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von Wegner F, Wiemers M, Hermann G, Tödt I, Tagliazucchi E, Laufs H. Complexity Measures for EEG Microstate Sequences: Concepts and Algorithms. Brain Topogr 2024; 37:296-311. [PMID: 37751054 PMCID: PMC10884068 DOI: 10.1007/s10548-023-01006-2] [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: 04/30/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
EEG microstate sequence analysis quantifies properties of ongoing brain electrical activity which is known to exhibit complex dynamics across many time scales. In this report we review recent developments in quantifying microstate sequence complexity, we classify these approaches with regard to different complexity concepts, and we evaluate excess entropy as a yet unexplored quantity in microstate research. We determined the quantities entropy rate, excess entropy, Lempel-Ziv complexity (LZC), and Hurst exponents on Potts model data, a discrete statistical mechanics model with a temperature-controlled phase transition. We then applied the same techniques to EEG microstate sequences from wakefulness and non-REM sleep stages and used first-order Markov surrogate data to determine which time scales contributed to the different complexity measures. We demonstrate that entropy rate and LZC measure the Kolmogorov complexity (randomness) of microstate sequences, whereas excess entropy and Hurst exponents describe statistical complexity which attains its maximum at intermediate levels of randomness. We confirmed the equivalence of entropy rate and LZC when the LZ-76 algorithm is used, a result previously reported for neural spike train analysis (Amigó et al., Neural Comput 16:717-736, https://doi.org/10.1162/089976604322860677 , 2004). Surrogate data analyses prove that entropy-based quantities and LZC focus on short-range temporal correlations, whereas Hurst exponents include short and long time scales. Sleep data analysis reveals that deeper sleep stages are accompanied by a decrease in Kolmogorov complexity and an increase in statistical complexity. Microstate jump sequences, where duplicate states have been removed, show higher randomness, lower statistical complexity, and no long-range correlations. Regarding the practical use of these methods, we suggest that LZC can be used as an efficient entropy rate estimator that avoids the estimation of joint entropies, whereas entropy rate estimation via joint entropies has the advantage of providing excess entropy as the second parameter of the same linear fit. We conclude that metrics of statistical complexity are a useful addition to microstate analysis and address a complexity concept that is not yet covered by existing microstate algorithms while being actively explored in other areas of brain research.
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Affiliation(s)
- Frederic von Wegner
- School of Biomedical Sciences, University of New South Wales (UNSW), Wallace Wurth, Kensington, NSW, 2052, Australia.
| | - Milena Wiemers
- Department of Neurology and Clinical Neurophysiology, Lüneburg Hospital, Bögelstrasse 1, 21339, Lüneburg, Germany
| | - Gesine Hermann
- Department of Neurology, Christian-Albrechts University, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Inken Tödt
- Institute of Sexual Medicine & Forensic Psychiatry and Psychotherapy, Christian-Albrechts University, Schwanenweg 24, 24105, Kiel, Germany
| | - Enzo Tagliazucchi
- Department of Physics, University of Buenos Aires, 1428, Buenos Aires, Argentina
| | - Helmut Laufs
- Department of Neurology, Christian-Albrechts University, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Hermann G, Tödt I, Tagliazucchi E, Todtenhaupt IK, Laufs H, von Wegner F. Propofol Reversibly Attenuates Short-Range Microstate Ordering and 20 Hz Microstate Oscillations. Brain Topogr 2024; 37:329-342. [PMID: 38228923 DOI: 10.1007/s10548-023-01023-1] [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: 05/09/2023] [Accepted: 11/18/2023] [Indexed: 01/18/2024]
Abstract
Microstate sequences summarize the changing voltage patterns measured by electroencephalography, using a clustering approach to reduce the high dimensionality of the underlying data. A common approach is to restrict the pattern matching step to local maxima of the global field power (GFP) and to interpolate the microstate fit in between. In this study, we investigate how the anesthetic propofol affects microstate sequence periodicity and predictability, and how these metrics are changed by interpolation. We performed two frequency analyses on microstate sequences, one based on time-lagged mutual information, the other based on Fourier transform methodology, and quantified the effects of interpolation. Resting-state microstate sequences had a 20 Hz frequency peak related to dominant 10 Hz (alpha) rhythms, and the Fourier approach demonstrated that all five microstate classes followed this frequency. The 20 Hz periodicity was reversibly attenuated under moderate propofol sedation, as shown by mutual information and Fourier analysis. Characteristic microstate frequencies could only be observed in non-interpolated microstate sequences and were masked by smoothing effects of interpolation. Information-theoretic analysis revealed faster microstate dynamics and larger entropy rates under propofol, whereas Shannon entropy did not change significantly. In moderate sedation, active information storage decreased for non-interpolated sequences. Signatures of non-equilibrium dynamics were observed in non-interpolated sequences, but no changes were observed between sedation levels. All changes occurred while subjects were able to perform an auditory perception task. In summary, we show that low dose propofol reversibly increases the randomness of microstate sequences and attenuates microstate oscillations without correlation to cognitive task performance. Microstate dynamics between GFP peaks reflect physiological processes that are not accessible in interpolated sequences.
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Affiliation(s)
- Gesine Hermann
- Department of Neurology, Christian-Albrechts University, University Hospital Schleswig Holstein, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Inken Tödt
- Institute of Sexual Medicine & Forensic Psychiatry and Psychotherapy, Christian-Albrechts University, Schwanenweg 24, 24105, Kiel, Germany
| | - Enzo Tagliazucchi
- Department of Physics, University of Buenos Aires, Buenos Aires, Argentina
| | - Inga Karin Todtenhaupt
- Department of Neurology, Christian-Albrechts University, University Hospital Schleswig Holstein, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Helmut Laufs
- Department of Neurology, Christian-Albrechts University, University Hospital Schleswig Holstein, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Frederic von Wegner
- School of Biomedical Sciences, UNSW, Wallace Wurth Building, Kensington, NSW, 2052, Australia.
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Schneider I, Schönfeld R, Hanert A, Philippen S, Tödt I, Granert O, Mehdorn M, Becktepe J, Deuschl G, Berg D, Paschen S, Bartsch T. Deep brain stimulation of the subthalamic nucleus restores spatial reversal learning in patients with Parkinson's disease. Brain Commun 2024; 6:fcae068. [PMID: 38560516 PMCID: PMC10979721 DOI: 10.1093/braincomms/fcae068] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/04/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Spatial learning and navigation are supported by distinct memory systems in the human brain such as the hippocampus-based navigational system and the striatum-cortex-based system involved in motor sequence, habit and reversal learning. Here, we studied the role of subthalamic circuits in hippocampus-associated spatial memory and striatal-associated spatial reversal learning formation in patients with Parkinson's disease, who underwent a deep brain stimulation of the subthalamic nucleus. Deep brain stimulation patients (Parkinson's disease-subthalamic nucleus: n = 26) and healthy subjects (n = 15) were tested in a novel experimental spatial memory task based on the Morris water maze that assesses both hippocampal place memory as well as spatial reversal learning. All subjects were trained to navigate to a distinct spatial location hidden within the virtual environment during 16 learning trials in a subthalamic nucleus Stim-On condition. Patients were then randomized into two groups with either a deep brain stimulation On or Off condition. Four hours later, subjects were retested in a delayed recall and reversal learning condition. The reversal learning was realized with a new hidden location that should be memorized during six consecutive trials. The performance was measured by means of an index indicating the improvement during the reversal learning. In the delayed recall condition, neither patients, healthy subjects nor the deep brain stimulation On- versus Off groups showed a difference in place memory performance of the former trained location. In the reversal learning condition, healthy subjects (reversal index 2.0) and patients in the deep brain stimulation On condition (reversal index 1.6) showed a significant improvement. However, patients in the deep brain stimulation Off condition (reversal index 1.1) performed significantly worse and did not improve. There were no differences between all groups in a final visual guided navigation task with a visible target. These results suggest that deep brain stimulation of subthalamic nucleus restores spatial reversal learning in a virtual navigation task in patients with Parkinson's disease and gives insight into the neuromodulation effects on cognition of subthalamic circuits in Parkinson's disease.
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Affiliation(s)
- Isabel Schneider
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Robby Schönfeld
- Institute of Psychology, Martin-Luther-University Halle-Wittenberg, Halle 06108, Germany
| | - Annika Hanert
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Sarah Philippen
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Inken Tödt
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Oliver Granert
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Maximilian Mehdorn
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Jos Becktepe
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Günther Deuschl
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Daniela Berg
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Steffen Paschen
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Thorsten Bartsch
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
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Brinker D, Granert O, Gövert F, Tödt I, Baumann A, Zeuner KE, Wolke R, Deuschl G, Becktepe JS. Grey matter correlates of dystonic soft signs in essential tremor. Parkinsonism Relat Disord 2023; 112:105457. [PMID: 37245277 DOI: 10.1016/j.parkreldis.2023.105457] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Questionable signs of dystonia are a common finding in patients with essential tremor (ET). Brain structural alterations in ET patients plus dystonic soft signs (ET + ds) in comparison to ET patients without dystonic soft signs (ET-ds) or patients with tremor associated with manifest dystonia (TAWD) have not been examined yet. Therefore, our study aims to explore alterations of brain grey matter in patients with ET + ds. METHODS A total of 68 elderly patients with ET-ds (n = 32), ET + ds (n = 20) or idiopathic cervical dystonia with dystonia associated action tremor of the upper limbs (TAWD, n = 16) and 42 age-matched healthy controls underwent a clinical and electrophysiological assessment and 3T MRI. For grey matter alterations T1 MRI images were analysed by voxel-based morphometry. Additionally, regression analyses with clinical parameters (tremor frequency, severity and disease duration) were performed. RESULTS VBM showed a significant increase of grey matter in the right lentiform nucleus in ET + ds and TAWD compared to HC and ET-ds. Further, an increase of cortical grey matter in the middle frontal gyrus in ET + ds was shown. The hypertrophy of the lentiform nucleus in ET + ds was correlated with disease severity and duration. CONCLUSION Patients with ET + ds showed grey matter brain structural alterations similar to TAWD. Our findings suggest an involvement of the basal ganglia-cortical loop in ET + ds which may indicate a pathophysiological similarity with TAWD rather than ET.
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Affiliation(s)
- Dana Brinker
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Oliver Granert
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Felix Gövert
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Inken Tödt
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Alexander Baumann
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Kirsten E Zeuner
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany
| | - Jos S Becktepe
- Department of Neurology, UKSH, Christian-Albrechts University Kiel, Germany.
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Al-Fatly B, Tödt I, Tischer M, Neimat J, Hedera P, Wong J, Okun M, Nowacki A, Aziz T, Prokop T, Coenen V, Bargiotas P, Lachenmayer L, Helmers AK, Paschen S, Kühn A, Horn A, Fox M, Becktepe J, Deuschl G. Optimal deep brain stimulation connectivity to treat Holmes tremor. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Hermann G, Tödt I, Laufs H, Tagliazucchi E, von Wegner F. FV 8 Quantifying consciousness in healthy adults using EEG phase coherence. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baumann A, Tödt I, Knutzen A, Gless CA, Granert O, Wolff S, Marquardt C, Becktepe JS, Peters S, Witt K, Zeuner KE. Neural Correlates of Executed Compared to Imagined Writing and Drawing Movements: A Functional Magnetic Resonance Imaging Study. Front Hum Neurosci 2022; 16:829576. [PMID: 35370576 PMCID: PMC8973008 DOI: 10.3389/fnhum.2022.829576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/06/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
Objective In this study we used functional magnetic resonance imaging (fMRI) to investigate whether motor imagery (MI) of handwriting and circle drawing activates a similar handwriting network as writing and drawing itself. Methods Eighteen healthy right-handed participants wrote the German word “Wellen” and drew continuously circles in a sitting (vertical position) and lying position (horizontal position) to capture kinematic handwriting parameters such as velocity, pressure and regularity of hand movements. Afterward, they performed the same tasks during fMRI in a MI and an executed condition. Results The kinematic analysis revealed a general correlation of handwriting parameters during sitting and lying except of pen pressure during drawing. Writing compared to imagined writing was accompanied by an increased activity of the ipsilateral cerebellum and the contralateral sensorimotor cortex. Executed compared to imagined drawing revealed elevated activity of a fronto–parieto-temporal network. By contrasting writing and drawing directly, executed writing induced an enhanced activation of the left somatosensory and premotor area. The comparison of the MI of these tasks revealed a higher involvement of occipital activation during imagined writing. Conclusion The kinematic results pointed to a high comparability of writing in a vertical and horizontal position. Overall, we observed highly overlapping cortical activity except of a higher involvement of motor control areas during motor execution. The sparse difference between writing and drawing can be explained by highly automatized writing in healthy individuals.
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Affiliation(s)
- Alexander Baumann
- Department of Neurology, University of Kiel, Kiel, Germany
- *Correspondence: Alexander Baumann,
| | - Inken Tödt
- Department of Neurology, University of Kiel, Kiel, Germany
| | - Arne Knutzen
- Department of Neurology, University of Kiel, Kiel, Germany
| | | | - Oliver Granert
- Department of Neurology, University of Kiel, Kiel, Germany
| | - Stephan Wolff
- Department of Radiology and Neuroradiology, University of Kiel, Kiel, Germany
| | | | | | - Sönke Peters
- Department of Radiology and Neuroradiology, University of Kiel, Kiel, Germany
| | - Karsten Witt
- Department of Neurology, Evangelical Hospital Oldenburg and Research Center Neurosensory Sciences, Carl von Ossietzky University, Oldenburg, Germany
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Tödt I, Al-Fatly B, Granert O, Kühn AA, Krack P, Rau J, Timmermann L, Schnitzler A, Paschen S, Helmers AK, Hartmann A, Bardinet E, Schuepbach M, Barbe MT, Dembek TA, Fraix V, Kübler D, Brefel-Courbon C, Gharabaghi A, Wojtecki L, Pinsker MO, Thobois S, Damier P, Witjas T, Houeto JL, Schade-Brittinger C, Vidailhet M, Horn A, Deuschl G. The Contribution of Subthalamic Nucleus Deep Brain Stimulation to the Improvement in Motor Functions and Quality of Life. Mov Disord 2022; 37:291-301. [PMID: 35112384 DOI: 10.1002/mds.28952] [Citation(s) in RCA: 8] [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: 09/06/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL. OBJECTIVES The relation between the stimulated part of the STN and clinical outcomes, including the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS) and the quality-of-life questionnaire, was assessed in a subcohort of the EARLYSTIM study. METHODS Sixty-nine patients from the EARLYSTIM cohort who underwent DBS, with a comprehensive clinical characterization before and 24 months after surgery, were included. Intercorrelations of clinical outcome changes, correlation between the affected functional parts of the STN, and changes in clinical outcomes were investigated. We further calculated sweet spots for different clinical parameters. RESULTS Improvements in the UPDRS III and Parkinson's Disease Questionnaire (PDQ-39) correlated positively with the extent of the overlap with the sensorimotor STN. The sweet spots for the UPDRS III (x = 11.6, y = -13.1, z = -6.3) and the PDQ-39 differed (x = 14.8, y = -12.4, z = -4.3) ~3.8 mm. CONCLUSIONS The main influence of DBS on QoL is likely mediated through the sensory-motor basal ganglia loop. The PDQ sweet spot is located in a posteroventral spatial location in the STN territory. For aspects of QoL, however, there was also evidence of improvement through stimulation of the other STN subnuclei. More research is necessary to customize the DBS target to individual symptoms of each patient. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Inken Tödt
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Bassam Al-Fatly
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Oliver Granert
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Paul Krack
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Joern Rau
- Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Ann-Kristin Helmers
- Department of Neurosurgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Andreas Hartmann
- Assistance-Publique Hôpitaux de Paris, Center d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Paris, France.,Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, Paris, France
| | - Eric Bardinet
- Department of Neurology, NS-PARK/F-CRIN, University Hospital of Besançon, Besançon, France.,Center de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle (ICM), Paris, France
| | - Michael Schuepbach
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.,Assistance-Publique Hôpitaux de Paris, Center d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Paris, France.,Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, Paris, France.,Institute of Neurology, Konolfingen, Switzerland
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Valerie Fraix
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.,Neurology Department, Grenoble University Hospital, Grenoble, France
| | - Dorothee Kübler
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | | | - Alireza Gharabaghi
- Department of Neurosurgery and Neurotechnology Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Lars Wojtecki
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist GmbH & Co.KG Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf Von-Broichhausen-Allee 1, Kempen, Germany
| | - Marcus O Pinsker
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Stephane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Center Expert Parkinson, Bron, France.,Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France
| | | | - Tatiana Witjas
- Department of Neurology, Timone University Hospital UMR 7289, CNRS Marseille, Marseille, France
| | - Jean-Luc Houeto
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Center Expert Parkinson, Bron, France
| | | | - Marie Vidailhet
- Department of Neurology, Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Salpêtriere University Hospital AP-HP, Paris, France
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
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9
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Schill J, Zeuner KE, Knutzen A, Tödt I, Simonyan K, Witt K. Functional Neural Networks in Writer's Cramp as Determined by Graph-Theoretical Analysis. Front Neurol 2021; 12:744503. [PMID: 34887826 PMCID: PMC8650489 DOI: 10.3389/fneur.2021.744503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/20/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023] Open
Abstract
Dystonia, a debilitating neurological movement disorder, is characterized by involuntary muscle contractions and develops from a complex pathophysiology. Graph theoretical analysis approaches have been employed to investigate functional network changes in patients with different forms of dystonia. In this study, we aimed to characterize the abnormal brain connectivity underlying writer's cramp, a focal hand dystonia. To this end, we examined functional magnetic resonance scans of 20 writer's cramp patients (11 females/nine males) and 26 healthy controls (10 females/16 males) performing a sequential finger tapping task with their non-dominant (and for patients non-dystonic) hand. Functional connectivity matrices were used to determine group averaged brain networks. Our data suggest that in their neuronal network writer's cramp patients recruited fewer regions that were functionally more segregated. However, this did not impair the network's efficiency for information transfer. A hub analysis revealed alterations in communication patterns of the primary motor cortex, the thalamus and the cerebellum. As we did not observe any differences in motor outcome between groups, we assume that these network changes constitute compensatory rerouting within the patient network. In a secondary analysis, we compared patients with simple writer's cramp (only affecting the hand while writing) and those with complex writer's cramp (affecting the hand also during other fine motor tasks). We found abnormal cerebellar connectivity in the simple writer's cramp group, which was less prominent in complex writer's cramp. Our preliminary findings suggest that longitudinal research concerning cerebellar connectivity during WC progression could provide insight on early compensatory mechanisms in WC.
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Affiliation(s)
- Jana Schill
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Kirsten E Zeuner
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Arne Knutzen
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Inken Tödt
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Kristina Simonyan
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
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10
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Tödt I, Baumann A, Knutzen A, Granert O, Tzvi E, Lindert J, Wolff S, Witt K, Zeuner KE. Abnormal effective connectivity in the sensory network in writer's cramp. Neuroimage Clin 2021; 31:102761. [PMID: 34298476 PMCID: PMC8378794 DOI: 10.1016/j.nicl.2021.102761] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Writer's cramp (WC), a task specific form of dystonia, is considered to be a motor network disorder, but abnormal sensory tactile processing has also been acknowledged. The sensory spatial discrimination threshold (SDT) can be determined with a spatial acuity test (JVP domes). In addition to increased SDT, patients with WC exhibited dysfunctional sensory processing in the sensory cortex, insula, basal ganglia and cerebellum in a functional magnetic resonance imaging (fMRI) study while performing the spatial acuity test. OBJECTIVES To assess whether effective connectivity (EC) in the sensory network including cortical, basal ganglia, thalamic and cerebellar regions of interest in WC patients is abnormal. METHODS We used fMRI and applied a block design, while 19 WC patients and 13 age-matched healthy controls performed a spatial discrimination task. Before we assessed EC using dynamic causal modelling, we compared three model structures based on the current literature. We enclosed regions of interest that are established for sensory processing during right hand stimulation: Left thalamus, somatosensory, parietal and insular cortex, posterior putamen, and right cerebellum. RESULTS The EC analysis revealed task-dependent decreased unidirectional connectivity between the insula and the posterior putamen. The connectivity involving the primary sensory cortex, parietal cortex and cerebellum were not abnormal in WC. The two groups showed no differences in their behavioural data. CONCLUSIONS Perception and integration of sensory information requires the exchange of information between the insula cortex and the putamen, a sensory process that was disturbed in WC patients.
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Affiliation(s)
- Inken Tödt
- Department of Neurology, Kiel University, Germany.
| | | | - Arne Knutzen
- Department of Neurology, Kiel University, Germany
| | | | - Elinor Tzvi
- Department of Neurology, Leipzig University, Germany
| | - Julia Lindert
- Brighton and Sussex University Hospitals NHS Trust, UK
| | | | - Karsten Witt
- Department of Neurology and Research Center Neurosensory Science, School of Medicine and Health Sciences - European Medical School, Carl von Ossietzky University, Oldenburg, Germany
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11
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Schmidt N, Tödt I, Berg D, Schlenstedt C, Folkerts AK, Ophey A, Dimenshteyn K, Elben S, Wojtecki L, Liepelt-Scarfone I, Schulte C, Sulzer P, Eggers C, Kalbe E, Witt K. Memory enhancement by multidomain group cognitive training in patients with Parkinson's disease and mild cognitive impairment: long-term effects of a multicenter randomized controlled trial. J Neurol 2021; 268:4655-4666. [PMID: 33904966 PMCID: PMC8563628 DOI: 10.1007/s00415-021-10568-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/11/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Meta-analyses indicate positive effects of cognitive training (CT) in patients with Parkinson's disease (PD), however, most previous studies had small sample sizes and did not evaluate long-term follow-up. Therefore, a multicenter randomized controlled, single-blinded trial (Train-ParC study) was conducted to examine CT effects in PD patients with mild cognitive impairment (PD-MCI). Immediately after CT, an enhancement of executive functions was demonstrated. Here, we present the long-term results 6 and 12 months after CT. METHODS At baseline, 64 PD-MCI patients were randomized to a multidomain CT group (n = 33) or to a low-intensity physical activity training control group (PT) (n = 31). Both interventions included 90 min training sessions twice a week for 6 weeks. 54 patients completed the 6 months (CT: n = 28, PT: n = 26) and 49 patients the 12 months follow-up assessment (CT: n = 25, PT: n = 24). Primary study outcomes were memory and executive functioning composite scores. Mixed repeated measures ANOVAs, post-hoc t tests and multiple regression analyses were conducted. RESULTS We found a significant time x group interaction effect for the memory composite score (p = 0.006, η2 = 0.214), but not for the executive composite score (p = 0.967, η2 = 0.002). Post-hoc t tests revealed significant verbal and nonverbal memory improvements from pre-intervention to 6 months, but not to 12 months follow-up assessment in the CT group. No significant predictors were found for predicting memory improvement after CT. CONCLUSIONS This study provides Class 1 evidence that multidomain CT enhances memory functioning in PD-MCI after 6 months but not after 12 months, whereas executive functioning did not change in the long-term. CLINICAL TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00010186), 21.3.2016 (The study registration is outlined as retrospective due to an administrative delay. The first patient was enrolled three months after the registration process was started. A formal confirmation of this process from the German Clinical Trials Register can be obtained from the authors.).
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Affiliation(s)
- Nele Schmidt
- Department of Neurology, University Oldenburg, Steinweg 13-17, 26122, Oldenburg, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Inken Tödt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Interventions (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anja Ophey
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Interventions (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karina Dimenshteyn
- Department of Neurology, Center for Movement Disorders and Neuromodulation and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Saskia Elben
- Department of Neurology, Center for Movement Disorders and Neuromodulation and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology, Center for Movement Disorders and Neuromodulation and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,IB Hochschule Für Gesundheit Und Soziales, Stuttgart, Germany
| | - Claudia Schulte
- Department of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Patricia Sulzer
- Department of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Center for Mind, Brain and Behavior (CMBB), Universities Marburg and Giessen, Marburg, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Interventions (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karsten Witt
- Department of Neurology, University Oldenburg, Steinweg 13-17, 26122, Oldenburg, Germany. .,Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
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12
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Elben S, Dimenshteyn K, Trenado C, Folkerts AK, Ophey A, Sulzer P, Becker S, Schmidt N, Tödt I, Witt K, Liepelt-Scarfone I, Yilmaz R, Kalbe E, Wojtecki L. Screen Fast, Screen Faster: A Pilot Study to Screen for Depressive Symptoms Using the Beck Depression Inventory Fast Screen in Parkinson's Disease With Mild Cognitive Impairment. Front Neurol 2021; 12:640137. [PMID: 33763020 PMCID: PMC7982682 DOI: 10.3389/fneur.2021.640137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/10/2020] [Accepted: 02/11/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: Depressive symptoms have a high prevalence in patients with Parkinson's disease (PD) and are associated with cognitive dysfunction. Especially in PD with mild cognitive impairment (MCI), a time-efficient and valid instrument for the assessment of depression primarily focusing on psychological symptoms and disregarding confounding somatic symptoms is needed. We performed an examination of the psychometric properties of the Beck Depression Inventory II (BDI-II) and the Beck Depression Inventory Fast Screen (BDI-FS). Methods: The sample consisted of 64 patients [22 females and 42 males, mean age: 67.27 years (SD = 7.32)]. Depressive symptoms were measured in a cohort of PD patients with MCI. For the BDI-II and BDI-FS the psychometric concepts of internal consistency, convergent validity and diagnostic agreement were assessed. Results: Patients gave higher ratings on test items addressing somatic symptoms than those addressing non-somatic ones. The correlation between the absolute total scores of the BDI-II and the BDI-FS was significant (r = 0.91, p < 0.001), which indicated convergent validity. The Cronbach's alpha values indicated adequate internal consistencies for both measures (BDI-II: 0.84; BDI-FS: 0.78). There was a higher than chance level agreement of diagnoses of the two questionnaires, measured by Cohen's kappa (0.58, p < 0.001). The agreements between previous diagnosis of depression and the diagnoses of the BDI-II/BDI-FS were also significantly higher than chance level (BDI-II: 0.34, p = 0.007, BDI-FS: 0.39, p = 0.002). Additional AUC analysis across different cutoffs showed that performance of BDI-FS was better than BDI-II, supporting the observation of an equivalent or better performance of BDI-FS than BDI-II. Importantly, AUC analysis confirmed that a cutoff = 4 for BDI-FS was suitable in the considered sample of patients with PD-MCI. Discussion: In a cohort of PD-MCI, the BDI-FS demonstrates adequate psychometric properties in comparison to the BDI-II and can be used as a screening measure for assessing depression in cognitively impaired PD patients, focusing solely on psychological symptoms. Still, further research is needed to validate this instrument.
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Affiliation(s)
- Saskia Elben
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Karina Dimenshteyn
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Carlos Trenado
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Systems Neuroscience and Neurotechnology Unit, Faculty of Medicine, Saarland University and HTW Saarland, Homburg, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anja Ophey
- Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Patricia Sulzer
- German Center of Neurodegenerative Diseases, Eberhard Karls University Tuebingen, Tübingen, Germany.,Clinical Neurodegeneration, Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Sara Becker
- German Center of Neurodegenerative Diseases, Eberhard Karls University Tuebingen, Tübingen, Germany.,Clinical Neurodegeneration, Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Nele Schmidt
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany.,Department of Neurology and Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Inken Tödt
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Karsten Witt
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany.,Department of Neurology and Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Inga Liepelt-Scarfone
- German Center of Neurodegenerative Diseases, Eberhard Karls University Tuebingen, Tübingen, Germany.,Clinical Neurodegeneration, Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, Tübingen, Germany.,Studienzentrum Stuttgart, IB Hochschule, Stuttgart, Germany
| | - Rezzak Yilmaz
- German Center of Neurodegenerative Diseases, Eberhard Karls University Tuebingen, Tübingen, Germany.,Clinical Neurodegeneration, Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, Tübingen, Germany.,Department of Neurology, University of Ankara Medical School, Ankara, Turkey
| | - Elke Kalbe
- Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lars Wojtecki
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Kempen, Germany
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