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Alho ATDL, Hamani C, Alho EJL, da Silva RE, Santos GAB, Neves RC, Carreira LL, Araújo CMM, Magalhães G, Coelho DB, Alegro MC, Martin MGM, Grinberg LT, Pasqualucci CA, Heinsen H, Fonoff ET, Amaro E. Magnetic resonance diffusion tensor imaging for the pedunculopontine nucleus: proof of concept and histological correlation. Brain Struct Funct 2017; 222:2547-2558. [PMID: 28283747 DOI: 10.1007/s00429-016-1356-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 06/16/2016] [Accepted: 12/19/2016] [Indexed: 12/18/2022]
Abstract
The pedunculopontine nucleus (PPN) has been proposed as target for deep brain stimulation (DBS) in patients with postural instability and gait disorders due to its involvement in muscle tonus adjustments and control of locomotion. However, it is a deep-seated brainstem nucleus without clear imaging or electrophysiological markers. Some studies suggested that diffusion tensor imaging (DTI) may help guiding electrode placement in the PPN by showing the surrounding fiber bundles, but none have provided a direct histological correlation. We investigated DTI fractional anisotropy (FA) maps from in vivo and in situ post-mortem magnetic resonance images (MRI) compared to histological evaluations for improving PPN targeting in humans. A post-mortem brain was scanned in a clinical 3T MR system in situ. Thereafter, the brain was processed with a special method ideally suited for cytoarchitectonic analyses. Also, nine volunteers had in vivo brain scanning using the same MRI protocol. Images from volunteers were compared to those obtained in the post-mortem study. FA values of the volunteers were obtained from PPN, inferior colliculus, cerebellar crossing fibers and medial lemniscus using histological data and atlas information. FA values in the PPN were significantly lower than in the surrounding white matter region and higher than in areas with predominantly gray matter. In Nissl-stained histologic sections, the PPN extended for more than 10 mm in the rostro-caudal axis being closely attached to the lateral parabrachial nucleus. Our DTI analyses and the spatial correlation with histological findings proposed a location for PPN that matched the position assigned to this nucleus in the literature. Coregistration of neuroimaging and cytoarchitectonic features can add value to help establishing functional architectonics of the PPN and facilitate neurosurgical targeting of this extended nucleus.
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Affiliation(s)
- A T D L Alho
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, Brazil.,Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.,Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C Hamani
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Centre for Addiction and Mental Health, Toronto, Canada
| | - E J L Alho
- Department of Neurology Faculdade de Medicina da Universidade de São Paulo, Divisão de Neurocirurgia Funcional do, Instituto de Psiquiatria-HCFMUSP, São Paulo, Brazil
| | - R E da Silva
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil
| | - G A B Santos
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil
| | - R C Neves
- Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L L Carreira
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil
| | - C M M Araújo
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.,Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Magalhães
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, Brazil.,Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.,Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - D B Coelho
- Escola de Educação Física e Esporte da Universidade de São Paulo, São Paulo, Brazil
| | - M C Alegro
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, Brazil.,Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.,Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - M G M Martin
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil
| | - L T Grinberg
- Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - C A Pasqualucci
- Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - H Heinsen
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.,Grupo de Estudos em Envelhecimento Cerebral e LIM 22, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Psychiatry, Psychiatric Clinic, Julius-Maximilians-University Würzburg, Universitätsklinikum Würzburg, Würzburg, Germany
| | - E T Fonoff
- Department of Neurology Faculdade de Medicina da Universidade de São Paulo, Divisão de Neurocirurgia Funcional do, Instituto de Psiquiatria-HCFMUSP, São Paulo, Brazil.
| | - E Amaro
- Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, Brazil.,Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil
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Trindade MC, Bittencourt T, Lorenzi-Filho G, Alves RC, de Andrade DC, Fonoff ET, Bor-Seng-Shu E, Machado AA, Teixeira MJ, Barbosa ER, Tribl GG. Restless legs syndrome in Wilson's disease: frequency, characteristics, and mimics. Acta Neurol Scand 2017; 135:211-218. [PMID: 26940540 DOI: 10.1111/ane.12585] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine characteristics, clinical significance, frequency, and mimics of restless legs syndrome (RLS) in a cohort of Wilson's disease (WD, n = 42/f = 18), compared to healthy, matched controls. MATERIALS AND METHODS Structured clinical interviews (patients and caregiving family members), repeated neurological examinations (afternoon and presleep), comprehensive laboratory tests, WD-, RLS-, and sleep-specific rating scales, and video-polysomnography. RESULTS Thirteen patients with WD (13/42 = 31.0%) clearly fulfilled the five diagnostic criteria of RLS; in eight patients (19.1%), the burden of RLS was clinically significant. The RLS was of moderate severity, equally distributed among sexes, manifested mainly in the evening and before falling asleep, and had developed mostly after clinical manifestation of WD (time elapsed 10.2 ± 14.5 years), still at a young mean age (27.5 ± 11.5 years). The known RLS-associated features were absent (normal iron and kidney parameters) or rare (positive family history, polyneuropathy). Compared to WD patients without RLS, patients with RLS were significantly elder and had suffered longer from WD. WD-specific RLS mimics as well as RLS confounding motor comorbidities (dystonia, tremor, chorea) were frequent and a diagnostic challenge; in difficult cases, the differentiation was reached by clinical observation of the motor behavior in the evening or at nighttime. CONCLUSION RLS was frequent in this cohort of WD and might be causally related to WD. RLS should be included in the diagnostic work-up of WD. In complex motor disorders, differential diagnosis of RLS might require evening/nighttime examination and video-polysomnography. In WD patients with a clinically significant RLS, treatment with dopaminergic substances may be considered.
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Affiliation(s)
- M. C. Trindade
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - T. Bittencourt
- Sleep Laboratory; Pulmonary Division; InCor; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - G. Lorenzi-Filho
- Sleep Laboratory; Pulmonary Division; InCor; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - R. C. Alves
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - D. C. de Andrade
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - E. T. Fonoff
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - E. Bor-Seng-Shu
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - A. A. Machado
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - M. J. Teixeira
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - E. R. Barbosa
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - G. G. Tribl
- Division of Neurology and Neurosurgery; Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
- Sleep Laboratory; Pulmonary Division; InCor; University of Sao Paulo School of Medicine; Sao Paulo Brazil
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Lopez WOC, Ângelos JS, Martinez RCR, Takimura CK, Teixeira MJ, Lemos Neto PA, Fonoff ET. Optical coherence tomography imaging of the basal ganglia: feasibility and brief review. ACTA ACUST UNITED AC 2015; 48:1156-9. [PMID: 26421868 PMCID: PMC4661034 DOI: 10.1590/1414-431x20154679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/15/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022]
Abstract
Optical coherence tomography (OCT) is a promising medical imaging technique that uses
light to capture real-time cross-sectional images from biological tissues in
micrometer resolution. Commercially available optical coherence tomography systems
are employed in diverse applications, including art conservation and diagnostic
medicine, notably in cardiology and ophthalmology. Application of this technology in
the brain may enable distinction between white matter and gray matter, and obtainment
of detailed images from within the encephalon. We present, herein, the in
vivo implementation of OCT imaging in the rat brain striatum. For this,
two male 60-day-old rats (Rattus norvegicus, Albinus variation,
Wistar) were stereotactically implanted with guide cannulas into the striatum to
guide a 2.7-French diameter high-definition OCT imaging catheter (Dragonfly™, St.
Jude Medical, USA). Obtained images were compared with corresponding histologically
stained sections to collect imaging samples. A brief analysis of OCT technology and
its current applications is also reported, as well as intra-cerebral OCT feasibility
on brain mapping during neurosurgical procedures.
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Affiliation(s)
- W O Contreras Lopez
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J S Ângelos
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R C R Martinez
- Laboratório de Neuromodulação e Dor Experimental, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - C K Takimura
- Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M J Teixeira
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P A Lemos Neto
- Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E T Fonoff
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Fonoff ET, Silva CP, Ballester G, Timo-Iaria C. Electro-oscillographic correlation between dorsal raphe nucleus, neocortex and hippocampus during wakefulness before and after serotoninergic inactivation. Braz J Med Biol Res 1999; 32:469-72. [PMID: 10347812 DOI: 10.1590/s0100-879x1999000400015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/22/2022] Open
Abstract
Theta rhythm in many brain structures characterizes wakefulness and desynchronized sleep in most subprimate mammalian brains. In close relation to behaviors, theta frequency and voltage undergo a fine modulation which may involve mobilization of dorsal raphe nucleus efferent pathways. In the present study we analyzed frequency modulation (through instantaneous frequency variation) of theta waves occurring in three cortical areas, in hippocampal CA1 and in the dorsal raphe nucleus of Wistar rats during normal wakefulness and after injection of the 5-HT1a receptor agonist 8-OH-DPAT into the dorsal raphe. We demonstrated that in attentive states the variation of theta frequency among the above structures is highly congruent, whereas after 8-OH-DPAT injection, although regular signals are present, the variation is much more complex and shows no relation to behaviors. Such functional uncoupling after blockade demonstrates the influence of dorsal raphe nucleus efferent serotoninergic fibers on the organization of alertness, as evaluated by electro-oscillographic analysis.
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Affiliation(s)
- E T Fonoff
- Departamento de Neurologia e Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, Brasil
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