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Surme MB, Ozturk S, Gonen M, Erol FS, Yildirim H, Aslan H, Korkmaz S. Analysis of diffusion changes in cerebral tissues of Parki̇nson's patients who underwent subthalamic nucleus deep brain stimulation: Correlation of improvements in motor and neuropsychiatric symptoms. Clin Neurol Neurosurg 2024; 244:108439. [PMID: 39089180 DOI: 10.1016/j.clineuro.2024.108439] [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: 01/17/2024] [Revised: 06/22/2024] [Accepted: 07/07/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVE Parkinson's disease (PD) as a neurodegenerative disorder characterized by a reduction in both the quantity and functionality of dopaminergic neurons. This succinctly highlights the central pathological feature of PD and its association with dopaminergic neuron degeneration, which underlies the motor and non-motor symptoms of the disease. This study aims to elucidate the nuances of apparent diffusion coefficient (ADC) changes in different cerebral regions by after the bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery of PD, as well as to investigate their potential interactions with the motor and neuropsychiatric spectrum. METHODS Patients who underwent STN-DBS surgery for PD between 2017 and 2019 were included in this study. The results of diffusion magnetic resonance imaging (MRI), Unified Parkinson Disease Rating Scale (UPDRS) III scores, Beck and Hamilton depression tests were recorded before and at the 3rd month of postoperative stimulation. The data obtained were evaluated with the Wilcoxon signed rank test. Result of the statistical tests were within the 95 % confidence interval and p values were significant below 0.05. RESULTS Our study was conducted with a total of 13 patients, 8 men and 5 women. As a result of measurements made in a total of 32 different regions, especially in the motor and neuropsychiatric areas of the brain, an increase in ADC values was found in all areas. ADC changes of eight localizations such as left corpus callosum, right corona radiata, left corona radiata, hippocampus, right insula, left superior cerebellar peduncle, left caudate nucleus and left putamen were statistically significant. UPDRS III scores improved by 57 % (p <0.05), and Beck and Hamilton depression scores by 25 % and 33 %, respectively (p> 0.05). CONCLUSIONS This article implicate that bilateral STN-DBS surgery potentially exerts beneficial effects on both motor and neuropsychiatric symptomatology in individuals with PD. We believe that this therapeutic mechanism is hypothesized to involve modulation of diffusion alterations within distinct cerebral tissues.
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Affiliation(s)
- Mehmet Besir Surme
- Eskisehir City Hospital, Neurosurgery Department, 1st floor Eskisehir, Turkey.
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Harmsen IE, Wolff Fernandes F, Krauss JK, Lozano AM. Where Are We with Deep Brain Stimulation? A Review of Scientific Publications and Ongoing Research. Stereotact Funct Neurosurg 2022; 100:184-197. [PMID: 35104819 DOI: 10.1159/000521372] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a neuromodulatory technique that delivers adjustable electrical stimuli to brain targets to relieve symptoms associated with dysregulated neural circuitry. Over the last several decades, DBS has been applied to a number of conditions, including motor, pain, mood, and cognitive disorders. An assessment of the body of work in this field is warranted to determine where we have been, define the current state of the field, and chart a path toward the future. OBJECTIVE The aim of the study was to assess the state of DBS-related research by analyzing the DBS literature as well as active studies sponsored by the National Institutes of Health (NIH) or German Research Foundation (Deutsche Forschungsgemeinschaft [DFG]). METHODS Peer-reviewed DBS publications were extracted from PubMed. Active NIH-funded DBS projects were extracted from the RePORT database and active DFG projects from the German Research Foundation database. Records were analyzed using custom-developed algorithms to generate a detailed overview of past and present DBS-related research. Specifically, records were categorized by publication year, journal, language, country of origin, contributing authors, disorder, brain target, study design, and topic. Expected project duration and costs were also provided for active studies. RESULTS In total, 8,974 publications, 172 active NIH-funded projects, and 34 active DFG projects were identified. Records spanned 52 different disorders across 31 distinct brain targets and showed a recent shift toward studies examining conditions other than movement disorders. Most published works involved human research (80.6% of published studies), of which 10.2% were identified as clinical trials. Increasingly, studies focused on imaging or electrophysiological changes associated with DBS (69.8% NIH-active and 70.6% DFG-active vs. 25.8% published) or developing new stimulation techniques and adaptive technologies (37.8% NIH-active and 17.6% DFG-active vs. 6.5% published). CONCLUSIONS This overview of past and present DBS-related studies provides insight into the status of DBS research and what we can anticipate in the future concerning new indications, improved/novel target selection and stimulation paradigms, closed-loop technology, and a better understanding of the mechanisms of action of DBS.
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Affiliation(s)
- Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Abstract
Positron emission tomography greatly advanced our understanding on the underlying neural mechanisms of movement disorders. PET with flurodeoxyglucose (FDG) is especially useful as it depicts regional metabolic activity level that can predict patients' symptoms. Multivariate pattern analysis has been used to determine and quantify the co-varying brain networks associated with specific clinical traits of neurodegenerative disease. The result is a biomarker, useful for diagnosis, treatments, and follow up studies. Parkinsonian traits and parkinsonisms are associated with specific spatial pattern of metabolic abnormality useful for differential diagnosis. This approach has also been used for monitoring disease progression and novel treatment responses mostly in Parkinson's disease. In this book chapter, we, illustrate and discuss the significance of the brain networks associated with disease and their modification with neuroplastic changes.
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Germann J, Mameli M, Elias GJB, Loh A, Taha A, Gouveia FV, Boutet A, Lozano AM. Deep Brain Stimulation of the Habenula: Systematic Review of the Literature and Clinical Trial Registries. Front Psychiatry 2021; 12:730931. [PMID: 34484011 PMCID: PMC8415908 DOI: 10.3389/fpsyt.2021.730931] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
The habenula is a small bilateral epithalamic structure that plays a key role in the regulation of the main monoaminergic systems. It is implicated in many aspects of behavior such as reward processing, motivational behavior, behavioral adaptation, and sensory integration. A role of the habenula has been indicated in the pathophysiology of a number of neuropsychiatric disorders such as depression, addiction, obsessive-compulsive disorder, and bipolar disorder. Neuromodulation of the habenula using deep brain stimulation (DBS) as potential treatment has been proposed and a first successful case of habenula DBS was reported a decade ago. To provide an overview of the current state of habenula DBS in human subjects for the treatment of neuropsychiatric disorders we conducted a systematic review of both the published literature using PUBMED and current and past registered clinical trials using ClinicalTrials.gov as well as the International Clinical Trials Registry Platform. Using PRISMA guidelines five articles and five registered clinical trials were identified. The published articles detailed the results of habenula DBS for the treatment of schizophrenia, depression, obsessive-compulsive disorder, and bipolar disorder. Four are single case studies; one reports findings in two patients and positive clinical outcome is described in five of the six patients. Of the five registered clinical trials identified, four investigate habenula DBS for the treatment of depression and one for obsessive-compulsive disorder. One trial is listed as terminated, one is recruiting, two are not yet recruiting and the status of the fifth is unknown. The planned enrollment varies between 2 to 13 subjects and four of the five are open label trials. While the published studies suggest a potential role of habenula DBS for a number of indications, future trials and studies are necessary. The outcomes of the ongoing clinical trials will provide further valuable insights. Establishing habenula DBS, however, will depend on successful randomized clinical trials to confirm application and clinical benefit of this promising intervention.
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Affiliation(s)
- Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, Lausanne, Switzerland
- INSERM, UMR-S 839, Paris, France
| | - Gavin J. B. Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Alaa Taha
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
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Paulo DL, Bick SK. Advanced Imaging in Psychiatric Neurosurgery: Toward Personalized Treatment. Neuromodulation 2021; 25:195-201. [PMID: 33788971 DOI: 10.1111/ner.13392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim is to review several recent landmark studies discussing the application of advanced neuroimaging to guide target selection in deep brain stimulation (DBS) for psychiatric disorders. MATERIALS AND METHODS We performed a PubMed literature search of articles related to psychiatric neurosurgery, DBS, diffusion tensor imaging, probabilistic tractography, functional magnetic resonance imaging (MRI), and blood oxygen level-dependent activation. Relevant articles were included in the review. RESULTS Recent advances in neuroimaging, namely the use of diffusion tensor imaging, probabilistic tractography, functional MRI, and Positron emission tomography have provided higher resolution depictions of structural and functional connectivity between regions of interest. Applying these imaging modalities to DBS has increased understanding of the mechanism of action of DBS from the single structure to network level, allowed for new DBS targets to be discovered, and allowed for individualized DBS targeting for psychiatric indications. CONCLUSIONS Advanced neuroimaging techniques may be especially important to guide personalized DBS targeting in psychiatric disorders such as treatment-resistant depression and obsessive-compulsive disorder where symptom profiles and underlying disordered circuitry are more heterogeneous. These articles suggest that advanced imaging can help to further individualize and optimize DBS, a promising next step in improving its efficacy.
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Affiliation(s)
- Danika L Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Beheshti I, Ko JH. Modulating brain networks associated with cognitive deficits in Parkinson's disease. Mol Med 2021; 27:24. [PMID: 33691622 PMCID: PMC7945662 DOI: 10.1186/s10020-021-00284-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson's disease (PD) is a relatively well characterised neurological disorder that primarily affects motor and cognitive functions. This paper reviews on how transcranial direct current stimulation (tDCS) can be used to modulate brain networks associated with cognitive deficits in PD. We first provide an overview of brain network abnormalities in PD, by introducing the brain network modulation approaches such as pharmacological interventions and brain stimulation techniques. We then present the potential underlying mechanisms of tDCS technique, and specifically highlight how tDCS can be applied to modulate brain network abnormality associated with cognitive dysfunction among PD patients. More importantly, we address the limitations of existing studies and suggest possible future directions, with the aim of helping researchers to further develop the use of tDCS technique in clinical settings.
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Affiliation(s)
- Iman Beheshti
- Department of Human Anatomy and Cell Science, University of Manitoba, 130-745 Bannatyne Ave., Winnipeg, MB R3E 0J9 Canada
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, 130-745 Bannatyne Ave., Winnipeg, MB R3E 0J9 Canada
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB Canada
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
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Tremblay S, Tuominen L, Zayed V, Pascual-Leone A, Joutsa J. The study of noninvasive brain stimulation using molecular brain imaging: A systematic review. Neuroimage 2020; 219:117023. [DOI: 10.1016/j.neuroimage.2020.117023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
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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]
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Kan Y, Wang W, Zhang SX, Ma H, Wang ZC, Yang JG. Neural metabolic activity in idiopathic tinnitus patients after repetitive transcranial magnetic stimulation. World J Clin Cases 2019; 7:1582-1590. [PMID: 31367617 PMCID: PMC6658381 DOI: 10.12998/wjcc.v7.i13.1582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The central mechanism of idiopathic tinnitus is related to hyperactivity of cortical and subcortical auditory and non-auditory areas. Repetitive transcranial magnetic stimulation (rTMS) is a well-tolerated, non-invasive potential treatment option for tinnitus.
AIM To investigate the changes of neural metabolic activity after rTMS in chronic idiopathic tinnitus (IT) patients.
METHODS Eleven patients underwent rTMS (1 Hz, 90% motor threshold, 1000 stimuli/day for consecutive 10 d) on the left temporoparietal region cortex. Tinnitus handicap inventory (THI) and visual analogue score (VAS) were assessed at baseline and posttreatment. All patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography to evaluate the neural metabolic activity. Data were preprocessed using statistical parametric mapping and Gretna software to extract the regions of interest (ROIs). The correlation between brain areas involved and THI scores was analyzed.
RESULTS Baseline and posttreatment parameters showed no significant difference regarding THI score (t = 1.019, P = 0.342 > 0.05) and VAS (t = 0.00, P = 1.0 > 0.05). Regions with the highest FDG uptake were the right inferior temporal gyrus (ITG), right parahippocampa gyrus (PHG), right hippocampus, rectus gyrus, left middle frontal gyrus, and right inferior frontal gyrus in IT patients. After rTMS treatment, IT patients showed increased activities in the right PHG, right superior temporal gyrus, right superior frontal gyrus, anterior insula, left inferior parietal lobule, and left precentral gyrus, and decreased activities in the left postcentral gyrus and left ITG. The ROIs in the right parahippocampa gyrus and right superior frontal gyrus were positively correlated with THI scores (r = 0.737, P = 0.037 < 0.05; r = 0.735, P = 0.038 < 0.05).
CONCLUSION Our study showed that 1-Hz rTMS directed to the left temporo-parietal junction resulted no statistically significant symptom alleviation. After treatment, brain areas of the limbic and prefrontal system showed high neutral metabolic activity. The auditory and non-auditory systems together will be the target for rTMS treatment.
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Affiliation(s)
- Ying Kan
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Shu-Xin Zhang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Huan Ma
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ji-Gang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Neville IS, Zaninotto AL, Hayashi CY, Rodrigues PA, Galhardoni R, Ciampi de Andrade D, Brunoni AR, Amorim RLO, Teixeira MJ, Paiva WS. Repetitive TMS does not improve cognition in patients with TBI: A randomized double-blind trial. Neurology 2019; 93:e190-e199. [PMID: 31175209 PMCID: PMC6656650 DOI: 10.1212/wnl.0000000000007748] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/01/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether high-frequency repetitive transcranial magnetic stimulation (rTMS) improves cognition in patients with severe traumatic brain injury. METHODS A single-center, randomized, double-blind, placebo-controlled study of rTMS was conducted in patients aged 18-60 years with chronic (>12 months postinjury) diffuse axonal injury (DAI). Patients were randomized to either a sham or real group in a 1:1 ratio. A 10-session rTMS protocol was used with 10-Hz stimulation over the left dorsolateral prefrontal cortex (DLPFC). Neuropsychological assessments were performed at 3 time points: at baseline, after the 10th rTMS session, and 90 days after intervention. The primary outcome was change in executive function evaluated using the Trail Making Test Part B. RESULTS Thirty patients with chronic DAI met the study criteria. Between-group comparisons of performance on TMT Part B at baseline and after the 10th rTMS session did not differ between groups (p = 0.680 and p = 0.341, respectively). No significant differences were observed on other neuropsychological tests. No differences in adverse events between treatment groups were observed. CONCLUSIONS Cognitive function in individuals with chronic DAI is not improved by high-frequency rTMS over the left DLPFC, though it appears safe and well-tolerated in this population. CLINICALTRIALSGOV IDENTIFIER NCT02167971. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for individuals with chronic DAI, high-frequency rTMS over the left DLPFC does not significantly improve cognition.
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Affiliation(s)
- Iuri Santana Neville
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil.
| | - Ana Luiza Zaninotto
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Cintya Yukie Hayashi
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Priscila Aparecida Rodrigues
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Ricardo Galhardoni
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Daniel Ciampi de Andrade
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Andre Russowsky Brunoni
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Robson L Oliveira Amorim
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Manoel Jacobsen Teixeira
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
| | - Wellingson Silva Paiva
- From the Division of Neurosurgery/LIM-62 (I.S.N., A.L.Z., C.Y.H., P.A.R., R.G., D.C.d.A., R.L.O.A., M.J.T., W.S.P.) and Department of Psychiatry, Instituto de Psiquiatria (A.R.B.), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, and Service of Interdisciplinary Neuromodulation (I.S.N., C.Y.H., R.G., D.C.d.A., A.R.B., M.J.T., W.S.P.), Universidade de Sao Paulo, Brazil; Neuromodulation Center (A.L.Z.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; School of Medicine (R.G.), Universidade da Cidade de Sao Paulo UNICID, Sao Paulo; and Department of Neurology (R.L.O.A.), Universidade Federal do Amazonas, Manaus, Brazil
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Deep TMS of the insula using the H-coil modulates dopamine release: a crossover [ 11C] PHNO-PET pilot trial in healthy humans. Brain Imaging Behav 2019; 12:1306-1317. [PMID: 29170944 DOI: 10.1007/s11682-017-9800-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Modulating the function of the insular cortex could be a novel therapeutic strategy to treat addiction to a variety of drugs of abuse as this region has been implicated in mediating drug reward and addictive processes. The recent advent of the H-coil has permitted the targeting of deeper brain structures which was not previously feasible. The goal of this study was to bilaterally target the insular region using the H-coil with repetitive Transcranial Magnetic Stimulation (rTMS) and subsequently measure changes in dopamine levels using Positron Emission Tomography (PET) with [11C]-(+)-propyl-hexahydro-naphtho-oxazin (PHNO). This was a within-subject, crossover, blinded and sham-controlled pilot study. Eight healthy, right-handed subjects, aged 19-45, participated in the investigation. All subjects underwent 3 PHNO-PET scans preceded by rTMS (sham, 1 Hz or 10 Hz), on 3 separate days. Low frequency rTMS (1 Hz), targeting the insular cortex, significantly decreased dopamine levels in the substantia nigra, sensorimotor striatum and associative striatum. Replicating this study in tobacco smokers or alcoholics would be a logical follow-up to assess whether H-coil stimulation of the bilateral insula can be employed as a treatment option for addiction. Trial registration: NCT02212405.
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Lio G, Thobois S, Ballanger B, Lau B, Boulinguez P. Removing deep brain stimulation artifacts from the electroencephalogram: Issues, recommendations and an open-source toolbox. Clin Neurophysiol 2018; 129:2170-2185. [PMID: 30144660 DOI: 10.1016/j.clinph.2018.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 07/23/2018] [Accepted: 07/28/2018] [Indexed: 12/30/2022]
Abstract
A major question for deep brain stimulation (DBS) research is understanding how DBS of one target area modulates activity in different parts of the brain. EEG gives privileged access to brain dynamics, but its use with implanted patients is limited since DBS adds significant high-amplitude electrical artifacts that can completely obscure neural activity measured using EEG. Here, we systematically review and discuss the methods available for removing DBS artifacts. These include simple techniques such as oversampling, antialiasing analog filtering and digital low-pass filtering, which are necessary but typically not sufficient to fully remove DBS artifacts when each is used in isolation. We also cover more advanced methods, including techniques tracking outliers in the frequency-domain, which can be effective, but are rarely used. The reason for that is twofold: First, it requires advanced skills in signal processing since no user friendly tool for removing DBS artifacts is currently available. Second, it involves fine-tuning to avoid over-aggressive filtering. We highlight an open-source toolbox incorporating most artifact removal methods, allowing users to combine different strategies.
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Affiliation(s)
- Guillaume Lio
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, Centre de Neuroscience Cognitive, Bron, France
| | - Stéphane Thobois
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, Centre de Neuroscience Cognitive, Bron, France; Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, Bron, France
| | - Bénédicte Ballanger
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Brian Lau
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, F-75013 Paris, France
| | - Philippe Boulinguez
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France.
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Transcranial Direct Current Stimulation (tDCS): A Promising Treatment for Major Depressive Disorder? Brain Sci 2018; 8:brainsci8050081. [PMID: 29734768 PMCID: PMC5977072 DOI: 10.3390/brainsci8050081] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) opens new perspectives in the treatment of major depressive disorder (MDD), because of its ability to modulate cortical excitability and induce long-lasting effects. The aim of this review is to summarize the current status of knowledge regarding tDCS application in MDD. Methods: In this review, we searched for articles published in PubMed/MEDLINE from the earliest available date to February 2018 that explored clinical and cognitive effects of tDCS in MDD. Results: Despite differences in design and stimulation parameters, the examined studies indicated beneficial effects of tDCS for MDD. These preliminary results, the non-invasiveness of tDCS, and its good tolerability support the need for further research on this technique. Conclusions: tDCS constitutes a promising therapeutic alternative for patients with MDD, but its place in the therapeutic armamentarium remains to be determined.
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Distinct brain metabolic patterns separately associated with cognition, motor function, and aging in Parkinson's disease dementia. Neurobiol Aging 2017; 60:81-91. [DOI: 10.1016/j.neurobiolaging.2017.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/16/2017] [Accepted: 08/19/2017] [Indexed: 11/20/2022]
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Sander CY, Hesse S. News and views on in-vivo imaging of neurotransmission using PET and MRI. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2017; 61:414-428. [PMID: 28750497 PMCID: PMC5916779 DOI: 10.23736/s1824-4785.17.03019-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Molecular neuroimaging with PET is an integrated tool in psychiatry research and drug-development for as long as this modality has been available, in particular for studying neurotransmission and endogenous neurotransmitter release. Pharmacologic, behavioral and other types of challenges are currently applied to induce changes in neurochemical levels that can be inferred through their effects on changes in receptor binding and related outcome measures. Based on the availability of tracers that are sensitive for measuring neurotransmitter release these experiments have focused on the brain's dopamine system, while recent developments have extended those studies to other targets such as the serotonin or choline system. With the introduction of hybrid, truly simultaneous PET/MRI systems, in-vivo imaging of the dynamics of neuroreceptor signal transmission in the brain using PET and functional MRI (fMRI) has become possible. fMRI has the ability to provide information about the effects of receptor function that are complementary to the PET measurement. Dynamic acquisition of both PET and fMRI signals enables not only an in-vivo real-time assessment of neurotransmitter or drug binding to receptors but also dynamic receptor adaptations and receptor-specific neurotransmission. While fMRI temporal resolution is comparatively fast in relation to PET, the timescale of observable biological processes is highly dependent on the kinetics of radiotracers and study design. Overall, the combination of the specificity of PET radiotracers to neuroreceptors, fMRI signal as a functional readout and integrated study design promises to expand our understanding of the location, propagation and connections of brain activity in health and disease.
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Affiliation(s)
- Christin Y Sander
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA -
- Harvard Medical School, Boston, MA, USA -
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- Integrated Treatment and Research Center (IFB) Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
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Hallett M, Di Iorio R, Rossini PM, Park JE, Chen R, Celnik P, Strafella AP, Matsumoto H, Ugawa Y. Contribution of transcranial magnetic stimulation to assessment of brain connectivity and networks. Clin Neurophysiol 2017; 128:2125-2139. [PMID: 28938143 DOI: 10.1016/j.clinph.2017.08.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/31/2017] [Accepted: 08/12/2017] [Indexed: 01/01/2023]
Abstract
The goal of this review is to show how transcranial magnetic stimulation (TMS) techniques can make a contribution to the study of brain networks. Brain networks are fundamental in understanding how the brain operates. Effects on remote areas can be directly observed or identified after a period of stimulation, and each section of this review will discuss one method. EEG analyzed following TMS is called TMS-evoked potentials (TEPs). A conditioning TMS can influence the effect of a test TMS given over the motor cortex. A disynaptic connection can be tested also by assessing the effect of a pre-conditioning stimulus on the conditioning-test pair. Basal ganglia-cortical relationships can be assessed using electrodes placed in the process of deep brain stimulation therapy. Cerebellar-cortical relationships can be determined using TMS over the cerebellum. Remote effects of TMS on the brain can be found as well using neuroimaging, including both positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). The methods complement each other since they give different views of brain networks, and it is often valuable to use more than one technique to achieve converging evidence. The final product of this type of work is to show how information is processed and transmitted in the brain.
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Affiliation(s)
- Mark Hallett
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | - Riccardo Di Iorio
- Department of Geriatrics, Institute of Neurology, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli Foundation, Rome, Italy
| | - Paolo Maria Rossini
- Department of Geriatrics, Institute of Neurology, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli Foundation, Rome, Italy; Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jung E Park
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA; Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Robert Chen
- Krembil Research Institute, University of Toronto, Toronto, Canada; Department of Medicine (Neurology), University of Toronto, Toronto, Canada
| | - Pablo Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, USA
| | - Antonio P Strafella
- Krembil Research Institute, University of Toronto, Toronto, Canada; Morton and Gloria Shulman Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Toronto Western Hospital, UHN, Canada; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Ontario, Canada
| | | | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Japan; Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Japan
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Herrington TM, Cheng JJ, Eskandar EN. Mechanisms of deep brain stimulation. J Neurophysiol 2015; 115:19-38. [PMID: 26510756 DOI: 10.1152/jn.00281.2015] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/22/2015] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) is widely used for the treatment of movement disorders including Parkinson's disease, essential tremor, and dystonia and, to a lesser extent, certain treatment-resistant neuropsychiatric disorders including obsessive-compulsive disorder. Rather than a single unifying mechanism, DBS likely acts via several, nonexclusive mechanisms including local and network-wide electrical and neurochemical effects of stimulation, modulation of oscillatory activity, synaptic plasticity, and, potentially, neuroprotection and neurogenesis. These different mechanisms vary in importance depending on the condition being treated and the target being stimulated. Here we review each of these in turn and illustrate how an understanding of these mechanisms is inspiring next-generation approaches to DBS.
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Affiliation(s)
- Todd M Herrington
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Jennifer J Cheng
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Emad N Eskandar
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Udupa K, Chen R. The mechanisms of action of deep brain stimulation and ideas for the future development. Prog Neurobiol 2015; 133:27-49. [DOI: 10.1016/j.pneurobio.2015.08.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 08/04/2015] [Accepted: 08/15/2015] [Indexed: 12/19/2022]
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Ko JH, Choi YY, Eidelberg D. Graph Theory-Guided Transcranial Magnetic Stimulation in Neurodegenerative Disorders. Bioelectron Med 2014. [DOI: 10.15424/bioelectronmed.2014.00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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