1
|
Wang L, Chang G, Yang M, Xu Z, Wang J, Xu H, He M, Dai L, Zhao Y, Ji Z, Zhang L. The Noninvasive Sonothermogenetics Used for Neuromodulation in M1 Region of Mice Brain by Overexpression of TRPV1. Neuroscience 2023; 527:22-36. [PMID: 37482284 DOI: 10.1016/j.neuroscience.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023]
Abstract
Sonogenetics is preferred for neuroregulation and the treatment of brain diseases due to its noninvasive properties. Ultrasonic stimulation produces thermal and mechanical effects, among others. Since transient receptor potential vanilloid 1 (TRPV1) could be activated at 42 °C, it is overexpressed in the M1 region of the mouse motor cortex to sense the change of temperature upon being stimulated by focused ultrasound. Whether the heat generated by ultrasonic stimulation could activate TRPV1 in the M1 region and induce changes in electromyography (EMG) signals collected from the mice's triceps was carefully verified. The position of the focused ultrasound and the temperature of the tissue at the location of the focused position were simulated using COMSOL software and verified via experiments. For Neuro-2a cells with TRPV1 overexpression, 42 °C could activate the TRPV1 and induce calcium influx. For mice with TRPV1 overexpression in the M1 region, tissue temperature of >42 °C in the M1 region induces an increased number of cfos, suggesting that neurons with overexpressed TRPV1 in the M1 region can be activated using focused ultrasound. Furthermore, when the temperature is >42 °C, the peak-to-peak value of the EMG signal for mice with TRPV1 overexpression in the M1 region was higher than that for mice without TRPV1 overexpression. The immunohistochemical results showed that ultrasound was not harmful to the stimulation site. The noninvasive ultrasound stimulation combined with thermosensitive protein TRPV1 overexpressed in neurocytes as sonothermogenetics technology has great potential to be used for the treatment of neurological diseases.
Collapse
Affiliation(s)
- Lulu Wang
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China
| | - Guanglei Chang
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China
| | - Miaomiao Yang
- School of Basic Medical Sciences, Zhengzhou University, No. 100 Science Avenue, Zhengzhou 450001, China
| | - Zhaobin Xu
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China
| | - Jianye Wang
- Institute of Physics, Henan Academy of Sciences, Zhengzhou 450046, China
| | - Hongliang Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou 450052, Henan Province, China
| | - Meixia He
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China
| | - Liping Dai
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China
| | - Yang Zhao
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China
| | - Zhenyu Ji
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China.
| | - Liguo Zhang
- BGI College, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450007, China; Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, China.
| |
Collapse
|
2
|
Dahmani L, Bai Y, Li M, Ren J, Shen L, Ma J, Li H, Wei W, Li P, Wang D, Du L, Cui W, Liu H, Wang M. Focused ultrasound thalamotomy for tremor treatment impacts the cerebello-thalamo-cortical network. NPJ Parkinsons Dis 2023; 9:90. [PMID: 37322044 DOI: 10.1038/s41531-023-00543-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
High-intensity Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a recent, non-invasive line of treatment for medication-resistant tremor. We used MRgFUS to produce small lesions in the thalamic ventral intermediate nucleus (VIM), an important node in the cerebello-thalamo-cortical tremor network, in 13 patients with tremor-dominant Parkinson's disease or essential tremor. Significant tremor alleviation in the target hand ensued (t(12) = 7.21, p < 0.001, two-tailed), which was strongly associated with the functional reorganization of the brain's hand region with the cerebellum (r = 0.91, p < 0.001, one-tailed). This reorganization potentially reflected a process of normalization, as there was a trend of increase in similarity between the hand cerebellar connectivity of the patients and that of a matched, healthy control group (n = 48) after treatment. Control regions in the ventral attention, dorsal attention, default, and frontoparietal networks, in comparison, exhibited no association with tremor alleviation and no normalization. More broadly, changes in functional connectivity were observed in regions belonging to the motor, limbic, visual, and dorsal attention networks, largely overlapping with regions connected to the lesion targets. Our results indicate that MRgFUS is a highly efficient treatment for tremor, and that lesioning the VIM may result in the reorganization of the cerebello-thalamo-cortical tremor network.
Collapse
Affiliation(s)
- Louisa Dahmani
- Department of Medical Imaging, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Yan Bai
- Department of Medical Imaging, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China
| | - Meiling Li
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Jianxun Ren
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Lunhao Shen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Jianjun Ma
- Department of Neurology, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyang Li
- Department of Neurosurgery, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Wei
- Department of Medical Imaging, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengyu Li
- Department of Medical Imaging, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China
| | - Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Lei Du
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | | | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
- Changping Laboratory, Beijing, China.
- Biomedical Pioneering Innovation Center, Peking University, Beijing, China.
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital & People Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
3
|
Marsili L, Keeling EG, Maciel R, Contarino MF, Zutt R, Okun MS, Almeida L, Deeb W, Kern D, Macias‐Garcia D, Carrillo F, Mir P, Merola A, Espay AJ, Fasano A. Functional Movement Disorders and Deep Brain Stimulation: A Multi-Center Study. Mov Disord Clin Pract 2023; 10:94-100. [PMID: 36704077 PMCID: PMC9847284 DOI: 10.1002/mdc3.13609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Functional movement disorders (FMD) are a commonly under-recognized diagnosis in patients with underlying neurodegenerative diseases. FMD have been observed in patients undergoing deep brain stimulation (DBS) for Parkinson's disease (PD) and other movement disorders. The prevalence of coexisting FMD among movement disorder-related DBS patients is unknown, and it may occur more often than previously recognized. Methods We retrospectively assessed the relative prevalence and clinical characteristics of FMD occurring post-DBS, in PD and dystonia patients (FMD+, n = 29). We compared this cohort with age at surgery-, sex-, and diagnosis-matched subjects without FMD post-DBS (FMD-, n = 29). Results Both the FMD prevalence (0.2%-2.1%) and the number of cases/DBS procedures/year varied across centers (0.15-3.65). A total of nine of 29 FMD+ cases reported worse outcomes following DBS. Although FMD+ and FMD- manifested similar features, FMD+ showed higher psychiatric comorbidity. Conclusions DBS may be complicated by the development of FMD in a subset of patients, particularly those with pre-morbid psychiatric conditions.
Collapse
Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's disease and Movement DisordersCincinnatiOhioUSA
| | - Elizabeth G. Keeling
- School of Life SciencesArizona State UniversityTempeArizonaUSA
- Barrow Neurological InstitutePhoenixArizonaUSA
| | - Ricardo Maciel
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Canada Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Maria Fiorella Contarino
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyHaga teaching HospitalThe HagueThe Netherlands
| | - Rodi Zutt
- Department of NeurologyHaga teaching HospitalThe HagueThe Netherlands
| | - Michael S. Okun
- Departments of Neurology and NeurosurgeryNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Leonardo Almeida
- Departments of Neurology and NeurosurgeryNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Wissam Deeb
- Departments of Neurology and NeurosurgeryNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Drew Kern
- Departments of Neurology and NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Daniel Macias‐Garcia
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología ClínicaInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Fatima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología ClínicaInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología ClínicaInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Departamento de MedicinaFacultad de Medicina, Universidad de SevillaSevilleSpain
| | - Aristide Merola
- Department of NeurologyThe Ohio State Wexner Medical CenterColumbusOhioUSA
| | - Alberto J. Espay
- Gardner Family Center for Parkinson's disease and Movement DisordersCincinnatiOhioUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Canada Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
| |
Collapse
|
4
|
Real-World Longitudinal Experience of Botulinum Toxin Therapy for Parkinson and Essential Tremor. Toxins (Basel) 2022; 14:toxins14080557. [PMID: 36006219 PMCID: PMC9413198 DOI: 10.3390/toxins14080557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Botulinum toxin type A (BoNT-A) therapy for upper-limb tremor has emerged as a promising option. However, it is unclear in real-world practices whether a technology-guided approach can compare with expert clinical assessments (including surface anatomy and palpation) for improving outcomes. This retrospective study aims to review our clinical outcomes of treating essential tremor (ET) and Parkinson’s disease (PD) tremor using either clinical- or kinematic-based injection pattern determination methods. Methods: 68 ET and 45 PD patients received at least one injection for their upper-limb tremor (unilateral or bilateral) in the last 7 years. Demographics of patients and BoNT-A injections were collected. A Mann–Whitney U statistical test was used to compare outcome measures between ET and PD cohorts. Results: Mean age (72 ± 9 years), number of injections (5), years receiving therapy (~2 years), clinic- (~57%) or kinematic-based patterns, and self-paying (52%) were similar between both cohorts. BoNT-A as a monotherapy in both upper limbs was received in more ET than PD patients. Double reconstitution of Xeomin® in the wrist flexors/extensors, supinator, biceps, and triceps were most injected. Discontinuation due to no benefit/weakness was not dependent on the injection pattern determination approach. Conclusions: Kinematic-based BoNT-A injections produced similar treatment outcomes to injections based on the clinical expertise of the expert injector. This suggests that kinematics could be used by a non-expert to attain equivalent efficacy potentially improving access to this treatment.
Collapse
|
5
|
Hossen A, Anwar AR, Koirala N, Ding H, Budker D, Wickenbrock A, Heute U, Deuschl G, Groppa S, Muthuraman M. Machine learning aided classification of tremor in multiple sclerosis. EBioMedicine 2022; 82:104152. [PMID: 35834887 PMCID: PMC9287478 DOI: 10.1016/j.ebiom.2022.104152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
|
6
|
Schreglmann S, Cagnan H. Towards phenotype-specific, non-invasive therapeutic interventions for tremor. Clin Neurophysiol 2022; 140:169-170. [PMID: 35618566 DOI: 10.1016/j.clinph.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sebastian Schreglmann
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg, Germany.
| | - Hayriye Cagnan
- MRC Brain Network Dynamics Unit, University of Oxford, OX1 3TH, UK
| |
Collapse
|
7
|
Bhidayasiri R, Maytharakcheep S, Phumphid S, Maetzler W. Improving functional disability in patients with tremor: A clinical perspective of the efficacies, considerations, and challenges of assistive technology. J Neurol Sci 2022; 435:120197. [DOI: 10.1016/j.jns.2022.120197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/06/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
|
8
|
Oh BH, Park YS. Ventralis oralis anterior (Voa) deep brain stimulation plus Gamma Knife thalamotomy in an elderly patient with essential tremor: A case report. Medicine (Baltimore) 2021; 100:e25461. [PMID: 33847653 PMCID: PMC8052051 DOI: 10.1097/md.0000000000025461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) provides a safe and effective therapy for medically refractory essential tremor (ET). However, DBS may be risky in elderly patients and those with ischemic brain lesions. Gamma Knife radiosurgery (GKS) is a minimally invasive procedure, but bilateral thalamotomy is dangerous. PATIENT CONCERNS We report a case of ventralis oralis anterior nucleus (Voa) DBS for dominant hand tremor plus Voa GKS for nondominant hand tremor in a very elderly patient with medically intractable ET. DIAGNOSIS An 83-year-old right-handed woman visited our hospital with a medically intractable ET. Because of the ischemic lesion in the right basal ganglia, we decided to perform left unilateral DBS instead of bilateral DBS. INTERVENTION We chose Voa as the target for DBS because, clinically, her tremor was mainly confined to her hands, and Voa had better intraoperative microelectrode recording results than Vim. OUTCOMES After 2 years, her right-hand tremor remained in an improved state, but she still had severe tremor in her left hand. Therefore, we performed GKS targeting the right Voa. One year after surgery, the patient's hand tremor successfully improved without any complications. LESSONS Salvage Voa GKS after unilateral Voa DBS is a valuable option for very elderly patients and patients with ischemic brain lesions. We suggest that Voa GKS thalamotomy is as useful and safe a surgical technique as Vim GKS for dystonic hand tremor. To the best of our knowledge, this is the first case report using salvage Voa as the only target for ET.
Collapse
Affiliation(s)
- Byeong Ho Oh
- Department of Neuroscience, Graduate School
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University
| | - Young Seok Park
- Department of Neuroscience, Graduate School
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital
- Institute for Stem Cell and Regenerative Medicine (ISCRM), Chungbuk National University, Cheongju, Republic of Korea
| |
Collapse
|
9
|
Schreglmann SR, Wang D, Peach RL, Li J, Zhang X, Latorre A, Rhodes E, Panella E, Cassara AM, Boyden ES, Barahona M, Santaniello S, Rothwell J, Bhatia KP, Grossman N. Non-invasive suppression of essential tremor via phase-locked disruption of its temporal coherence. Nat Commun 2021; 12:363. [PMID: 33441542 PMCID: PMC7806740 DOI: 10.1038/s41467-020-20581-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022] Open
Abstract
Aberrant neural oscillations hallmark numerous brain disorders. Here, we first report a method to track the phase of neural oscillations in real-time via endpoint-corrected Hilbert transform (ecHT) that mitigates the characteristic Gibbs distortion. We then used ecHT to show that the aberrant neural oscillation that hallmarks essential tremor (ET) syndrome, the most common adult movement disorder, can be transiently suppressed via transcranial electrical stimulation of the cerebellum phase-locked to the tremor. The tremor suppression is sustained shortly after the end of the stimulation and can be phenomenologically predicted. Finally, we use feature-based statistical-learning and neurophysiological-modelling to show that the suppression of ET is mechanistically attributed to a disruption of the temporal coherence of the aberrant oscillations in the olivocerebellar loop, thus establishing its causal role. The suppression of aberrant neural oscillation via phase-locked driven disruption of temporal coherence may in the future represent a powerful neuromodulatory strategy to treat brain disorders.
Collapse
Affiliation(s)
- Sebastian R Schreglmann
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK
| | - David Wang
- Computer Science and Artificial Intelligence Laboratory, Massachussetts Institute of Technology (MIT), Cambridge, MA, 02139, USA
- NuVu studio Inc, Cambridge, MA, 02139, USA
| | - Robert L Peach
- Department of Mathematics and EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ, UK
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK
| | - Junheng Li
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK
| | - Xu Zhang
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
- CT Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Anna Latorre
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK
| | - Edward Rhodes
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK
| | - Emanuele Panella
- Department of Physics, Imperial College London, London, SW7 2AZ, UK
| | - Antonino M Cassara
- IT'IS Foundation for Research on Information Technologies in Society, 8004, Zurich, Switzerland
| | - Edward S Boyden
- Department of Media Arts and Sciences, MIT, Cambridge, MA, 02139, USA
- McGovern Institute for Brain Research, MIT, Cambridge, MA, 02139, USA
- Howard Hughes Medical Institute, Cambridge, MA, 02142, USA
- Department of Biological Engineering, MIT, Cambridge, MA, 02139, USA
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA, 02139, USA
- Centre for Neurobiological Engineering, MIT, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA, 02139, USA
| | - Mauricio Barahona
- Department of Mathematics and EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ, UK
| | - Sabato Santaniello
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
- CT Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - John Rothwell
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK
| | - Kailash P Bhatia
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK.
| | - Nir Grossman
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK.
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK.
- Department of Media Arts and Sciences, MIT, Cambridge, MA, 02139, USA.
- McGovern Institute for Brain Research, MIT, Cambridge, MA, 02139, USA.
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK.
- Centre for Neurotechnology, Imperial College London, London, SW7 2AZ, UK.
| |
Collapse
|
10
|
Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor - the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment. Tremor Other Hyperkinet Mov (N Y) 2020; 10:61. [PMID: 33442486 PMCID: PMC7774361 DOI: 10.5334/tohm.582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Hand tremor associated with Parkinson disease (PD) and essential tremor (ET) can often become challenging to treat in clinical practice. Local injections of botulinum toxin-A (BoNT-A) for hand tremor is an evolving field with newer injection techniques being utilized in clinical studies. The utility of BoNT-A therapy for ET and PD-tremor however, has been questioned based on the high incidence of finger and hand weakness after treatment. Method: The study includes detailed analysis of the techniques utilized in BoNT injection in ET and PD tremor. Results: There were 4 high-quality investigations which consisted of Class I or II double-blind placebo-controlled trials and one medium-quality study that was a prospective, open label, class III investigation. Discussion: This paper discusses two recently developed technology-based injection methods for BoNT-A therapy of ET and PD tremor, which includes comprehensive EMG screening of forearm and arm muscles with selective injections (Yale method) and the whole arm kinematic tremor assessment developed by Jog et al. In recent years, controlled, blinded studies of these two methods have shown significant post-injection reduction of finger, hand and whole limb tremor compared to the previously published controlled clinical trials not using these methodologies.
Collapse
|
11
|
Bruno F, Catalucci A, Arrigoni F, Sucapane P, Cerone D, Cerrone P, Ricci A, Marini C, Masciocchi C. An experience-based review of HIFU in functional interventional neuroradiology: transcranial MRgFUS thalamotomy for treatment of tremor. Radiol Med 2020; 125:877-886. [PMID: 32266693 DOI: 10.1007/s11547-020-01186-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/24/2020] [Indexed: 12/16/2022]
Abstract
Tremor is a common and very disabling symptom in patients with essential tremor and Parkinson's disease. In the recent years, transcranial ablation of thalamic nuclei using magnetic resonance guided high-intensity focused ultrasound has emerged as a minimally invasive treatment for tremor. The aim of this review is to discuss, in the light of our single-center experience, the technique, current applications, results, and future perspectives of this novel technology.
Collapse
Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, 67100, L'Aquila, Italy.
| | | | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, 67100, L'Aquila, Italy
| | | | - Davide Cerone
- Neurology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Paolo Cerrone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, 67100, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | - Carmine Marini
- Neurology Unit, Department of Medicine, Health and Environment Sciences, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, 67100, L'Aquila, Italy
| |
Collapse
|
12
|
Krishna V, Young NA, Sammartino F. Imaging: Patient Selection, Targeting, and Outcome Biomarkers. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
13
|
Mechanical vibration does not systematically reduce the tremor in essential tremor patients. Sci Rep 2019; 9:16476. [PMID: 31712728 PMCID: PMC6848159 DOI: 10.1038/s41598-019-52988-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
Essential tremor (ET) is a major cause of disability and is not effectively managed in half of the patients. We investigated whether mechanical vibration could reduce tremor in ET by selectively recruiting afferent pathways. We used piezoelectric actuators to deliver vibratory stimuli to the hand and forearm during long trials (4 min), while we monitored the tremor using inertial sensors. We analyzed the effect of four stimulation strategies, including different constant and variable vibration frequencies, in 18 ET patients. Although there was not a clear homogeneous response to vibration across patients and strategies, in most cases (50–72%) mechanical vibration was associated with an increase in the amplitude of their tremor. In contrast, the tremor was reduced in 5–22% of the patients, depending on the strategy. However, these results are hard to interpret given the intrinsic variability of the tremor: during equally long trials without vibration, the tremor changed significantly in 67% of the patients (increased in 45%; decreased in 22%). We conclude that mechanical vibration of the limb does not have a systematic effect on tremor in ET. Moreover, the observed intrinsic variability of the tremor should be taken into account when designing future experiments to assess tremor in ET and how it responds to any intervention.
Collapse
|
14
|
Rajalingam R, Breen DP, Chen R, Fox S, Kalia LV, Munhoz RP, Slow E, Strafella AP, Lang AE, Fasano A. The clinical significance of lower limb tremors. Parkinsonism Relat Disord 2019; 65:165-171. [PMID: 31201091 DOI: 10.1016/j.parkreldis.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To explore the prevalence, clinical course and associated features of lower limb tremor in the most common tremor syndromes. METHODS This retrospective chart review studied lower limb tremor patients as defined by a Tremor Rating Scale score ≥1 in either lower limb. We compared and correlated their characteristics, also comparing them with patients without lower limb tremor. RESULTS Of the 283 patients with lower limb tremor (58.3% males, age: 65.0 ± 16.0 years, tremor duration: 25.6 ± 17.9 years), 255 patients within six tremor syndrome groups were included in the final analysis. Prevalence of patients with lower limb tremor (either rest, postural or kinetic) was lowest (28.6%) in the essential tremor (ET) group and highest (69%) in the parkinsonian tremor (PT) group. Lower limb tremor score was higher in patients classified as having intention tremor (IT) compared to ET and dystonic tremor (DT). Total tremor score was highest in IT and lowest in ET. We found a positive correlation between total lower limb tremor score and total tremor score in most groups. In addition, there was a positive correlation between lower limb tremor score and upper limb tremor score. Finally, compared to patients without lower limb tremor, all diagnostic groups with lower limb tremor, with the exception of functional tremor (FT), had worse total tremor score; and disease duration was longer in ET-plus, DT and PT patients with lower limb tremor compared to those without. CONCLUSIONS Lower limb tremor is less commonly observed in ET than other tremor syndromes, is a marker of symptom severity of the underlying disease condition in all tremor syndromes except FT, and reflects longer disease duration in ET-plus, DT and PT.
Collapse
Affiliation(s)
- Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK; Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, Scotland, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Susan Fox
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Lorraine V Kalia
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Elizabeth Slow
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada
| | - Antonio P Strafella
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada; Division of Neurology, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada.
| |
Collapse
|
15
|
Samotus O, Lee J, Jog M. Personalized Bilateral Upper Limb Essential Tremor Therapy with Botulinum Toxin Using Kinematics. Toxins (Basel) 2019; 11:toxins11020125. [PMID: 30791440 PMCID: PMC6409675 DOI: 10.3390/toxins11020125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/16/2022] Open
Abstract
Variability of multi-joint essential tremor (ET) between patients and within the two upper limbs makes a visual assessment for the determination of botulinum toxin type A (BoNT-A) injections challenging. Kinematic tremor analysis guidance has succeeded in overcoming this challenge by making effective long-term unilateral BoNT-A injections for disabling ET. In this open-label study, 31 ET participants received three bilateral arm BoNT-A injection cycles over 30 weeks with follow-ups six-weeks post-treatment. Whole-arm kinematic assessment of tremor using a customized, automated algorithm provided muscle selection and dosing per muscle without clinician’s assessment. Efficacy endpoints included Fahn-Tolosa-Marin tremor scale, quality of life (QoL) questionnaire, and maximum grip strength. BoNT-A reduced tremor amplitude by 47.7% in both the arms at week-6 (p < 0.005) that persisted from weeks 18–30. QoL was improved by 26.5% (p < 0.005) over the treatment period. Functional interference due to tremor was reduced by 30% (p < 0.005) from weeks 6–30. Maximum grip strength was reduced at week 6 (p = 0.001) but was not functionally impaired for the participants. Effective bilateral ET therapy by personalized BoNT-A injections could be achieved using computer-assisted tremor analysis. By removing variability inherent within the clinical assessments, this standardized tremor analysis method enabled patients to have improved bimanual upper limb functionality after the first treatment.
Collapse
Affiliation(s)
- Olivia Samotus
- Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada.
- Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada.
| | - Jack Lee
- Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada.
| | - Mandar Jog
- Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada.
- Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada.
| |
Collapse
|
16
|
Hybrid deep brain stimulation system to manage stimulation-induced side effects in essential tremor patients. Parkinsonism Relat Disord 2019; 58:85-86. [DOI: 10.1016/j.parkreldis.2018.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/10/2018] [Accepted: 07/22/2018] [Indexed: 11/19/2022]
|
17
|
Li C, Gajic-Veljanoski O, Schaink AK, Higgins C, Fasano A, Sikich N, Dhalla I, Ng V. Cost-Effectiveness of Magnetic Resonance-Guided Focused Ultrasound for Essential Tremor. Mov Disord 2018; 34:735-743. [PMID: 30589951 DOI: 10.1002/mds.27587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Radiofrequency thalamotomy and deep brain stimulation are current treatments for moderate to severe medication-refractory essential tremor. However, they are invasive and thus carry risks. Magnetic resonance-guided focused ultrasound is a new, less invasive surgical option. The objective of the present study was to determine the cost-effectiveness of magnetic resonance-guided focused ultrasound compared with standard treatments in Canada. METHODS We conducted a cost-utility analysis using a Markov cohort model. We compared magnetic resonance-guided focused ultrasound with no surgery in people ineligible for invasive neurosurgery and with radiofrequency thalamotomy and deep brain stimulation in people eligible for invasive neurosurgery. In the reference case analysis, we used a 5-year time horizon and a public payer perspective and discounted costs and benefits at 1.5% per year. RESULTS Compared with no surgery in people ineligible for invasive neurosurgery, magnetic resonance-guided focused ultrasound cost $21,438 more but yielded 0.47 additional quality-adjusted life years, producing an incremental cost-effectiveness ratio of $45,817 per quality-adjusted life year gained. In people eligible for invasive neurosurgery, magnetic resonance-guided focused ultrasound was slightly less effective but much less expensive compared with the current standard of care, deep brain stimulation. The results were sensitive to assumptions regarding the time horizon, cost of magnetic resonance-guided focused ultrasound, and probability of recurrence. CONCLUSIONS In people ineligible for invasive neurosurgery, the incremental cost-effectiveness ratio of magnetic resonance-guided focused ultrasound versus no surgery is comparable to many other tests and treatments that are widely adopted in high-income countries. In people eligible for invasive neurosurgery, magnetic resonance-guided focused ultrasound is also a reasonable option. © 2018 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Chunmei Li
- Health Quality Ontario, Toronto, Ontario, Canada
| | | | | | | | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre, Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Nancy Sikich
- Health Quality Ontario, Toronto, Ontario, Canada
| | - Irfan Dhalla
- Health Quality Ontario, Toronto, Ontario, Canada
| | - Vivian Ng
- Health Quality Ontario, Toronto, Ontario, Canada
| |
Collapse
|
18
|
The Role of the Anesthesiologist during Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Tremor: A Single-Center Experience. PARKINSONS DISEASE 2018; 2018:9764807. [PMID: 30123491 PMCID: PMC6079322 DOI: 10.1155/2018/9764807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 01/30/2023]
Abstract
Ablative incisionless neurosurgery has become possible through advances in focused ultrasound and magnetic resonance imaging (MRI). The great advantage of MRI-guided focused ultrasound (MRgFUS) is that the ablation is performed through an intact skull without surgery. Here, we review the new modality of MRgFUS for treating tremor and enlighten the role of the anesthesiologist in the unique procedural setting of the MRI suite. During the MRgFUS process, the patients should be awake and are required to cooperate with the medical staff to allow assessment of tremor reduction and potential occurrence of adverse effects. In addition, the patient's head is immobilized inside the MRI tunnel for hours. This combination presents major challenges for the attending anesthesiologist, who is required to try to prevent pain and nausea and when present, to treat these symptoms. Anxiety, vertigo, and vomiting may occur during treatment and require urgent treatment. Here, we review the literature available on anesthetic management during the procedure and our own experience and provide recommendations based on our collected knowledge.
Collapse
|
19
|
Muthuraman M, Raethjen J, Koirala N, Anwar AR, Mideksa KG, Elble R, Groppa S, Deuschl G. Cerebello-cortical network fingerprints differ between essential, Parkinson’s and mimicked tremors. Brain 2018; 141:1770-1781. [DOI: 10.1093/brain/awy098] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz-55131, Germany
| | - Jan Raethjen
- Department of Neurology, Christian-Albrechts-University, Kiel-24105, Germany
| | - Nabin Koirala
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz-55131, Germany
| | - Abdul Rauf Anwar
- Department of Neurology, Christian-Albrechts-University, Kiel-24105, Germany
- Biomedical Engineering Centre, University of Engineering & Technology, Lahore (KSK Campus)-54890, Pakistan
| | - Kidist G Mideksa
- Department of Neurology, Christian-Albrechts-University, Kiel-24105, Germany
- Institute for Circuit and System Theory, Christian-Albrechts-University, Kiel-24143, Germany
| | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, 62794-9643, USA
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz-55131, Germany
| | - Günter Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel-24105, Germany
| |
Collapse
|
20
|
Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics. Can J Neurol Sci 2017; 45:11-22. [DOI: 10.1017/cjn.2017.260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractBackground:There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters.Methods:Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn–Tolosa–Marin (FTM) scale, the Unified Parkinson’s Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist’s interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics.Results:There was a 33.8% (p<0.05) functional improvement (FTM part C) and a 39.8% (p<0.0005) improvement in QUEST score at week 96 compared to pretreatment scores at week 0. Although there was a 44.6% (p<0.0005) non-dose-dependent reduction in maximal grip strength, only 2 participants complained of mild weakness. Following the fourth serial treatment, mean action tremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48.Conclusions:Individualized BoNT-A dosing patterns to each individual’s tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.
Collapse
|
21
|
|
22
|
Soh D, Fasano A. Multiple sclerosis tremor: are technical advances enough? Lancet Neurol 2017. [PMID: 28642123 DOI: 10.1016/s1474-4422(17)30198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Derrick Soh
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada; Krembil Research Institute, Toronto, ON, M5T 2S8, Canada.
| |
Collapse
|
23
|
Samotus O, Lee J, Jog M. Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections. PLoS One 2017; 12:e0178670. [PMID: 28586370 PMCID: PMC5460844 DOI: 10.1371/journal.pone.0178670] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/17/2017] [Indexed: 12/14/2022] Open
Abstract
Objective Current pharmacological agents used to treat Parkinson disease (PD) tremor and essential tremor (ET) provide suboptimal benefit and are commonly associated with significant adverse effects. Botulinum toxin type A (BoNT-A) has been shown to be effective for wrist tremor though functionally bothersome muscle weakness frequently occurs. This is the longest study to date demonstrating that BoNT-A therapy coupled with kinematic guidance can provide efficacious outcomes for upper limb tremor with minimized unwanted weakness. Methods A total of 28 PD and 24 ET participants with bothersome, disabling tremor, received six serial BoNT-A treatments every 16 weeks starting at week 0 with a follow-up visit 6 weeks following a treatment, totaling 96 weeks. Clinical scales, including Fahn-Tolosa-Marin tremor rating scale (FTM), and sensor-based tremor assessments were conducted at each visit. Kinematics was utilized to identify which arm muscles contributed to the tremulous movements and the experienced injector used clinical expertise in determining BoNT-A dosages. Results Following BoNT-A treatment, clinical ratings of tremor severity and functional ability (FTM) showed significant improvements following the first treatment which was maintained up to week 96 in PD and ET. Kinematics detected a significant reduction in PD and ET tremor amplitudes by 70% and 76% over the treatment course, respectively. By objectively distinguishing tremulous muscles and tremor severity, adverse effects were limited to mild perceived weakness by participants in injected muscles during follow-ups. Following the fourth treatment, BoNT-A dosages in flexor and extensor wrist muscles and biceps were reduced for those experiencing residual weakness which ultimately did not interfere with tremor relief or arm function. Conclusions Kinematics is an objective method that can aid clinicians in assessing and determining optimal BoNT-A parameters to alleviate both PD and ET tremor. BoNT-A injections are tolerable and effective when focal therapy regimens are determined and optimized kinematically over a long-term.
Collapse
Affiliation(s)
- Olivia Samotus
- London Health Sciences Centre – Lawson Health Research Institute, Department of Clinical Neurological Sciences, London, Ontario, Canada
- University of Western, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Jack Lee
- London Health Sciences Centre – Lawson Health Research Institute, Department of Clinical Neurological Sciences, London, Ontario, Canada
| | - Mandar Jog
- London Health Sciences Centre – Lawson Health Research Institute, Department of Clinical Neurological Sciences, London, Ontario, Canada
- University of Western, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- * E-mail:
| |
Collapse
|
24
|
Rohani M, Fasano A. Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:462. [PMID: 28503363 PMCID: PMC5425801 DOI: 10.7916/d8z89jn1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/17/2017] [Indexed: 01/09/2023]
Abstract
Background While there is no breakthrough progress in the medical treatment of essential tremor (ET), in the past decades several remarkable achievements happened in the surgical field, such as radiofrequency thalamotomy, thalamic deep brain stimulation, and gamma knife thalamotomy. The most recent advance in this area is magnetic resonance-guided focused ultrasound (MRgFUS). Methods The purpose of this review is to discuss the new developments and trials of MRgFUS in the treatment of ET and other tremor disorders. Results MRgFUS is an incisionless surgery performed without anesthesia and ionizing radiation (no risk of cumulative dose and delayed side effects). Studies have shown the safety and effectiveness of unilateral MRgFUS-thalamotomy in the treatment of ET. It has been successfully used in a few patients with Parkinson’s disease-related tremor, and in fewer patients with fragile X-associated tremor/ataxia syndrome. The safety and long-term effects of the procedure are still unclear, as temporary and permanent adverse events have been reported as well as recurrence of tremor. Discussion MRgFUS is a promising new surgical approach with a number of unknowns and unsolved issues. It represents a valuable option particularly for patients who refused or could not be candidates for other procedures, deep brain stimulation in particular.
Collapse
Affiliation(s)
- Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Zheng X, Vieira Campos A, Ordieres-Meré J, Balseiro J, Labrador Marcos S, Aladro Y. Continuous Monitoring of Essential Tremor Using a Portable System Based on Smartwatch. Front Neurol 2017; 8:96. [PMID: 28360883 PMCID: PMC5350115 DOI: 10.3389/fneur.2017.00096] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/27/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Essential tremor (ET) shows amplitude fluctuations throughout the day, presenting challenges in both clinical and treatment monitoring. Tremor severity is currently evaluated by validated rating scales, which only provide a timely and subjective assessment during a clinical visit. Motor sensors have shown favorable performances in quantifying tremor objectively. METHODS A new highly portable system was used to monitor tremor continuously during daily lives. It consists of a smartwatch with a triaxial accelerometer, a smartphone, and a remote server. An experiment was conducted involving eight ET patients. The average effective data collection time per patient was 26 (±6.05) hours. Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) was adopted as the gold standard to classify tremor and to validate the performance of the system. Quantitative analysis of tremor severity on different time scales is validated. RESULTS Significant correlations were observed between neurologist's FTMTRS and patient's FTMTRS auto-assessment scores (r = 0.84; p = 0.009), between the device quantitative measures and the scores from the standardized assessments of neurologists (r = 0.80; p = 0.005) and patient's auto-evaluation (r = 0.97; p = 0.032), and between patient's FTMTRS auto-assessment scores day-to-day (r = 0.87; p < 0.001). A graphical representation of four patients with different degrees of tremor was presented, and a representative system is proposed to summarize the tremor scoring at different time scales. CONCLUSION This study demonstrates the feasibility of prolonged and continuous monitoring of tremor severity during daily activities by a highly portable non-restrictive system, a useful tool to analyze efficacy and effectiveness of treatment.
Collapse
Affiliation(s)
- Xiaochen Zheng
- Department of Industrial Engineering, Technical University of Madrid , Madrid , Spain
| | | | - Joaquín Ordieres-Meré
- Department of Industrial Engineering, Technical University of Madrid , Madrid , Spain
| | - Jose Balseiro
- University Hospital of Getafe, Getafe , Madrid , Spain
| | | | | |
Collapse
|
26
|
Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I. Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases. J Neurosurg 2017; 128:202-210. [PMID: 28298022 DOI: 10.3171/2016.10.jns16758] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Thalamotomy of the ventral intermediate nucleus (VIM) is effective in alleviating medication-resistant tremor in patients with essential tremor (ET) and Parkinson's disease (PD). MR-guided focused ultrasound (MRgFUS) is an innovative technology that enables noninvasive thalamotomy via thermal ablation. METHODS Patients with severe medication-resistant tremor underwent unilateral VIM thalamotomy using MRgFUS. Effects on tremor were evaluated using the Clinical Rating Scale for Tremor (CRST) in patients with ET and by the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS) in patients with PD and ET-PD (defined as patients with ET who developed PD many years later). Quality of life in ET was measured by the Quality of Life in Essential Tremor (QUEST) questionnaire and in PD by the PD Questionnaire (PDQ-39). RESULTS Thirty patients underwent MRgFUS, including 18 with ET, 9 with PD, and 3 with ET-PD. The mean age of the study population was 68.9 ± 8.3 years (range 46-87 years) with a mean disease duration of 12.1 ± 8.9 years (range 2-30 years). MRgFUS created a lesion at the planned target in all patients, resulting in cessation of tremor in the treated hand immediately following treatment. At 1 month posttreatment, the mean CRST score of the patients with ET decreased from 40.7 ± 11.6 to 9.3 ± 7.1 (p < 0.001) and was 8.2 ± 5.0 six months after treatment (p < 0.001, compared with baseline). Average QUEST scores decreased from 44.8 ± 12.9 to 13.1 ± 13.2 (p < 0.001) and was 12.3 ± 7.2 six months after treatment (p < 0.001). In patients with PD, the mean score of the motor part of the UPDRS decreased from 24.9 ± 8.0 to 16.4 ± 11.1 (p = 0.042) at 1 month and was 13.4 ± 9.2 six months after treatment (p = 0.009, compared with baseline). The mean PDQ-39 score decreased from 38.6 ± 16.8 to 26.1 ± 7.2 (p = 0.036) and was 20.6 ± 8.8 six months after treatment (p = 0.008). During follow-up of 6-24 months (mean 11.5 ± 7.2 months, median 12.0 months), tremor reappeared in 6 of the patients (2 with ET, 2 with PD, and 2 with ET-PD), to a lesser degree than before the procedure in 5. Adverse events that transiently occurred during sonication included headache (n = 11), short-lasting vertigo (n = 14) and dizziness (n = 4), nausea (n = 3), burning scalp sensation (n = 3), vomiting (n = 2) and lip paresthesia (n = 2). Adverse events that lasted after the procedure included gait ataxia (n = 5), unsteady feeling (n = 4), taste disturbances (n = 4), asthenia (n = 4), and hand ataxia (n = 3). No adverse event lasted beyond 3 months. Patients underwent on average 21.0 ± 6.9 sonications (range 14-45 sonications) with an average maximal sonication time of 16.0 ± 3.0 seconds (range 13-24 seconds). The mean maximal energy reached was 12,500 ± 4274 J (range 5850-23,040 J) with a mean maximal temperature of 56.5° ± 2.2°C (range 55°-60°C). CONCLUSIONS MRgFUS VIM thalamotomy to relieve medication-resistant tremor was safe and effective in patients with ET, PD, and ET-PD. Current results emphasize the superior adverse events profile of MRgFUS over other surgical approaches for treating tremor with similar efficacy. Large randomized studies are needed to assess prolonged efficacy and safety.
Collapse
Affiliation(s)
- Menashe Zaaroor
- Departments of1Neurosurgery.,2Technion Faculty of Medicine, Haifa,Israel
| | | | - Dorith Goldsher
- 2Technion Faculty of Medicine, Haifa,Israel.,3Radiology, and
| | | | | | - Ilana Schlesinger
- 2Technion Faculty of Medicine, Haifa,Israel.,4Neurology, Rambam Health Care Campus; and
| |
Collapse
|
27
|
Kim W, Sharim J, Tenn S, Kaprealian T, Bordelon Y, Agazaryan N, Pouratian N. Diffusion tractography imaging-guided frameless linear accelerator stereotactic radiosurgical thalamotomy for tremor: case report. J Neurosurg 2017; 128:215-221. [PMID: 28298033 DOI: 10.3171/2016.10.jns161603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Essential tremor and Parkinson's disease-associated tremor are extremely prevalent within the field of movement disorders. The ventral intermediate (VIM) nucleus of the thalamus has been commonly used as both a neuromodulatory and neuroablative target for the treatment of these forms of tremor. With both deep brain stimulation and Gamma Knife radiosurgery, there is an abundance of literature regarding the surgical planning, targeting, and outcomes of these methodologies. To date, there have been no reports of frameless, linear accelerator (LINAC)-based thalomotomies for tremor. The authors report the case of a patient with tremor-dominant Parkinson's disease, with poor tremor improvement with medication, who was offered LINAC-based thalamotomy. High-resolution 0.9-mm isotropic MR images were obtained, and simulation was performed via CT with 1.5-mm contiguous slices. The VIM thalamic nucleus was determined using diffusion tensor imaging (DTI)-based segmentation on FSL using probabilistic tractography. The supplemental motor and premotor areas were the cortical target masks. The authors centered their isocenter within the region of the DTI-determined target and treated the patient with 140 Gy in a single fraction. The DTI-determined target had coordinates of 14.2 mm lateral and 8.36 mm anterior to the posterior commissure (PC), and 3 mm superior to the anterior commissure (AC)-PC line, which differed by 3.30 mm from the original target determined by anatomical considerations (15.5 mm lateral and 7 mm anterior to the PC, and 0 mm superior to the AC-PC line). There was faint radiographic evidence of lesioning at the 3-month follow-up within the target zone, which continued to consolidate on subsequent scans. The patient experienced continued right upper-extremity resting tremor improvement starting at 10 months until it was completely resolved at 22 months of follow-up. Frameless LINAC-based thalamotomy guided by DTI-based thalamic segmentation is a feasible method for achieving radiosurgical lesions of the VIM thalamus to treat tremor.
Collapse
Affiliation(s)
| | - Justin Sharim
- 2David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | | | | |
Collapse
|
28
|
Houle G, Schmouth JF, Leblond CS, Ambalavanan A, Spiegelman D, Laurent SB, Bourassa CV, Panisset M, Chouinard S, Dupré N, Vilariño-Güell C, Rajput A, Dion PA, Rouleau GA. Teneurin transmembrane protein 4 is not a cause for essential tremor in a Canadian population. Mov Disord 2017; 32:292-295. [PMID: 28158909 DOI: 10.1002/mds.26753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/12/2016] [Accepted: 07/17/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Mutations in teneurin transmembrane protein 4 were reported to be a risk factor for essential tremor, but the relevance of this across different population remains to be examined. The aim of this study was to determine the frequency and spectrum of variations in teneurin transmembrane protein 4 in a cohort of Canadian essential tremor cases. METHODS The coding portion of teneurin transmembrane protein 4 was sequenced in 269 unrelated essential tremor cases and 288 matched control individuals using a targeted and high-throughput sequencing approach. RESULTS A total of 157 single nucleotide variations were identified, and from these 99 were a missense or nonsense mutation. A total of 68 cases were carriers of ≥1 rare missense or nonsense mutations, and 39 control individuals were carriers of the same types of variations. Gene-based association tests were used to jointly analyze the single nucleotide variations. CONCLUSIONS Our results do not support a positive association between teneurin transmembrane protein 4 and the Canadian population. © 2017 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Gabrielle Houle
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Jean-François Schmouth
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Claire S Leblond
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Amirthagowri Ambalavanan
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Dan Spiegelman
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Sandra B Laurent
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | | | - Michel Panisset
- Centre Hospitalier Universitaire de Montréal (CHUM)-Notre-Dame, André Barbeau Movement Disorders Unit, Montreal, Quebec, Canada
| | - Sylvain Chouinard
- Centre Hospitalier Universitaire de Montréal (CHUM)-Notre-Dame, André Barbeau Movement Disorders Unit, Montreal, Quebec, Canada
| | - Nicolas Dupré
- Department of Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,Département des Sciences Neurologiques, CHU de Québec (Enfant-Jésus), Quebec City, Quebec, Canada
| | - Carles Vilariño-Güell
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Rajput
- Division of Neurology, Saskatchewan Movement Disorders Program, University of Saskatchewan, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
| | - Patrick A Dion
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
29
|
Gigante AF, Pellicciari R, Iliceto G, Liuzzi D, Mancino PV, Custodero GE, Guido M, Livrea P, Defazio G. Rest tremor in Parkinson's disease: Body distribution and time of appearance. J Neurol Sci 2016; 375:215-219. [PMID: 28320133 DOI: 10.1016/j.jns.2016.12.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/28/2016] [Accepted: 12/27/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess body distribution and timing of appearance of rest tremor in Parkinson's disease. METHODS Information was obtained by a computerized database containing historical information collected at the first visit and data collected during the subsequent follow-up visits. Information on rest tremor developed during the follow-up could be therefore obtained by our own observation in a proportion of patients. RESULTS Among 289 patients, rest tremor was reported at disease onset in 65.4% of cases and detected at last follow-up examination in 74.4% of patients. Analysis of patients who did not report rest tremor at disease onset indicated that 26% of such patients (9% in the overall population) manifested rest tremor over the disease course. Rest tremor spread to new sites in 39% of patients who manifested rest tremor at disease onset. Regardless of tremor presentation at disease onset or during the follow-up, upper limb was the most frequent tremor localization. Over the follow-up, rest tremor developed faster in the upper limb than in other body sites. The risk of developing rest tremor during the follow-up was not affected by sex, side of motor symptom onset and site of tremor presentation. However, age of disease onset >63years was associated with an increased risk of rest tremor spread. CONCLUSIONS This study provides new information about body distribution and timing of rest tremor appearance during the course of early stages of Parkinson's disease that may help clinicians in patients' counselling.
Collapse
Affiliation(s)
- Angelo Fabio Gigante
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Roberta Pellicciari
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Giovanni Iliceto
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Daniele Liuzzi
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Paola Vincenza Mancino
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Giacomo Emanuele Custodero
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Marco Guido
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Paolo Livrea
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy
| | - Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy.
| |
Collapse
|
30
|
Löscher W, Gillard M, Sands ZA, Kaminski RM, Klitgaard H. Synaptic Vesicle Glycoprotein 2A Ligands in the Treatment of Epilepsy and Beyond. CNS Drugs 2016; 30:1055-1077. [PMID: 27752944 PMCID: PMC5078162 DOI: 10.1007/s40263-016-0384-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The synaptic vesicle glycoprotein SV2A belongs to the major facilitator superfamily (MFS) of transporters and is an integral constituent of synaptic vesicle membranes. SV2A has been demonstrated to be involved in vesicle trafficking and exocytosis, processes crucial for neurotransmission. The anti-seizure drug levetiracetam was the first ligand to target SV2A and displays a broad spectrum of anti-seizure activity in various preclinical models. Several lines of preclinical and clinical evidence, including genetics and protein expression changes, support an important role of SV2A in epilepsy pathophysiology. While the functional consequences of SV2A ligand binding are not fully elucidated, studies suggest that subsequent SV2A conformational changes may contribute to seizure protection. Conversely, the recently discovered negative SV2A modulators, such as UCB0255, counteract the anti-seizure effect of levetiracetam and display procognitive properties in preclinical models. More broadly, dysfunction of SV2A may also be involved in Alzheimer's disease and other types of cognitive impairment, suggesting potential novel therapies for levetiracetam and its congeners. Furthermore, emerging data indicate that there may be important roles for two other SV2 isoforms (SV2B and SV2C) in the pathogenesis of epilepsy, as well as other neurodegenerative diseases. Utilization of recently developed SV2A positron emission tomography ligands will strengthen and reinforce the pharmacological evidence that SV2A is a druggable target, and will provide a better understanding of its role in epilepsy and other neurological diseases, aiding in further defining the full therapeutic potential of SV2A modulation.
Collapse
Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.
- Center for Systems Neuroscience, Hannover, Germany.
| | | | | | | | | |
Collapse
|
31
|
Essential tremor: Update of therapeutic strategies (medical treatment and gamma knife thalamotomy). Rev Neurol (Paris) 2016; 172:408-415. [DOI: 10.1016/j.neurol.2016.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/06/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022]
|
32
|
Arruda BL, Arruda PH, Magstadt DR, Schwartz KJ, Dohlman T, Schleining JA, Patterson AR, Visek CA, Victoria JG. Identification of a Divergent Lineage Porcine Pestivirus in Nursing Piglets with Congenital Tremors and Reproduction of Disease following Experimental Inoculation. PLoS One 2016; 11:e0150104. [PMID: 26909691 PMCID: PMC4766193 DOI: 10.1371/journal.pone.0150104] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/09/2016] [Indexed: 12/13/2022] Open
Abstract
Congenital tremors is a sporadic disease of neonatal pigs characterized by action-related repetitive myoclonus. A majority of outbreaks of congenital tremors have been attributed to an unidentified virus. The objectives of this project were to 1) detect potential pathogen(s) in samples from piglets with congenital tremors and 2) develop an infection model to reproduce disease. Using next-generation sequencing, a divergent lineage pestivirus was detected in piglets with congenital tremors. The virus was originally most closely related to a bat pestivirus but is now more closely related to a recently published novel porcine pestivirus provisionally named atypical porcine pestivirus. A quantitative real-time PCR detected the virus in samples from neonatal piglets with congenital tremors from two separate farms, but not in samples from unaffected piglets from the same farm. To fulfill the second objective, pregnant sows were inoculated with either serum containing the pestivirus or PBS (control) by intravenous and intranasal routes simultaneously with direct inoculation of fetal amniotic vesicles by ultrasound-guided surgical technique. Inoculations were performed at either 45 or 62 days of gestation. All sows inoculated with the novel pestivirus farrowed piglets affected with congenital tremors while PBS-inoculated control piglets were unaffected. Tremor severity for each piglet was scored from videos taken 0, 1 and 2 days post-farrowing. Tremor severity remained relatively constant from 0 to 2 days post-farrowing for a majority of piglets. The prevalence of congenital tremors in pestivirus-inoculated litters ranged from 57% (4 out of 7 affected piglets) to 100% (10 out of 10 affected piglets). The virus was consistently detected by PCR in tissues from piglets with congenital tremors but was not detected in control piglets. Samples positive by PCR in greater than 90% of piglets sampled included brainstem (37 out of 41), mesenteric lymph node (37 out of 41), tracheobronchial lymph node (37 out of 41), and whole blood (19 out of 20). Although the first description of congenital tremors was in 1922, this is the first reported reproduction of congenital tremors following experimental inoculation with a divergent lineage porcine pestivirus. Studies investigating disease mechanism, epidemiology, and diagnostic assay development are needed to better understand the pathophysiology of congenital tremors due to this pestivirus.
Collapse
Affiliation(s)
- Bailey L. Arruda
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
- * E-mail:
| | - Paulo H. Arruda
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
| | - Drew R. Magstadt
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
| | - Kent J. Schwartz
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
| | - Tyler Dohlman
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
| | - Jennifer A. Schleining
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
| | - Abby R. Patterson
- Boehringer Ingelheim Vetmedica, Inc., Ames, Iowa, United States of America
| | - Callie A. Visek
- Boehringer Ingelheim Vetmedica, Inc., Ames, Iowa, United States of America
| | - Joseph G. Victoria
- Boehringer Ingelheim Vetmedica, Inc., Ames, Iowa, United States of America
| |
Collapse
|