmann
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marta Verrecchia
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marc Erich Latoschik
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Andrea Canessa
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genova, Italy
| | - Martin Fischbach
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Pini-CTO, Milano, Italy
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9
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Esposti R, Marchese SM, Farinelli V, Bolzoni F, Cavallari P. Dual-Hemisphere Transcranial Direct Current Stimulation on Parietal Operculum Does Not Affect the Programming of Intra-limb Anticipatory Postural Adjustments. Front Physiol 2021; 12:789886. [PMID: 34987420 PMCID: PMC8721103 DOI: 10.3389/fphys.2021.789886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
Evidence shows that the postural and focal components within the voluntary motor command are functionally unique. In 2015, we reported that the supplementary motor area (SMA) processes Anticipatory Postural Adjustments (APAs) separately from the command to focal muscles, so we are still searching for a hierarchically higher area able to process both components. Among these, the parietal operculum (PO) seemed to be a good candidate, as it is a hub integrating both sensory and motor streams. However, in 2019, we reported that transcranial Direct Current Stimulation (tDCS), applied with an active electrode on the PO contralateral to the moving segment vs. a larger reference electrode on the opposite forehead, did not affect intra-limb APAs associated to brisk flexions of the index-finger. Nevertheless, literature reports that two active electrodes of opposite polarities, one on each PO (dual-hemisphere, dh-tDCS), elicit stronger effects than the "active vs. reference" arrangement. Thus, in the present study, the same intra-limb APAs were recorded before, during and after dh-tDCS on PO. Twenty right-handed subjects were tested, 10 for each polarity: anode on the left vs. cathode on the right, and vice versa. Again, dh-tDCS was ineffective on APA amplitude and timing, as well as on prime mover recruitment and index-finger kinematics. These results confirm the conclusion that PO does not take part in intra-limb APA control. Therefore, our search for an area in which the motor command to prime mover and postural muscles are still processed together will have to address other structures.
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Affiliation(s)
- Roberto Esposti
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Silvia M. Marchese
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Veronica Farinelli
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesco Bolzoni
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paolo Cavallari
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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10
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Farinelli V, Bolzoni F, Marchese SM, Esposti R, Cavallari P. A Novel Viewpoint on the Anticipatory Postural Adjustments During Gait Initiation. Front Hum Neurosci 2021; 15:709780. [PMID: 34707487 PMCID: PMC8543010 DOI: 10.3389/fnhum.2021.709780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Anticipatory postural adjustments (APAs) are the coordinated muscular activities that precede the voluntary movements to counteract the associated postural perturbations. Many studies about gait initiation call APAs those activities that precede the heel-off of the leading foot, thus taking heel-off as the onset of voluntary movement. In particular, leg muscles drive the center of pressure (CoP) both laterally, to shift the body weight over the trailing foot and backward, to create a disequilibrium torque pushing forward the center of mass (CoM). However, since subjects want to propel their body rather than lift their foot, the onset of gait should be the CoM displacement, which starts with the backward CoP shift. If so, the leg muscles driving such a shift are the prime movers. Moreover, since the disequilibrium torque is mechanically equivalent to a forward force acting at the pelvis level, APAs should be required to link the body segments to the pelvis: distributing such concentrated force throughout the body would make all segments move homogeneously. In the aim of testing this hypothesis, we analyzed gait initiation in 15 right-footed healthy subjects, searching for activities in trunk muscles that precede the onset of the backward CoP shift. Subjects stood on a force plate for about 10 s and then started walking at their natural speed. A minimum of 10 trials were collected. A force plate measured the CoP position while wireless probes recorded the electromyographic activities. Recordings ascertained that at gait onset APAs develop in trunk muscles. On the right side, Rectus Abdominis and Obliquus Abdominis were activated in 11 and 13 subjects, respectively, starting on average 33 and 54 ms before the CoP shift; Erector Spinae (ES) at L2 and T3 levels was instead inhibited (9 and 7 subjects, 104 and 120 ms). On the contralateral side, the same muscles showed excitatory APAs (abdominals in 11 and 12 subjects, 27 and 82 ms; ES in 10 and 7 subjects, 75 and 32 ms). The results of this study provide a novel framework for distinguishing postural from voluntary actions, which may be relevant for the diagnosis and rehabilitation of gait disorders.
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Affiliation(s)
- Veronica Farinelli
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesco Bolzoni
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Silvia Maria Marchese
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Esposti
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Cavallari
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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11
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Thenaisie Y, Palmisano C, Canessa A, Keulen BJ, Capetian P, Jiménez MC, Bally JF, Manferlotti E, Beccaria L, Zutt R, Courtine G, Bloch J, van der Gaag NA, Hoffmann CF, Moraud EM, Isaias IU, Contarino MF. Towards adaptive deep brain stimulation: clinical and technical notes on a novel commercial device for chronic brain sensing. J Neural Eng 2021; 18. [PMID: 34388744 DOI: 10.1088/1741-2552/ac1d5b] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Objective. Technical advances in deep brain stimulation (DBS) are crucial to improve therapeutic efficacy and battery life. We report the potentialities and pitfalls of one of the first commercially available devices capable of recording brain local field potentials (LFPs) from the implanted DBS leads, chronically and during stimulation. The aim was to provide clinicians with well-grounded tips on how to maximize the capabilities of this novel device, both in everyday practice and for research purposes.Approach. We collected clinical and neurophysiological data of the first 20 patients (14 with Parkinson's disease (PD), five with dystonia, one with chronic pain) that received the Percept™ PC in our centres. We also performed tests in a saline bath to validate the recordings quality.Main results. The Percept PC reliably recorded the LFP of the implanted site, wirelessly and in real time. We recorded the most promising clinically useful biomarkers for PD and dystonia (beta and theta oscillations) with and without stimulation. Furthermore, we provide an open-source code to facilitate export and analysis of data. Critical aspects of the system are presently related to contact selection, artefact detection, data loss, and synchronization with other devices.Significance. New technologies will soon allow closed-loop neuromodulation therapies, capable of adapting stimulation based on real-time symptom-specific and task-dependent input signals. However, technical aspects need to be considered to ensure reliable recordings. The critical use by a growing number of DBS experts will alert new users about the currently observed shortcomings and inform on how to overcome them.
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Affiliation(s)
- Yohann Thenaisie
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne and Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Chiara Palmisano
- Department of Neurology, University Hospital and Julius Maximilian University, Würzburg, Germany.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea Canessa
- Department of Neurology, University Hospital and Julius Maximilian University, Würzburg, Germany.,Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Bart J Keulen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.,Educational Programme, Technical Medicine, Delft University of Technology, Delft; Leiden University Medical Center, Leiden; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Philipp Capetian
- Department of Neurology, University Hospital and Julius Maximilian University, Würzburg, Germany
| | - Mayte Castro Jiménez
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien F Bally
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Elena Manferlotti
- Department of Neurology, University Hospital and Julius Maximilian University, Würzburg, Germany.,The BioRobotics Institute and Department of Excellence of Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Laura Beccaria
- Department of Neurology, University Hospital and Julius Maximilian University, Würzburg, Germany
| | - Rodi Zutt
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Grégoire Courtine
- Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne and Ecole Polytechnique Fédérale de Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne and Ecole Polytechnique Fédérale de Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Niels A van der Gaag
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Carel F Hoffmann
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne and Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Ioannis U Isaias
- Department of Neurology, University Hospital and Julius Maximilian University, Würzburg, Germany
| | - M Fiorella Contarino
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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12
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García-Soidán JL, García-Liñeira J, Leirós-Rodríguez R, Soto-Rodríguez A. Physical Activity Practice and Optimal Development of Postural Control in School Children: Are They Related? J Clin Med 2020; 9:jcm9092919. [PMID: 32927763 PMCID: PMC7565156 DOI: 10.3390/jcm9092919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background: This study aims to analyze the effect of physical activity practice on the postural control state of school children. If such an effect was detected, the second aim of the study was to identify which specific capacities of postural control benefited the most from physical activity. Methods: A cross-sectional study was performed using a convenience sample of 118 healthy children (54 girls) with a mean age of 10.3 ± 1.2 years. Their weight and height were measured. The accelerometric assessment of balance included four different tests in static balance and walking. Results: Physical activity habit prevalence was 38.9% in girls and 60.9% in boys, and its frequency was 2.3 days per week in girls and 2.8 days in boys. The active children obtained lower accelerations, but the active and sedentary girls showed lower accelerometric values than the active boys. The logistic regression analysis demonstrated the influence of sex on the accelerations of the body (p < 0.001), regardless of the habit of physical activity. Conclusions: Active children have better postural control than sedentary children, although sedentary girls have better balance than active boys. Therefore, physical activity practice seems to favor a more efficient development of postural control, but it cannot level or reverse the effect of the neurophysiological factors that are conditioned by sex.
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Affiliation(s)
- Jose L. García-Soidán
- Faculty of Education and Sport Sciences, University of Vigo, Campus a Xunqueira, s/n. 36005 Pontevedra, Spain; (J.L.G.-S.); (J.G.-L.)
| | - Jesús García-Liñeira
- Faculty of Education and Sport Sciences, University of Vigo, Campus a Xunqueira, s/n. 36005 Pontevedra, Spain; (J.L.G.-S.); (J.G.-L.)
| | - Raquel Leirós-Rodríguez
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Campus Ponferrada, University of León, 2440 Ponferrada, Spain
- Correspondence: ; Tel.: +34-987-44-20-00
| | - Anxela Soto-Rodríguez
- Health Service from Galicia (SERGAS), Galician Health Services—Ourense Hospital, s/n. 32005 Ourense, Spain;
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13
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Palmisano C, Todisco M, Marotta G, Volkmann J, Pacchetti C, Frigo CA, Pezzoli G, Isaias IU. Gait initiation in progressive supranuclear palsy: brain metabolic correlates. NEUROIMAGE-CLINICAL 2020; 28:102408. [PMID: 33353609 PMCID: PMC7689404 DOI: 10.1016/j.nicl.2020.102408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/29/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Dysfunctional gait initiation in progressive supranuclear palsy relates to poor feedforward motor control. Hypometabolism of the caudate nucleus impairs programming of anticipatory postural adjustments. Thalamic hypometabolism correlates with the center of mass kinematic resultants of anticipatory postural adjustments.
The initiation of gait is a highly challenging task for the balance control system, and can be used to investigate the neural control of upright posture maintenance during whole-body movement. Gait initiation is a centrally-mediated motion achieved in a principled, controlled manner, including predictive mechanisms (anticipatory postural adjustments, APA) that destabilize the antigravitary postural set of body segments for the execution of functionally-optimized stepping. Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by early impairment of balance and frequent falls. The neural correlates of postural imbalance and falls in PSP are largely unknown. We biomechanically assessed the APA at gait initiation (imbalance, unloading, and stepping phases) of 26 patients with PSP and 14 age-matched healthy controls. Fourteen of 26 enrolled patients were able to perform valid gait initiation trials. The influence of anthropometric and base-of-support measurements on the biomechanical outcome variables was assessed and removed. Biomechanical data were correlated with clinical findings and, in 11 patients, with brain metabolic abnormalities measured using positron emission tomography and 2-deoxy-2-[18F]fluoro-D-glucose. Patients with PSP showed impaired modulation of the center of pressure displacement for a proper setting of the center of mass momentum and subsequent efficient stepping. Biomechanical measurements correlated with “Limb motor” and “Gait and midline” subscores of the Progressive Supranuclear Palsy Rating Scale. Decreased regional glucose uptake in the caudate nucleus correlated with impaired APA programming. Hypometabolism of the caudate nucleus, supplementary motor area, cingulate cortex, thalamus, and midbrain was associated with specific biomechanical resultants of APA. Our findings show that postural instability at gait initiation in patients with PSP correlates with deficient APA production, and is associated with multiple and distinctive dysfunctioning of different areas of the supraspinal locomotor network. Objective biomechanical measures can help to understand fall-related pathophysiological mechanisms and to better monitor disease progression and new interventions.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; MBMC Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimiliano Todisco
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Carlo A Frigo
- MBMC Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
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14
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Palesi F, Lorenzi RM, Casellato C, Ritter P, Jirsa V, Gandini Wheeler-Kingshott CA, D’Angelo E. The Importance of Cerebellar Connectivity on Simulated Brain Dynamics. Front Cell Neurosci 2020; 14:240. [PMID: 32848628 PMCID: PMC7411185 DOI: 10.3389/fncel.2020.00240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 11/14/2022] Open
Abstract
The brain shows a complex multiscale organization that prevents a direct understanding of how structure, function and dynamics are correlated. To date, advances in neural modeling offer a unique opportunity for simulating global brain dynamics by embedding empirical data on different scales in a mathematical framework. The Virtual Brain (TVB) is an advanced data-driven model allowing to simulate brain dynamics starting from individual subjects' structural and functional connectivity obtained, for example, from magnetic resonance imaging (MRI). The use of TVB has been limited so far to cerebral connectivity but here, for the first time, we have introduced cerebellar nodes and interconnecting tracts to demonstrate the impact of cerebro-cerebellar loops on brain dynamics. Indeed, the matching between the empirical and simulated functional connectome was significantly improved when including the cerebro-cerebellar loops. This positive result should be considered as a first step, since issues remain open about the best strategy to reconstruct effective structural connectivity and the nature of the neural mass or mean-field models generating local activity in the nodes. For example, signal processing is known to differ remarkably between cortical and cerebellar microcircuits. Tackling these challenges is expected to further improve the predictive power of functional brain activity simulations, using TVB or other similar tools, in explaining not just global brain dynamics but also the role of cerebellum in determining brain states in physiological conditions and in the numerous pathologies affecting the cerebro-cerebellar loops.
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Affiliation(s)
- Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Claudia Casellato
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Petra Ritter
- Brain Simulation Section, Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Viktor Jirsa
- Institut de Neurosciences des Systèmes – Inserm UMR1106, Aix-Marseille Université, Marseille, France
| | - Claudia A.M. Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
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