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Bange M, Gonzalez-Escamilla G, Herz DM, Tinkhauser G, Glaser M, Ciolac D, Pogosyan A, Kreis SL, Luhmann HJ, Tan H, Groppa S. Subthalamic stimulation modulates context-dependent effects of beta bursts during fine motor control. Nat Commun 2024; 15:3166. [PMID: 38605062 PMCID: PMC11009405 DOI: 10.1038/s41467-024-47555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
Increasing evidence suggests a considerable role of pre-movement beta bursts for motor control and its impairment in Parkinson's disease. However, whether beta bursts occur during precise and prolonged movements and if they affect fine motor control remains unclear. To investigate the role of within-movement beta bursts for fine motor control, we here combine invasive electrophysiological recordings and clinical deep brain stimulation in the subthalamic nucleus in 19 patients with Parkinson's disease performing a context-varying task that comprised template-guided and free spiral drawing. We determined beta bursts in narrow frequency bands around patient-specific peaks and assessed burst amplitude, duration, and their immediate impact on drawing speed. We reveal that beta bursts occur during the execution of drawing movements with reduced duration and amplitude in comparison to rest. Exclusively when drawing freely, they parallel reductions in acceleration. Deep brain stimulation increases the acceleration around beta bursts in addition to a general increase in drawing velocity and improvements of clinical function. These results provide evidence for a diverse and task-specific role of subthalamic beta bursts for fine motor control in Parkinson's disease; suggesting that pathological beta bursts act in a context dependent manner, which can be targeted by clinical deep brain stimulation.
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Affiliation(s)
- Manuel Bange
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Damian M Herz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dumitru Ciolac
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Svenja L Kreis
- Institute of Physiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
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Herz DM. Neuroscience: Therapy modulates decision-making in Parkinson's disease. Curr Biol 2024; 34:R148-R150. [PMID: 38412825 DOI: 10.1016/j.cub.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
There is mounting evidence that decision-making can be affected by treatment in Parkinson's disease. A new study shows that dopamine and deep brain stimulation, two mainstay treatments of Parkinson's, differently affect how patients make decisions weighing rewards against effort costs.
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Affiliation(s)
- Damian M Herz
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
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Groppa S, Gonzalez-Escamilla G, Tinkhauser G, Baqapuri HI, Sajonz B, Wiest C, Pereira J, Herz DM, Dold MR, Bange M, Ciolac D, Almeida V, Neuber J, Mirzac D, Martín-Rodríguez JF, Dresel C, Muthuraman M, Adarmes Gomez AD, Navas M, Temiz G, Gunduz A, Rotaru L, Winter Y, Schuurman R, Contarino MF, Glaser M, Tangermann M, Leentjens AFG, Mir P, Torres Diaz CV, Karachi C, Linden DEJ, Tan H, Coenen VA. Perspectives of Implementation of Closed-Loop Deep Brain Stimulation: From Neurological to Psychiatric Disorders. Stereotact Funct Neurosurg 2023; 102:40-54. [PMID: 38086346 DOI: 10.1159/000535114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/07/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy to alleviate symptoms and improve quality of life in movement disorders such as Parkinson's disease, essential tremor, and dystonia, which is also being applied in several psychiatric disorders, such as obsessive-compulsive disorder and depression, when they are otherwise resistant to therapy. SUMMARY At present, DBS is clinically applied in the so-called open-loop approach, with fixed stimulation parameters, irrespective of the patients' clinical state(s). This approach ignores the brain states or feedback from the central nervous system or peripheral recordings, thus potentially limiting its efficacy and inducing side effects by stimulation of the targeted networks below or above the therapeutic level. KEY MESSAGES The currently emerging closed-loop (CL) approaches are designed to adapt stimulation parameters to the electrophysiological surrogates of disease symptoms and states. CL-DBS paves the way for adaptive personalized DBS protocols. This review elaborates on the perspectives of the CL technology and discusses its opportunities as well as its potential pitfalls for both clinical and research use in neuropsychiatric disorders.
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Affiliation(s)
- Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Halim Ibrahim Baqapuri
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bastian Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Wiest
- MRC Brain Network Dynamics Unit, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Joana Pereira
- Department of Stereotactic and Functional Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Damian M Herz
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias R Dold
- Department of Artificial Intelligence, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Manuel Bange
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dumitru Ciolac
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Viviane Almeida
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - John Neuber
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniela Mirzac
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Juan Francisco Martín-Rodríguez
- Servicio de Neurología y Neurofisiología Clínica, Unidad de Trastornos del Movimiento, Instituto de Biomedicina de Sevilla, (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Seville, Spain
| | - Christian Dresel
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Astrid D Adarmes Gomez
- Servicio de Neurología y Neurofisiología Clínica, Unidad de Trastornos del Movimiento, Instituto de Biomedicina de Sevilla, (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - Marta Navas
- Department of Functional Neurosurgery, Hospital Ruber International, Madrid, Spain
| | - Gizem Temiz
- Neurosurgery Department, Hôpital de la Salpêtrière, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aysegul Gunduz
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, Florida, USA
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, Florida, USA
| | - Lilia Rotaru
- Diomid Gherman Institute of Neurology and Neurosurgery Chisinau, Chișinău, Moldova
| | - Yaroslav Winter
- Department of Neurology, Mainz Comprehensive Epilepsy and Sleep Medicine Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology, Philipps University, Marburg, Germany
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria F Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Tangermann
- Department of Artificial Intelligence, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Albert F G Leentjens
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pablo Mir
- Servicio de Neurología y Neurofisiología Clínica, Unidad de Trastornos del Movimiento, Instituto de Biomedicina de Sevilla, (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | | | - Carine Karachi
- Neurosurgery Department, Hôpital de la Salpêtrière, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David E J Linden
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Center for Deep Brain Stimulation, University of Freiburg, Freiburg im Breisgau, Germany
- Center for Basics in Neuromodulation (Neuromod Basics), Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Herz DM, Brown P. Moving, fast and slow: behavioural insights into bradykinesia in Parkinson's disease. Brain 2023; 146:3576-3586. [PMID: 36864683 PMCID: PMC10473574 DOI: 10.1093/brain/awad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
The debilitating symptoms of Parkinson's disease, including the hallmark slowness of movement, termed bradykinesia, were described more than 100 years ago. Despite significant advances in elucidating the genetic, molecular and neurobiological changes in Parkinson's disease, it remains conceptually unclear exactly why patients with Parkinson's disease move slowly. To address this, we summarize behavioural observations of movement slowness in Parkinson's disease and discuss these findings in a behavioural framework of optimal control. In this framework, agents optimize the time it takes to gather and harvest rewards by adapting their movement vigour according to the reward that is at stake and the effort that needs to be expended. Thus, slow movements can be favourable when the reward is deemed unappealing or the movement very costly. While reduced reward sensitivity, which makes patients less inclined to work for reward, has been reported in Parkinson's disease, this appears to be related mainly to motivational deficits (apathy) rather than bradykinesia. Increased effort sensitivity has been proposed to underlie movement slowness in Parkinson's disease. However, careful behavioural observations of bradykinesia are inconsistent with abnormal computations of effort costs due to accuracy constraints or movement energetic expenditure. These inconsistencies can be resolved when considering that a general disability to switch between stable and dynamic movement states can contribute to an abnormal composite effort cost related to movement in Parkinson's disease. This can account for paradoxical observations such as the abnormally slow relaxation of isometric contractions or difficulties in halting a movement in Parkinson's disease, both of which increase movement energy expenditure. A sound understanding of the abnormal behavioural computations mediating motor impairment in Parkinson's disease will be vital for linking them to their underlying neural dynamics in distributed brain networks and for grounding future experimental studies in well-defined behavioural frameworks.
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Affiliation(s)
- Damian M Herz
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3TH, UK
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Peter Brown
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3TH, UK
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Herz DM, Bange M, Gonzalez-Escamilla G, Auer M, Muthuraman M, Glaser M, Bogacz R, Pogosyan A, Tan H, Groppa S, Brown P. Dynamic modulation of subthalamic nucleus activity facilitates adaptive behavior. PLoS Biol 2023; 21:e3002140. [PMID: 37262014 PMCID: PMC10234560 DOI: 10.1371/journal.pbio.3002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/26/2023] [Indexed: 06/03/2023] Open
Abstract
Adapting actions to changing goals and environments is central to intelligent behavior. There is evidence that the basal ganglia play a crucial role in reinforcing or adapting actions depending on their outcome. However, the corresponding electrophysiological correlates in the basal ganglia and the extent to which these causally contribute to action adaptation in humans is unclear. Here, we recorded electrophysiological activity and applied bursts of electrical stimulation to the subthalamic nucleus, a core area of the basal ganglia, in 16 patients with Parkinson's disease (PD) on medication using temporarily externalized deep brain stimulation (DBS) electrodes. Patients as well as 16 age- and gender-matched healthy participants attempted to produce forces as close as possible to a target force to collect a maximum number of points. The target force changed over trials without being explicitly shown on the screen so that participants had to infer target force based on the feedback they received after each movement. Patients and healthy participants were able to adapt their force according to the feedback they received (P < 0.001). At the neural level, decreases in subthalamic beta (13 to 30 Hz) activity reflected poorer outcomes and stronger action adaptation in 2 distinct time windows (Pcluster-corrected < 0.05). Stimulation of the subthalamic nucleus reduced beta activity and led to stronger action adaptation if applied within the time windows when subthalamic activity reflected action outcomes and adaptation (Pcluster-corrected < 0.05). The more the stimulation volume was connected to motor cortex, the stronger was this behavioral effect (Pcorrected = 0.037). These results suggest that dynamic modulation of the subthalamic nucleus and interconnected cortical areas facilitates adaptive behavior.
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Affiliation(s)
- Damian M. Herz
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manuel Bange
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Miriam Auer
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Neural Engineering with Signal Analytics and Artificial Intelligence, Department of Neurology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Rafal Bogacz
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Huiling Tan
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter Brown
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Herz DM, Meder D, Camilleri JA, Eickhoff SB, Siebner HR. Brain Motor Network Changes in Parkinson's Disease: Evidence from Meta-Analytic Modeling. Mov Disord 2021; 36:1180-1190. [PMID: 33427336 PMCID: PMC8127399 DOI: 10.1002/mds.28468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Motor‐related brain activity in Parkinson's disease has been investigated in a multitude of functional neuroimaging studies, which often yielded apparently conflicting results. Our previous meta‐analysis did not resolve inconsistencies regarding cortical activation differences in Parkinson's disease, which might be related to the limited number of studies that could be included. Therefore, we conducted a revised meta‐analysis including a larger number of studies. The objectives of this study were to elucidate brain areas that consistently show abnormal motor‐related activation in Parkinson's disease and to reveal their functional connectivity profiles using meta‐analytic approaches. Methods We applied a quantitative meta‐analysis of functional neuroimaging studies testing limb movements in Parkinson's disease comprising data from 39 studies, of which 15 studies (285 of 571 individual patients) were published after the previous meta‐analysis. We also conducted meta‐analytic connectivity modeling to elucidate the connectivity profiles of areas showing abnormal activation. Results We found consistent motor‐related underactivation of bilateral posterior putamen and cerebellum in Parkinson's disease. Primary motor cortex and the supplementary motor area also showed deficient activation, whereas cortical regions localized directly anterior to these areas expressed overactivation. Connectivity modeling revealed that areas showing decreased activation shared a common pathway through the posterior putamen, whereas areas showing increased activation were connected to the anterior putamen. Conclusions Despite conflicting results in individual neuroimaging studies, this revised meta‐analytic approach identified consistent patterns of abnormal motor‐related activation in Parkinson's disease. The distinct patterns of decreased and increased activity might be determined by their connectivity with different subregions of the putamen. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Damian M Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Julia A Camilleri
- Research Center Juelich, Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Juelich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Simon B Eickhoff
- Research Center Juelich, Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Juelich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lohse A, Meder D, Nielsen S, Lund AE, Herz DM, Løkkegaard A, Siebner HR. Low-frequency transcranial stimulation of pre-supplementary motor area alleviates levodopa-induced dyskinesia in Parkinson's disease: a randomized cross-over trial. Brain Commun 2020; 2:fcaa147. [PMID: 33225277 PMCID: PMC7667528 DOI: 10.1093/braincomms/fcaa147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022] Open
Abstract
Levodopa-induced dyskinesia gradually emerges during long-term dopamine therapy, causing major disability in patients with Parkinson disease. Using pharmacodynamic functional MRI, we have previously shown that the intake of levodopa triggers an excessive activation of the pre-supplementary motor area in Parkinson disease patients with peak-of-dose dyskinesia. In this pre-registered, interventional study, we tested whether the abnormal responsiveness of the pre-supplementary motor area to levodopa may constitute a ‘stimulation target’ for treating dyskinesia. A gender-balanced group of 17 Parkinson disease patients with peak-of-dose dyskinesia received 30 min of robot-assisted repetitive transcranial magnetic stimulation, after they had paused their anti-Parkinson medication. Real-repetitive transcranial magnetic stimulation at 100% or sham-repetitive transcranial magnetic stimulation at 30% of individual resting corticomotor threshold of left first dorsal interosseous muscle was applied on separate days in counterbalanced order. Following repetitive transcranial magnetic stimulation, patients took 200 mg of oral levodopa and underwent functional MRI to map brain activity, while they performed the same go/no-go task as in our previous study. Blinded video assessment revealed that real-repetitive transcranial magnetic stimulation delayed the onset of dyskinesia and reduced its severity relative to sham-repetitive transcranial magnetic stimulation. Individual improvement in dyskinesia severity scaled linearly with the modulatory effect of real-repetitive transcranial magnetic stimulation on task-related activation in the pre-supplementary motor area. Stimulation-induced delay in dyskinesia onset correlated positively with the induced electrical field strength in the pre-supplementary motor area. Our results provide converging evidence that the levodopa-triggered increase in pre-supplementary motor area activity plays a causal role in the pathophysiology of peak-of-dose dyskinesia and constitutes a promising cortical target for brain stimulation therapy.
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Affiliation(s)
- Allan Lohse
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen 2400, Denmark
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Silas Nielsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Anders Elkjær Lund
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Damian M Herz
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen 2400, Denmark
| | - Annemette Løkkegaard
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen 2400, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen 2400, Denmark.,Faculty of Medical and Health Sciences, Institute for Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
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Haagensen BN, Herz DM, Meder D, Madsen KH, Løkkegaard A, Siebner HR. Linking brain activity during sequential gambling to impulse control in Parkinson's disease. Neuroimage Clin 2020; 27:102330. [PMID: 32688307 PMCID: PMC7369593 DOI: 10.1016/j.nicl.2020.102330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022]
Abstract
Dopaminergic treatment may impair the ability to suppress impulsive behaviours in patients with Parkinson's disease, triggering impulse control disorders. It is unclear how dopaminergic medication affects the neural networks that contribute to withholding inappropriate actions. To address this question, we mapped task-related brain activity with whole-brain functional magnetic resonance imaging at 3 Tesla in 26 patients with Parkinson's disease. Patients performed a sequential gambling task while being ON and OFF their regular dopaminergic treatment. During a gambling round, patients repeatedly decided between the option to continue with gambling and accumulate more monetary reward under increasing risk or the option to bank the current balance and start a new round. 13 patients had an impulse control disorder (ICD + group). These patients did not differ in risk-taking attitude during sequential gambling from 13 patients without impulse control disorder (ICD - group), but they displayed differences in gambling-related activity in cortico-subcortical brain areas supporting inhibitory control. First, the ICD + group showed reduced "continue-to-gamble" activity in right inferior frontal gyrus and subthalamic nucleus. Second, the individual risk-attitude scaled positively with "continue-to-gamble" activity in right subthalamic nucleus and striatum in the ICD - group only. Third, ICD + patients differed in their functional neural responses to dopaminergic treatment from ICD - patients: dopaminergic therapy reduced functional connectivity between inferior frontal gyrus and subthalamic nucleus during "continue-to-gamble" decisions and attenuated striatal responses towards accumulating reward and risk. Together, the medication-independent (trait) and medication-related (state) differences in neural activity may set a permissive stage for the emergence of impulse control disorders during dopamine replacement therapy in Parkinson's disease.
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Affiliation(s)
- Brian N Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Damian M Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Annemette Løkkegaard
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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9
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Tinkhauser G, Pogosyan A, Tan H, Herz DM, Kühn AA, Brown P. Beta burst dynamics in Parkinson's disease OFF and ON dopaminergic medication. Brain 2017; 140:2968-2981. [PMID: 29053865 PMCID: PMC5667742 DOI: 10.1093/brain/awx252] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/05/2017] [Indexed: 01/23/2023] Open
Abstract
Exaggerated basal ganglia beta activity (13–35 Hz) is commonly
found in patients with Parkinson’s disease and can be suppressed by
dopaminergic medication, with the degree of suppression being correlated with
the improvement in motor symptoms. Importantly, beta activity is not
continuously elevated, but fluctuates to give beta bursts. The percentage number
of longer beta bursts in a given interval is positively correlated with clinical
impairment in Parkinson’s disease patients. Here we determine whether the
characteristics of beta bursts are dependent on dopaminergic state. Local field
potentials were recorded from the subthalamic nucleus of eight
Parkinson’s disease patients during temporary lead externalization during
surgery for deep brain stimulation. The recordings took place with the patient
quietly seated following overnight withdrawal of levodopa and after
administration of levodopa. Beta bursts were defined by applying a common
amplitude threshold and burst characteristics were compared between the two drug
conditions. The amplitude of beta bursts, indicative of the degree of local
neural synchronization, progressively increased with burst duration. Treatment
with levodopa limited this evolution leading to a relative increase of shorter,
lower amplitude bursts. Synchronization, however, was not limited to local
neural populations during bursts, but also, when such bursts were cotemporaneous
across the hemispheres, was evidenced by bilateral phase synchronization. The
probability of beta bursts and the proportion of cotemporaneous bursts were
reduced by levodopa. The percentage number of longer beta bursts in a given
interval was positively related to motor impairment, while the opposite was true
for the percentage number of short duration beta bursts. Importantly, the
decrease in burst duration was also correlated with the motor improvement. In
conclusion, we demonstrate that long duration beta bursts are associated with an
increase in local and interhemispheric synchronization. This may compromise
information coding capacity and thereby motor processing. Dopaminergic activity
limits this uncontrolled beta synchronization by terminating long duration beta
bursts, with positive consequences on network state and motor symptoms.
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Affiliation(s)
- Gerd Tinkhauser
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Damian M Herz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Andrea A Kühn
- Department of Neurology, Charitè, Universitätsmedizin Berlin, Germany
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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10
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Fischer P, Pogosyan A, Herz DM, Cheeran B, Green AL, Fitzgerald J, Aziz TZ, Hyam J, Little S, Foltynie T, Limousin P, Zrinzo L, Brown P, Tan H. Subthalamic nucleus gamma activity increases not only during movement but also during movement inhibition. eLife 2017; 6. [PMID: 28742498 PMCID: PMC5526662 DOI: 10.7554/elife.23947] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/27/2017] [Indexed: 11/13/2022] Open
Abstract
Gamma activity in the subthalamic nucleus (STN) is widely viewed as a pro-kinetic rhythm. Here we test the hypothesis that rather than being specifically linked to movement execution, gamma activity reflects dynamic processing in this nucleus. We investigated the role of gamma during fast stopping and recorded scalp electroencephalogram and local field potentials from deep brain stimulation electrodes in 9 Parkinson’s disease patients. Patients interrupted finger tapping (paced by a metronome) in response to a stop-signal sound, which was timed such that successful stopping would occur only in ~50% of all trials. STN gamma (60–90 Hz) increased most strongly when the tap was successfully stopped, whereas phase-based connectivity between the contralateral STN and motor cortex decreased. Beta or theta power seemed less directly related to stopping. In summary, STN gamma activity may support flexible motor control as it did not only increase during movement execution but also during rapid action-stopping. DOI:http://dx.doi.org/10.7554/eLife.23947.001 Being able to stop walking to allow a car to pass is one example of how terminating a movement midway through can be essential for surviving in an ever-changing world. However, people with Parkinson’s disease sometimes struggle to stop performing a repetitive movement. Also, they may find themselves stopping despite having intended to keep moving. This inability to control stopping and starting can play havoc with everyday activities such as walking. Some people with Parkinson’s disease find that their symptoms improve after a treatment called deep brain stimulation. Surgeons lower electrodes into specific regions of the brain and use them to block the abnormal electrical activity that causes problems with movement. One of the main brain regions targeted is an area called the subthalamic nucleus. Whenever people initiate a movement, nerve cells in the subthalamic nucleus start to become activated at the same time. This synchronization generates rhythmic waves of activity in the subthalamic nucleus, which are called gamma waves. To find out whether gamma waves are also involved in stopping a movement, Fischer et al. measured activity in the subthalamic nucleus of nine patients with Parkinson’s disease as they performed a finger tapping exercise. The patients had to tap their finger in time with a metronome, but refrain from tapping whenever they heard a high pitched noise. As expected, a burst of gamma waves accompanied the start of each finger tap. However, Fischer et al. showed that an increase in gamma waves also occurred whenever patients successfully stopped a finger tap midway. Gamma waves may thus help people to interact flexibly with the world around them. Techniques like deep brain stimulation have the potential to manipulate gamma waves. In order to treat symptoms without causing side effects, we need to work out how to target brain waves that are altered in patients, without disrupting other processes. A key step towards achieving this is to understand how brain waves change during essential behaviours such as stopping an on-going movement. DOI:http://dx.doi.org/10.7554/eLife.23947.002
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Affiliation(s)
- Petra Fischer
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Damian M Herz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Binith Cheeran
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - James Fitzgerald
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Jonathan Hyam
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Simon Little
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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11
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Steiner LA, Neumann WJ, Staub-Bartelt F, Herz DM, Tan H, Pogosyan A, Kuhn AA, Brown P. Subthalamic beta dynamics mirror Parkinsonian bradykinesia months after neurostimulator implantation. Mov Disord 2017. [PMID: 28639263 PMCID: PMC5575541 DOI: 10.1002/mds.27068] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Exaggerated oscillatory activity in the beta frequency band in the subthalamic nucleus has been suggested to be related to bradykinesia in Parkinson's disease (PD). However, studies seeking correlations between such activity in the local field potential and motor performance have been limited to the immediate postoperative period, which may be confounded by a stun effect that leads to the temporary alleviation of PD deficits. Methods Local field potentials were recorded simultaneously with motor performance in PD patients several months after neurostimulator implantation. This was enabled by the chronic implantation of a pulse generator with the capacity to record and transmit local field potentials from deep brain stimulation electrodes. Specifically, we investigated oscillatory beta power dynamics and objective measures of bradykinesia during an upper limb alternating pronation and supination task in 9 patients. Results Although beta power was suppressed during continuously repeated movements, this suppression progressively diminished over time in tandem with a progressive decrement in the frequency and amplitude of movements. The relationship between changes within local field potentials and movement parameters was significant across patients, and not present for theta/alpha frequencies (5‐12 Hz). Change in movement frequency furthermore related to beta power dynamics within patients. Conclusions Changes in beta power are linked to changes in movement performance and the sequence effect of bradykinesia months after neurostimulator implantation. These findings provide further evidence that beta power may serve as a biomarker for bradykinesia and provide a suitable substrate for feedback control in chronic adaptive deep brain stimulation. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Leon Amadeus Steiner
- Department of Neurology, Charité, Campus Virchow Klinikum, University Medicine Berlin, Berlin, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Wolf-Julian Neumann
- Department of Neurology, Charité, Campus Virchow Klinikum, University Medicine Berlin, Berlin, Germany
| | - Franziska Staub-Bartelt
- Department of Neurology, Charité, Campus Virchow Klinikum, University Medicine Berlin, Berlin, Germany
| | - Damian M Herz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Huiling Tan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Alek Pogosyan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Andrea A Kuhn
- Department of Neurology, Charité, Campus Virchow Klinikum, University Medicine Berlin, Berlin, Germany.,NeuroCure, Charité, University Medicine Berlin, Berlin, Germany
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
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12
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Tahmasian M, Eickhoff SB, Giehl K, Schwartz F, Herz DM, Drzezga A, van Eimeren T, Laird AR, Fox PT, Khazaie H, Zarei M, Eggers C, Eickhoff CR. Resting-state functional reorganization in Parkinson's disease: An activation likelihood estimation meta-analysis. Cortex 2017; 92:119-138. [PMID: 28467917 DOI: 10.1016/j.cortex.2017.03.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/15/2017] [Accepted: 03/31/2017] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) is a common progressive neurodegenerative disorder. Studies using resting-state functional magnetic resonance imaging (fMRI) to investigate underlying pathophysiology of motor and non-motor symptoms in PD yielded largely inconsistent results. This quantitative neuroimaging meta-analysis aims to identify consistent abnormal intrinsic functional patterns in PD across studies. We used PubMed to retrieve suitable resting-state studies and stereotactic data were extracted from 28 individual between-group comparisons. Convergence across their findings was tested using the activation likelihood estimation (ALE) approach. We found convergent evidence for intrinsic functional disturbances in bilateral inferior parietal lobule (IPL) and the supramarginal gyrus in PD patients compared to healthy subjects. In follow-up task-based and task-independent functional connectivity (FC) analyses using two independent healthy subject data sets, we found that the regions showing convergent aberrations in PD formed an interconnected network mainly with the default mode network (DMN). Behavioral characterization of these regions using the BrainMap database suggested associated dysfunction of perception and executive processes. Taken together, our findings highlight the role of parietal cortex in the pathophysiology of PD.
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Affiliation(s)
- Masoud Tahmasian
- Department of Neurology, University Hospital Cologne, Germany; Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany; Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
| | - Simon B Eickhoff
- Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1, INM-7), Research Center Jülich, Jülich, Germany
| | - Kathrin Giehl
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Frank Schwartz
- Department of Neurology, University Hospital Cologne, Germany
| | - Damian M Herz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Thilo van Eimeren
- Department of Neurology, University Hospital Cologne, Germany; Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mojtaba Zarei
- Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Carsten Eggers
- Department of Neurology, University Hospital Cologne, Germany; Department of Neurology, Phillips University Marburg, Germany
| | - Claudia R Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
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13
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Tinkhauser G, Pogosyan A, Little S, Beudel M, Herz DM, Tan H, Brown P. The modulatory effect of adaptive deep brain stimulation on beta bursts in Parkinson's disease. Brain 2017; 140:1053-1067. [PMID: 28334851 PMCID: PMC5382944 DOI: 10.1093/brain/awx010] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/13/2022] Open
Abstract
Adaptive deep brain stimulation uses feedback about the state of neural circuits to control stimulation rather than delivering fixed stimulation all the time, as currently performed. In patients with Parkinson's disease, elevations in beta activity (13-35 Hz) in the subthalamic nucleus have been demonstrated to correlate with clinical impairment and have provided the basis for feedback control in trials of adaptive deep brain stimulation. These pilot studies have suggested that adaptive deep brain stimulation may potentially be more effective, efficient and selective than conventional deep brain stimulation, implying mechanistic differences between the two approaches. Here we test the hypothesis that such differences arise through differential effects on the temporal dynamics of beta activity. The latter is not constantly increased in Parkinson's disease, but comes in bursts of different durations and amplitudes. We demonstrate that the amplitude of beta activity in the subthalamic nucleus increases in proportion to burst duration, consistent with progressively increasing synchronization. Effective adaptive deep brain stimulation truncated long beta bursts shifting the distribution of burst duration away from long duration with large amplitude towards short duration, lower amplitude bursts. Critically, bursts with shorter duration are negatively and bursts with longer duration positively correlated with the motor impairment off stimulation. Conventional deep brain stimulation did not change the distribution of burst durations. Although both adaptive and conventional deep brain stimulation suppressed mean beta activity amplitude compared to the unstimulated state, this was achieved by a selective effect on burst duration during adaptive deep brain stimulation, whereas conventional deep brain stimulation globally suppressed beta activity. We posit that the relatively selective effect of adaptive deep brain stimulation provides a rationale for why this approach could be more efficacious than conventional continuous deep brain stimulation in the treatment of Parkinson's disease, and helps inform how adaptive deep brain stimulation might best be delivered.
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Affiliation(s)
- Gerd Tinkhauser
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Simon Little
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Martijn Beudel
- University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Damian M. Herz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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14
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Herz DM, Tan H, Brittain JS, Fischer P, Cheeran B, Green AL, FitzGerald J, Aziz TZ, Ashkan K, Little S, Foltynie T, Limousin P, Zrinzo L, Bogacz R, Brown P. Distinct mechanisms mediate speed-accuracy adjustments in cortico-subthalamic networks. eLife 2017; 6. [PMID: 28137358 PMCID: PMC5287713 DOI: 10.7554/elife.21481] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/15/2017] [Indexed: 01/29/2023] Open
Abstract
Optimal decision-making requires balancing fast but error-prone and more accurate but slower decisions through adjustments of decision thresholds. Here, we demonstrate two distinct correlates of such speed-accuracy adjustments by recording subthalamic nucleus (STN) activity and electroencephalography in 11 Parkinson’s disease patients during a perceptual decision-making task; STN low-frequency oscillatory (LFO) activity (2–8 Hz), coupled to activity at prefrontal electrode Fz, and STN beta activity (13–30 Hz) coupled to electrodes C3/C4 close to motor cortex. These two correlates differed not only in their cortical topography and spectral characteristics but also in the relative timing of recruitment and in their precise relationship with decision thresholds. Increases of STN LFO power preceding the response predicted increased thresholds only after accuracy instructions, while cue-induced reductions of STN beta power decreased thresholds irrespective of instructions. These findings indicate that distinct neural mechanisms determine whether a decision will be made in haste or with caution. DOI:http://dx.doi.org/10.7554/eLife.21481.001 In everyday decisions, we have to balance how quickly we need to make a decision with how accurate we want our decision to be. For example, if you plan your next holiday you might want to make sure that you pick the best destination without caring too much about the time it takes to arrive at that decision. On the other hand, in your lunch break you might want to quickly choose between the different meals on the menu to make sure you are back at work on time, even though you might overlook a dish that you would have preferred. This effect – that decisions we make in haste are more likely to be suboptimal than slower, more deliberate decisions – is known as the speed-accuracy trade-off. One theory suggests that the activity of a brain area termed the subthalamic nucleus reflects whether people will prioritize speed or accuracy during decision-making. This area is seated deep inside the brain, meaning that it is normally difficult to record its activity. Herz et al. have now recorded the activity of the subthalamic nucleus in individuals with Parkinson’s disease who underwent brain surgery as part of their treatment. When these individuals switched between fast and cautious decision-making, the activity in the subthalamic nucleus changed, as did its relationship with the activity seen in other brain areas. Furthermore, these activity changes predicted how much information participants acquired before committing to a choice. Deep brain stimulation of the subthalamic nucleus is now a standard treatment for Parkinson’s disease. It will be important to assess whether this treatment affects the changes in subthalamic activity that are related to decision-making, and whether this affects whether an individual is more likely to make fast or accurate decisions. DOI:http://dx.doi.org/10.7554/eLife.21481.002
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Affiliation(s)
- Damian M Herz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - John-Stuart Brittain
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Petra Fischer
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Binith Cheeran
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - James FitzGerald
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Simon Little
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Rafal Bogacz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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15
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Herz DM, Zavala BA, Bogacz R, Brown P. Neural Correlates of Decision Thresholds in the Human Subthalamic Nucleus. Curr Biol 2016; 26:916-20. [PMID: 26996501 PMCID: PMC4826434 DOI: 10.1016/j.cub.2016.01.051] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 01/22/2016] [Indexed: 01/21/2023]
Abstract
If humans are faced with difficult choices when making decisions, the ability to slow down responses becomes critical in order to avoid suboptimal choices. Current models of decision making assume that the subthalamic nucleus (STN) mediates this function by elevating decision thresholds, thereby requiring more evidence to be accumulated before responding [1-9]. However, direct electrophysiological evidence for the exact role of STN during adjustment of decision thresholds is lacking. Here, we show that trial-by-trial variations in STN low-frequency oscillatory activity predict adjustments of decision thresholds before subjects make a response. The relationship between STN activity and decision thresholds critically depends on the subjects' level of cautiousness. While increased oscillatory activity of the STN predicts elevated decision thresholds during high levels of cautiousness, it predicts decreased decision thresholds during low levels of cautiousness. This context-dependent relationship may be mediated by increased influence of the medial prefrontal cortex (mPFC)-STN pathway on decision thresholds during high cautiousness. Subjects who exhibit a stronger increase in phase alignment of low-frequency oscillatory activity in mPFC and STN before making a response have higher decision thresholds and commit fewer erroneous responses. Together, our results demonstrate that STN low-frequency oscillatory activity and corresponding mPFC-STN coupling are involved in determining how much evidence subjects accumulate before making a decision. This finding might explain why deep-brain stimulation of the STN can impair subjects' ability to slow down responses and can induce impulsive suboptimal decisions.
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Affiliation(s)
- Damian M Herz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Mansfield Road, Oxford OX1 3TH, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Baltazar A Zavala
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK; Surgical Neurology Branch, National Institutes of Health, 10 Center Drive, 3D 20, Bethesda, MD 20814, USA
| | - Rafal Bogacz
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Mansfield Road, Oxford OX1 3TH, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Mansfield Road, Oxford OX1 3TH, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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Herz DM, Haagensen BN, Nielsen SH, Madsen KH, Løkkegaard A, Siebner HR. Resting-state connectivity predicts levodopa-induced dyskinesias in Parkinson's disease. Mov Disord 2016; 31:521-9. [PMID: 26954295 PMCID: PMC5069605 DOI: 10.1002/mds.26540] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/17/2015] [Accepted: 12/13/2015] [Indexed: 12/02/2022] Open
Abstract
Background Levodopa‐induced dyskinesias are a common side effect of dopaminergic therapy in PD, but their neural correlates remain poorly understood. Objectives This study examines whether dyskinesias are associated with abnormal dopaminergic modulation of resting‐state cortico‐striatal connectivity. Methods Twelve PD patients with peak‐of‐dose dyskinesias and 12 patients without dyskinesias were withdrawn from dopaminergic medication. All patients received a single dose of fast‐acting soluble levodopa and then underwent resting‐state functional magnetic resonance imaging before any dyskinesias emerged. Levodopa‐induced modulation of cortico‐striatal resting‐state connectivity was assessed between the putamen and the following 3 cortical regions of interest: supplementary motor area, primary sensorimotor cortex, and right inferior frontal gyrus. These functional connectivity measures were entered into a linear support vector classifier to predict whether an individual patient would develop dyskinesias after levodopa intake. Linear regression analysis was applied to test which connectivity measures would predict dyskinesia severity. Results Dopaminergic modulation of resting‐state connectivity between the putamen and primary sensorimotor cortex in the most affected hemisphere predicted whether patients would develop dyskinesias with a specificity of 100% and a sensitivity of 91% (P < .0001). Modulation of resting‐state connectivity between the supplementary motor area and putamen predicted interindividual differences in dyskinesia severity (R2 = 0.627, P = .004). Resting‐state connectivity between the right inferior frontal gyrus and putamen neither predicted dyskinesia status nor dyskinesia severity. Conclusions The results corroborate the notion that altered dopaminergic modulation of cortico‐striatal connectivity plays a key role in the pathophysiology of dyskinesias in PD. © 2016 International Parkinson and Movement Disorder Society
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Affiliation(s)
- Damian M Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Brian N Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Silas H Nielsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Cognitive Systems, Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Annemette Løkkegaard
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Løkkegaard A, Herz DM, Haagensen BN, Lorentzen AK, Eickhoff SB, Siebner HR. Altered sensorimotor activation patterns in idiopathic dystonia-an activation likelihood estimation meta-analysis of functional brain imaging studies. Hum Brain Mapp 2015; 37:547-57. [PMID: 26549606 PMCID: PMC4738472 DOI: 10.1002/hbm.23050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 09/17/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022] Open
Abstract
Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. Functional neuroimaging studies have yielded abnormal task‐related sensorimotor activation in dystonia, but the results appear to be rather variable across studies. Further, study size was usually small including different types of dystonia. Here we performed an activation likelihood estimation (ALE) meta‐analysis of functional neuroimaging studies in patients with primary dystonia to test for convergence of dystonia‐related alterations in task‐related activity across studies. Activation likelihood estimates were based on previously reported regional maxima of task‐related increases or decreases in dystonia patients compared to healthy controls. The meta‐analyses encompassed data from 179 patients with dystonia reported in 18 functional neuroimaging studies using a range of sensorimotor tasks. Patients with dystonia showed bilateral increases in task‐related activation in the parietal operculum and ventral postcentral gyrus as well as right middle temporal gyrus. Decreases in task‐related activation converged in left supplementary motor area and left postcentral gyrus, right superior temporal gyrus and dorsal midbrain. Apart from the midbrain cluster, all between‐group differences in task‐related activity were retrieved in a sub‐analysis including only the 14 studies on patients with focal dystonia. For focal dystonia, an additional cluster of increased sensorimotor activation emerged in the caudal cingulate motor zone. The results show that dystonia is consistently associated with abnormal somatosensory processing in the primary and secondary somatosensory cortex along with abnormal sensorimotor activation of mesial premotor and right lateral temporal cortex. Hum Brain Mapp 37:547–557, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Annemette Løkkegaard
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Damian M. Herz
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Brian N. Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Anne K. Lorentzen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM‐1), Research Center JülichGermany
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich‐Heine University DüsseldorfGermany
| | - Hartwig R. Siebner
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
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Herz DM, Haagensen BN, Christensen MS, Madsen KH, Rowe JB, Løkkegaard A, Siebner HR. Abnormal dopaminergic modulation of striato-cortical networks underlies levodopa-induced dyskinesias in humans. Brain 2015; 138:1658-66. [PMID: 25882651 PMCID: PMC4614130 DOI: 10.1093/brain/awv096] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/11/2015] [Indexed: 02/02/2023] Open
Abstract
Dopaminergic signalling in the striatum contributes to reinforcement of actions and motivational enhancement of motor vigour. Parkinson's disease leads to progressive dopaminergic denervation of the striatum, impairing the function of cortico-basal ganglia networks. While levodopa therapy alleviates basal ganglia dysfunction in Parkinson's disease, it often elicits involuntary movements, referred to as levodopa-induced peak-of-dose dyskinesias. Here, we used a novel pharmacodynamic neuroimaging approach to identify the changes in cortico-basal ganglia connectivity that herald the emergence of levodopa-induced dyskinesias. Twenty-six patients with Parkinson's disease (age range: 51-84 years; 11 females) received a single dose of levodopa and then performed a task in which they had to produce or suppress a movement in response to visual cues. Task-related activity was continuously mapped with functional magnetic resonance imaging. Dynamic causal modelling was applied to assess levodopa-induced modulation of effective connectivity between the pre-supplementary motor area, primary motor cortex and putamen when patients suppressed a motor response. Bayesian model selection revealed that patients who later developed levodopa-induced dyskinesias, but not patients without dyskinesias, showed a linear increase in connectivity between the putamen and primary motor cortex after levodopa intake during movement suppression. Individual dyskinesia severity was predicted by levodopa-induced modulation of striato-cortical feedback connections from putamen to the pre-supplementary motor area (Pcorrected = 0.020) and primary motor cortex (Pcorrected = 0.044), but not feed-forward connections from the cortex to the putamen. Our results identify for the first time, aberrant dopaminergic modulation of striatal-cortical connectivity as a neural signature of levodopa-induced dyskinesias in humans. We argue that excessive striato-cortical connectivity in response to levodopa produces an aberrant reinforcement signal producing an abnormal motor drive that ultimately triggers involuntary movements.
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Affiliation(s)
- Damian M. Herz
- 1 Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,2 Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Brian N. Haagensen
- 1 Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mark S. Christensen
- 1 Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,3 Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark,4 Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer H. Madsen
- 1 Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,5 DTU Compute, Technical University of Denmark, Lyngby, Denmark
| | - James B. Rowe
- 6 Department of Clinical Neurosciences, Cambridge University, Cambridge, UK,7 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK,8 Behavioural and Clinical Neuroscience Institute, Cambridge, UK
| | - Annemette Løkkegaard
- 2 Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Hartwig R. Siebner
- 1 Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,2 Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark,9 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Herz DM, Haagensen BN, Christensen MS, Madsen KH, Rowe JB, Løkkegaard A, Siebner HR. The acute brain response to levodopa heralds dyskinesias in Parkinson disease. Ann Neurol 2014; 75:829-36. [PMID: 24889498 PMCID: PMC4112717 DOI: 10.1002/ana.24138] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/08/2014] [Accepted: 03/13/2014] [Indexed: 11/15/2022]
Abstract
Objective In Parkinson disease (PD), long‐term treatment with the dopamine precursor levodopa gradually induces involuntary “dyskinesia” movements. The neural mechanisms underlying the emergence of levodopa‐induced dyskinesias in vivo are still poorly understood. Here, we applied functional magnetic resonance imaging (fMRI) to map the emergence of peak‐of‐dose dyskinesias in patients with PD. Methods Thirteen PD patients with dyskinesias and 13 PD patients without dyskinesias received 200mg fast‐acting oral levodopa following prolonged withdrawal from their normal dopaminergic medication. Immediately before and after levodopa intake, we performed fMRI, while patients produced a mouse click with the right or left hand or no action (No‐Go) contingent on 3 arbitrary cues. The scan was continued for 45 minutes after levodopa intake or until dyskinesias emerged. Results During No‐Go trials, PD patients who would later develop dyskinesias showed an abnormal gradual increase of activity in the presupplementary motor area (preSMA) and the bilateral putamen. This hyperactivity emerged during the first 20 minutes after levodopa intake. At the individual level, the excessive No‐Go activity in the predyskinesia period predicted whether an individual patient would subsequently develop dyskinesias (p < 0.001) as well as severity of their day‐to‐day symptomatic dyskinesias (p < 0.001). Interpretation PD patients with dyskinesias display an immediate hypersensitivity of preSMA and putamen to levodopa, which heralds the failure of neural networks to suppress involuntary dyskinetic movements. Ann Neurol 2014;75:829–836
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Affiliation(s)
- Damian M Herz
- Danish Research Center for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Herz DM, Siebner HR, Hulme OJ, Florin E, Christensen MS, Timmermann L. Levodopa reinstates connectivity from prefrontal to premotor cortex during externally paced movement in Parkinson's disease. Neuroimage 2013; 90:15-23. [PMID: 24269570 DOI: 10.1016/j.neuroimage.2013.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/31/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022] Open
Abstract
Dopamine deficiency affects functional integration of activity in distributed neural regions. It has been suggested that lack of dopamine induces disruption of neural interactions between prefrontal and premotor areas, which might underlie impairment of motor control observed in patients with Parkinson's disease (PD). In this study we recorded cortical activity with high-density electroencephalography in 11 patients with PD as a pathological model of dopamine deficiency, and 13 healthy control subjects. Participants performed repetitive extension-flexion movements of their right index finger, which were externally paced at a rate of 0.5 Hz. This required participants to align their movement velocity to the slow external pace. Patients were studied after at least 12-hour withdrawal of dopaminergic medication (OFF state) and after intake of the dopamine precursor levodopa (ON state) in order to examine oscillatory coupling between prefrontal and premotor areas during respectively low and high levels of dopamine. In 10 patients and 12 control participants multiple source beamformer analysis yielded task-related activation of a contralateral cortical network comprising prefrontal cortex (PFC), lateral premotor cortex (lPM), supplementary motor area (SMA) and primary motor cortex (M1). Dynamic causal modelling was used to characterize task-related oscillatory coupling between prefrontal and premotor cortical areas. Healthy participants showed task-induced coupling from PFC to SMA, which was modulated within the γ-band. In the OFF state, PD patients did not express any frequency-specific coupling between prefrontal and premotor areas. Application of levodopa reinstated task-related coupling from PFC to SMA, which was expressed as high-β-γ coupling. Additionally, strong within-frequency γ-coupling as well as cross-frequency θ-γ coupling was observed from PFC to lPM. Enhancement of this cross-frequency θ-γ coupling after application of levodopa was positively correlated with individual improvement in motor function. The results demonstrate that dopamine deficiency impairs the ability to establish oscillatory coupling between prefrontal and premotor areas during an externally paced motor task. Application of extrinsic dopamine in PD patients reinstates physiological prefrontal-premotor coupling and additionally induces within- and cross-frequency coupling from prefrontal to premotor areas, which is not expressed in healthy participants.
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Affiliation(s)
- Damian M Herz
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Oliver J Hulme
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Esther Florin
- Department of Neurology, University Hospital Cologne, Cologne, Germany; McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Mark S Christensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Herz DM, Eickhoff SB, Løkkegaard A, Siebner HR. Functional neuroimaging of motor control in Parkinson's disease: a meta-analysis. Hum Brain Mapp 2013; 35:3227-37. [PMID: 24123553 DOI: 10.1002/hbm.22397] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/07/2013] [Accepted: 08/13/2013] [Indexed: 12/13/2022] Open
Abstract
Functional neuroimaging has been widely used to study the activation patterns of the motor network in patients with Parkinson's disease (PD), but these studies have yielded conflicting results. This meta-analysis of previous neuroimaging studies was performed to identify patterns of abnormal movement-related activation in PD that were consistent across studies. We applied activation likelihood estimation (ALE) of functional neuroimaging studies probing motor function in patients with PD. The meta-analysis encompassed data from 283 patients with PD reported in 24 functional neuroimaging studies and yielded consistent alterations in neural activity in patients with PD. Differences in cortical activation between PD patients and healthy controls converged in a left-lateralized fronto-parietal network comprising the presupplementary motor area, primary motor cortex, inferior parietal cortex, and superior parietal lobule. Both, increases as well as decreases in motor cortical activity, which were related to differences in movement timing and selection in the applied motor tasks, were reported in these cortical areas. In the basal ganglia, PD patients expressed a decrease of motor activation in the posterior motor putamen, which improved with dopaminergic medication. The likelihood of detecting a decrease in putaminal activity increased with motor impairment. This reduced motor activation of the posterior putamen across previous neuroimaging studies indicates that nigrostriatal dopaminergic denervation affects neural processing in the denervated striatal motor territory. In contrast, fronto-parietal motor areas display both increases as well as decreases in movement related activation. This points to a more complex relationship between altered cortical physiology and nigrostriatal dopaminergic denervation in PD.
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Affiliation(s)
- Damian M Herz
- Danish Research Center for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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