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Silva NA, Barrios-Martinez J, Yeh FC, Hodaie M, Roque D, Boerwinkle VL, Krishna V. Diffusion and functional MRI in surgical neuromodulation. Neurotherapeutics 2024; 21:e00364. [PMID: 38669936 PMCID: PMC11064589 DOI: 10.1016/j.neurot.2024.e00364] [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: 11/06/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Surgical neuromodulation has witnessed significant progress in recent decades. Notably, deep brain stimulation (DBS), delivered precisely within therapeutic targets, has revolutionized the treatment of medication-refractory movement disorders and is now expanding for refractory psychiatric disorders, refractory epilepsy, and post-stroke motor recovery. In parallel, the advent of incisionless treatment with focused ultrasound ablation (FUSA) can offer patients life-changing symptomatic relief. Recent research has underscored the potential to further optimize DBS and FUSA outcomes by conceptualizing the therapeutic targets as critical nodes embedded within specific brain networks instead of strictly anatomical structures. This paradigm shift was facilitated by integrating two imaging modalities used regularly in brain connectomics research: diffusion MRI (dMRI) and functional MRI (fMRI). These advanced imaging techniques have helped optimize the targeting and programming techniques of surgical neuromodulation, all while holding immense promise for investigations into treating other neurological and psychiatric conditions. This review aims to provide a fundamental background of advanced imaging for clinicians and scientists, exploring the synergy between current and future approaches to neuromodulation as they relate to dMRI and fMRI capabilities. Focused research in this area is required to optimize existing, functional neurosurgical treatments while serving to build an investigative infrastructure to unlock novel targets to alleviate the burden of other neurological and psychiatric disorders.
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Affiliation(s)
- Nicole A Silva
- Department of Neurological Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Daniel Roque
- Department of Neurology, University of North Carolina in Chapel Hill, NC, USA
| | - Varina L Boerwinkle
- Department of Neurology, University of North Carolina in Chapel Hill, NC, USA
| | - Vibhor Krishna
- Department of Neurological Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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El Ouadih Y, Marques A, Pereira B, Luisoni M, Claise B, Coste J, Sontheimer A, Chaix R, Debilly B, Derost P, Morand D, Durif F, Lemaire JJ. Deep brain stimulation of the subthalamic nucleus in severe Parkinson's disease: relationships between dual-contact topographic setting and 1-year worsening of speech and gait. Acta Neurochir (Wien) 2023; 165:3927-3941. [PMID: 37889334 DOI: 10.1007/s00701-023-05843-9] [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: 01/17/2023] [Accepted: 06/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates severe motor fluctuations and dyskinesia in Parkinson's disease, but may result in speech and gait disorders. Among the suspected or demonstrated causes of these adverse effects, we focused on the topography of contact balance (CB; individual, right and left relative dual positions), a scantly studied topic, analyzing the relationships between symmetric or non-symmetric settings, and the worsening of these signs. METHOD An observational monocentric study was conducted on a series of 92 patients after ethical approval. CB was specified by longitudinal and transversal positions and relation to the STN (CB sub-aspects) and totalized at the patient level (patient CB). CB was deemed symmetric when the two contacts were at the same locations relative to the STN. CB was deemed asymmetric when at least one sub-aspect differed in the patient CB. Baseline and 1-year characteristics were routinely collected: (i) general, namely, Unified Parkinson's Disease Rating Scores (UPDRS), II, III motor and IV, daily levodopa equivalent doses, and Parkinson's Disease Questionnaire of Quality of Life (PDQ39) scores; (ii) specific, namely scores for speech (II-5 and III-18) and axial signs (II-14, III-28, III-29, and III-30). Only significant correlations were considered (p < 0.05). RESULTS Baseline characteristics were comparable (symmetric versus asymmetric). CB settings were related to deteriorations of speech and axial signs: communication PDQ39 and UPDRS speech and gait scores worsened exclusively with symmetric settings; the most influential CB sub-aspect was symmetric longitudinal position. CONCLUSION Our findings suggest that avoiding symmetric CB settings, whether by electrode positioning or shaping of electric fields, could reduce worsening of speech and gait.
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Affiliation(s)
- Youssef El Ouadih
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Ana Marques
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Maxime Luisoni
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Béatrice Claise
- Service de Radiologie, Unité de Neuroradiologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jérôme Coste
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Anna Sontheimer
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Rémi Chaix
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Dominique Morand
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Franck Durif
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France.
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
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Yang B, Wang X, Mo J, Li Z, Hu W, Zhang C, Zhao B, Gao D, Zhang X, Zou L, Zhao X, Guo Z, Zhang J, Zhang K. The altered spontaneous neural activity in patients with Parkinson's disease and its predictive value for the motor improvement of deep brain stimulation. Neuroimage Clin 2023; 38:103430. [PMID: 37182459 PMCID: PMC10197096 DOI: 10.1016/j.nicl.2023.103430] [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: 12/03/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND This study aims to investigate the altered spontaneous neural activity in patients with Parkinson's disease (PD) revealed by amplitudes of low-frequency fluctuations (ALFF) of resting-state fMRI, and the feasibility of using ALFF as neuroimaging predictors for motor improvement after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS Fourty-four patients and 44 healthy controls were included in this study. First, the ALFF of patients with PD was compared with that of controls; then significant clusters were correlated with motor improvement after DBS (unified Parkinson's disease rating scale (UPDRS-III)) and other clinical variables. Second, regression and classification of the machine learning models were conducted to predict motor improvement after DBS. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the classification model. RESULTS Compared with healthy controls, patients with PD showed increased ALFF in the bilateral motor area and decreased ALFF in the bilateral temporal cortex and cerebellum. The Hoehn-Yahr stages correlated with ALFF within the bilateral cerebellum (p = 0.021), and UPDRS-III improvement correlated with ALFF in the left (p < 0.001) and right (p = 0.005) motor areas. The regression model showed a significant correlation between the predicted and observed UPDRS-III changes (R = 0.65, p < 0.001). The ROC analysis revealed an area under the curve (AUC) of 0.94 which differentiated moderate and superior DBS responders. CONCLUSION The results revealed altered ALFF patterns in patients with PD and their correlations with clinical variables. Both binary and continuous ALFF can potentially serve as predictive biomarkers for DBS response.
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Affiliation(s)
- Bowen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zilin Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dongmei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Liangying Zou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xuemin Zhao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhihao Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Bingham CS, Petersen MV, Parent M, McIntyre CC. Evolving characterization of the human hyperdirect pathway. Brain Struct Funct 2023; 228:353-365. [PMID: 36708394 PMCID: PMC10716731 DOI: 10.1007/s00429-023-02610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
The hyperdirect pathway (HDP) represents the main glutamatergic input to the subthalamic nucleus (STN), through which the motor and prefrontal cerebral cortex can modulate basal ganglia activity. Further, direct activation of the motor HDP is thought to be an important component of therapeutic deep brain stimulation (DBS), mediating the disruption of pathological oscillations. Alternatively, unintended recruitment of the prefrontal HDP may partly explain some cognitive side effects of DBS therapy. Previous work describing the HDP has focused on non-human primate (NHP) histological pathway tracings, diffusion-weighted MRI analysis of human white matter, and electrophysiology studies involving paired cortical recordings with DBS. However, none of these approaches alone yields a complete understanding of the complexities of the HDP. As such, we propose that generative modeling methods hold promise to bridge anatomy and physiology results, from both NHPs and humans, into a more detailed representation of the human HDP. Nonetheless, numerous features of the HDP remain to be experimentally described before model-based methods can simulate corticosubthalamic activity with a high degree of scientific detail. Therefore, the goals of this review are to examine the experimental evidence for HDP projections from across the primate neocortex and discuss new data which are required to improve the utility of anatomical and biophysical models of the human corticosubthalamic system.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Martin Parent
- Department of Psychiatry and Neuroscience, Laval University, Quebec, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Neurosurgery, Duke University, Durham, NC, USA.
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Nomogram to Predict Cognitive State Improvement after Deep Brain Stimulation for Parkinson's Disease. Brain Sci 2022; 12:brainsci12060759. [PMID: 35741644 PMCID: PMC9220903 DOI: 10.3390/brainsci12060759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/27/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: Parkinson’s disease (PD) is a common neurodegenerative disease, for which cognitive impairment is a non-motor symptom (NMS). Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for PD. This study established a nomogram to predict cognitive improvement rate after STN-DBS in PD patients. Methods: We retrospectively analyzed 103 PD patients who underwent STN-DBS. Patients were followed up to measure improvement in MoCA scores one year after surgery. Univariate and multivariate logistic regression analyses were used to identify factors affecting improvement in cognitive status. A nomogram was developed to predict this factor. The discrimination and fitting performance were evaluated by receiver operating characteristics (ROC) analysis, calibration diagram, and decision curve analysis (DCA). Results: Among 103 patients, the mean improvement rate of the MoCA score was 37.3% and the median improvement rate was 27.3%, of which 64% improved cognition, 27% worsened cognition, and 8.7% remained unchanged. Logistic multivariate regression analysis showed that years of education, UPDRSIII drug use, MoCA Preop, and MMSE Preop scores were independent factors affecting the cognitive improvement rate. A nomogram model was subsequently developed. The C-index of the nomogram was 0.98 (95%CI, 0.97–1.00), and the area under the ROC was 0.98 (95%CI 0.97–1.00). The calibration plot and DCA demonstrated the goodness-of-fit between nomogram predictions and actual observations. Conclusion: Our nomogram could effectively predict the possibility of achieving good cognitive improvement one year after STN-DBS in patients with PD. This model has value in judging the expected cognitive improvement of patients with PD undergoing STN-DBS.
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Wu L, Canna A, Narvaez O, Ma J, Sang S, Lehto LJ, Sierra A, Tanila H, Zhang Y, Gröhn O, Low WC, Filip P, Mangia S, Michaeli S. Orientation selective DBS of entorhinal cortex and medial septal nucleus modulates activity of rat brain areas involved in memory and cognition. Sci Rep 2022; 12:8565. [PMID: 35595790 PMCID: PMC9122972 DOI: 10.1038/s41598-022-12383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
The recently introduced orientation selective deep brain stimulation (OS-DBS) technique freely controls the direction of the electric field's spatial gradient by using multiple contacts with independent current sources within a multielectrode array. The goal of OS-DBS is to align the electrical field along the axonal track of interest passing through the stimulation site. Here we utilized OS-DBS with a planar 3-channel electrode for stimulating the rat entorhinal cortex (EC) and medial septal nucleus (MSN), two promising areas for DBS treatment of Alzheimer's disease. The brain responses to OS-DBS were monitored by whole brain functional magnetic resonance imaging (fMRI) at 9.4 T with Multi-Band Sweep Imaging with Fourier Transformation (MB-SWIFT). Varying the in-plane OS-DBS stimulation angle in the EC resulted in activity modulation of multiple downstream brain areas involved in memory and cognition. Contrary to that, no angle dependence of brain activations was observed when stimulating the MSN, consistent with predictions based on the electrode configuration and on the main axonal directions of the targets derived from diffusion MRI tractography and histology. We conclude that tuning the OS-DBS stimulation angle modulates the activation of brain areas relevant to Alzheimer's disease, thus holding great promise in the DBS treatment of the disease.
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Affiliation(s)
- Lin Wu
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Antonietta Canna
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.,University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Omar Narvaez
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jun Ma
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
| | - Sheng Sang
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Lauri J Lehto
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Heikki Tanila
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Yuan Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Walter C Low
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
| | - Pavel Filip
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Silvia Mangia
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Shalom Michaeli
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA. .,Radiology Department, Center for MR Research, University of Minnesota, 2021 6th St. SE, Minneapolis, MN, 55455, USA.
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Loh A, Gwun D, Chow CT, Boutet A, Tasserie J, Germann J, Santyr B, Elias G, Yamamoto K, Sarica C, Vetkas A, Zemmar A, Madhavan R, Fasano A, Lozano AM. Probing responses to deep brain stimulation with functional magnetic resonance imaging. Brain Stimul 2022; 15:683-694. [PMID: 35447378 DOI: 10.1016/j.brs.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an established treatment for certain movement disorders and has additionally shown promise for various psychiatric, cognitive, and seizure disorders. However, the mechanisms through which stimulation exerts therapeutic effects are incompletely understood. A technique that may help to address this knowledge gap is functional magnetic resonance imaging (fMRI). This is a non-invasive imaging tool which permits the observation of DBS effects in vivo. OBJECTIVE The objective of this review was to provide a comprehensive overview of studies in which fMRI during active DBS was performed, including studied disorders, stimulated brain regions, experimental designs, and the insights gleaned from stimulation-evoked fMRI responses. METHODS We conducted a systematic review of published human studies in which fMRI was performed during active stimulation in DBS patients. The search was conducted using PubMED and MEDLINE. RESULTS The rate of fMRI DBS studies is increasing over time, with 37 studies identified overall. The median number of DBS patients per study was 10 (range = 1-67, interquartile range = 11). Studies examined fMRI responses in various disease cohorts, including Parkinson's disease (24 studies), essential tremor (3 studies), epilepsy (3 studies), obsessive-compulsive disorder (2 studies), pain (2 studies), Tourette syndrome (1 study), major depressive disorder, anorexia, and bipolar disorder (1 study), and dementia with Lewy bodies (1 study). The most commonly stimulated brain region was the subthalamic nucleus (24 studies). Studies showed that DBS modulates large-scale brain networks, and that stimulation-evoked fMRI responses are related to the site of stimulation, stimulation parameters, patient characteristics, and therapeutic outcomes. Finally, a number of studies proposed fMRI-based biomarkers for DBS treatment, highlighting ways in which fMRI could be used to confirm circuit engagement and refine DBS therapy. CONCLUSION A review of the literature reflects an exciting and expanding field, showing that the combination of DBS and fMRI represents a uniquely powerful tool for simultaneously manipulating and observing neural circuitry. Future work should focus on relatively understudied disease cohorts and stimulated regions, while focusing on the prospective validation of putative fMRI-based biomarkers.
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Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - David Gwun
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Ajmal Zemmar
- Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China; Department of Neurosurgery, University of Louisville, Louisville, KY, United States
| | | | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
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Miao J, Tantawi M, Koa V, Zhang AB, Zhang V, Sharan A, Wu C, Matias CM. Use of Functional MRI in Deep Brain Stimulation in Parkinson's Diseases: A Systematic Review. Front Neurol 2022; 13:849918. [PMID: 35401406 PMCID: PMC8984293 DOI: 10.3389/fneur.2022.849918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Deep brain stimulation (DBS) has been used to modulate aberrant circuits associated with Parkinson's disease (PD) for decades and has shown robust therapeutic benefits. However, the mechanism of action of DBS remains incompletely understood. With technological advances, there is an emerging use of functional magnetic resonance imaging (fMRI) after DBS implantation to explore the effects of stimulation on brain networks in PD. This systematic review was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to summarize peer-reviewed articles published within the past 10 years in which fMRI was employed on patients with PD-DBS. Search in PubMed database provided 353 references, and screenings resulted in a total of 19 studies for qualitative synthesis regarding study designs (fMRI scan timepoints and paradigm), methodology, and PD subtypes. This review concluded that fMRI may be used in patients with PD-DBS after proper safety test; resting-state and block-based fMRI designs have been employed to explore the effects of DBS on brain networks and the mechanism of action of the DBS, respectively. With further validation of safety use of fMRI and advances in imaging techniques, fMRI may play an increasingly important role in better understanding of the mechanism of stimulation as well as in improving clinical care to provide subject-specific neuromodulation treatments.
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Affiliation(s)
- Jingya Miao
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mohamed Tantawi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Victoria Koa
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashley B. Zhang
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Veronica Zhang
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Caio M. Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
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10
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He C, Zhang F, Li L, Jiang C, Li L. Measurement of Lead Localization Accuracy Based on Magnetic Resonance Imaging. Front Neurosci 2021; 15:632822. [PMID: 35002596 PMCID: PMC8727439 DOI: 10.3389/fnins.2021.632822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Post-implantation localization of deep brain stimulation (DBS) lead based on a magnetic resonance (MR) image is widely used. Existing localization methods use artifact center method or template registration method, which may lead to a considerable deviation of > 2 mm, and result in severe side effects or even surgical failure. Accurate measurement of lead position can instantly inform surgeons of the imprecise implantation. This study aimed to identify the influencing factors in DBS lead post-implantation localization approach, analyze their influence, and describe a localization approach that uses the individual template method to reduce the deviation. We verified that reconstructing direction should be parallel or perpendicular to lead direction, instead of the magnetic field. Besides, we used simplified relationship between magnetic field angle and deviation error to correct the localization results. The mean localization error can be reduced after correction and favors the feasibility of direct localization of DBS lead using MR images. We also discussed influence of in vivo noise on localization frequency and the possibility of using only MR images to localize the contacts.
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Affiliation(s)
- Changgeng He
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Feng Zhang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Linze Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Changqing Jiang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China
- Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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11
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Steinmüller JB, Bjarkam CR, Orlowski D, Sørensen JCH, Glud AN. Anterograde Tracing From the Göttingen Minipig Motor and Prefrontal Cortex Displays a Topographic Subthalamic and Striatal Axonal Termination Pattern Comparable to Previous Findings in Primates. Front Neural Circuits 2021; 15:716145. [PMID: 34899195 PMCID: PMC8661455 DOI: 10.3389/fncir.2021.716145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/02/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Deep brain stimulation (DBS) of the dorsal subthalamic nucleus (STN) is a validated neurosurgical treatment of Parkinson’s Disease (PD). To investigate the mechanism of action, including potential DBS induced neuroplasticity, we have previously used a minipig model of Parkinson’s Disease, although the basal ganglia circuitry was not elucidated in detail. Aim: To describe the cortical projections from the primary motor cortex (M1) to the basal ganglia and confirm the presence of a cortico-striatal pathway and a hyperdirect pathway to the subthalamic nucleus, respectively, which is known to exist in primates. Materials and Methods: Five female Göttingen minipigs were injected into the primary motor cortex (n = 4) and adjacent prefrontal cortex (n = 1) with the anterograde neuronal tracer, Biotinylated Dextran Amine (BDA). 4 weeks later the animals were sacrificed and the brains cryosectioned into 30 μm thick coronal sections for subsequent microscopic analysis. Results: The hyperdirect axonal connections from the primary motor cortex were seen to terminate in the dorsolateral STN, whereas the axonal projections from the prefrontal cortex terminated medially in the STN. Furthermore, striatal tracing from the motor cortex was especially prominent in the dorsolateral putamen and less so in the dorsolateral caudate nucleus. The prefrontal efferents were concentrated mainly in the caudate nucleus and to a smaller degree in the juxtacapsular dorsal putamen, but they were also found in the nucleus accumbens and ventral prefrontal cortex. Discussion: The organization of the Göttingen minipig basal ganglia circuitry is in accordance with previous descriptions in primates. The existence of a cortico-striatal and hyperdirect basal ganglia pathway in this non-primate, large animal model may accordingly permit further translational studies on STN-DBS induced neuroplasticity of major relevance for future DBS treatments.
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Affiliation(s)
- Johannes Bech Steinmüller
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Dariusz Orlowski
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Andreas Nørgaard Glud
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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12
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Rahimpour S, Rajkumar S, Hallett M. The Supplementary Motor Complex in Parkinson's Disease. J Mov Disord 2021; 15:21-32. [PMID: 34814237 PMCID: PMC8820882 DOI: 10.14802/jmd.21075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and nonmotor symptoms. Although the basal ganglia is traditionally the primary brain region implicated in this disease process, this limited view ignores the roles of the cortex and cerebellum that are networked with the basal ganglia to support motor and cognitive functions. In particular, recent research has highlighted dysfunction in the supplementary motor complex (SMC) in patients with PD. Using the PubMed and Google Scholar search engines, we identified research articles using keywords pertaining to the involvement of the SMC in action sequencing impairments, temporal processing disturbances, and gait impairment in patients with PD. A review of abstracts and full-text articles was used to identify relevant articles. In this review of 63 articles, we focus on the role of the SMC in PD, highlighting anatomical and functional data to create new perspectives in understanding clinical symptoms and, potentially, new therapeutic targets. The SMC has a nuanced role in the pathophysiology of PD, with both hypo- and hyperactivation associated with various symptoms. Further studies using more standardized patient populations and functional tasks are needed to more clearly elucidate the role of this region in the pathophysiology and treatment of PD.
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Affiliation(s)
- Shervin Rahimpour
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Shashank Rajkumar
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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13
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Optogenetic stimulation of glutamatergic neurons in the cuneiform nucleus controls locomotion in a mouse model of Parkinson's disease. Proc Natl Acad Sci U S A 2021; 118:2110934118. [PMID: 34670837 DOI: 10.1073/pnas.2110934118] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 01/22/2023] Open
Abstract
In Parkinson's disease (PD), the loss of midbrain dopaminergic cells results in severe locomotor deficits, such as gait freezing and akinesia. Growing evidence indicates that these deficits can be attributed to the decreased activity in the mesencephalic locomotor region (MLR), a brainstem region controlling locomotion. Clinicians are exploring the deep brain stimulation of the MLR as a treatment option to improve locomotor function. The results are variable, from modest to promising. However, within the MLR, clinicians have targeted the pedunculopontine nucleus exclusively, while leaving the cuneiform nucleus unexplored. To our knowledge, the effects of cuneiform nucleus stimulation have never been determined in parkinsonian conditions in any animal model. Here, we addressed this issue in a mouse model of PD, based on the bilateral striatal injection of 6-hydroxydopamine, which damaged the nigrostriatal pathway and decreased locomotor activity. We show that selective optogenetic stimulation of glutamatergic neurons in the cuneiform nucleus in mice expressing channelrhodopsin in a Cre-dependent manner in Vglut2-positive neurons (Vglut2-ChR2-EYFP mice) increased the number of locomotor initiations, increased the time spent in locomotion, and controlled locomotor speed. Using deep learning-based movement analysis, we found that the limb kinematics of optogenetic-evoked locomotion in pathological conditions were largely similar to those recorded in intact animals. Our work identifies the glutamatergic neurons of the cuneiform nucleus as a potentially clinically relevant target to improve locomotor activity in parkinsonian conditions. Our study should open avenues to develop the targeted stimulation of these neurons using deep brain stimulation, pharmacotherapy, or optogenetics.
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14
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Silemek B, Seifert F, Petzold J, Hoffmann W, Pfeiffer H, Speck O, Rose G, Ittermann B, Winter L. Rapid safety assessment and mitigation of radiofrequency induced implant heating using small root mean square sensors and the sensor matrix Q s. Magn Reson Med 2021; 87:509-527. [PMID: 34397114 DOI: 10.1002/mrm.28968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Rapid detection and mitigation of radiofrequency (RF)-induced implant heating during MRI based on small and low-cost embedded sensors. THEORY AND METHODS A diode and a thermistor are embedded at the tip of an elongated mock implant. RF-induced voltages or temperature change measured by these root mean square (RMS) sensors are used to construct the sensor Q-Matrix (QS ). Hazard prediction, monitoring and parallel transmit (pTx)-based mitigation using these sensors is demonstrated in benchtop measurements at 300 MHz and within a 3T MRI. RESULTS QS acquisition and mitigation can be performed in <20 ms demonstrating real-time capability. The acquisitions can be performed using safe low powers (<3 W) due to the high reading precision of the diode (126 µV) and thermistor (26 µK). The orthogonal projection method used for pTx mitigation was able to reduce the induced signals and temperatures in all 155 investigated locations. Using the QS approach in a pTx capable 3T MRI with either a two-channel body coil or an eight-channel head coil, RF-induced heating was successfully assessed, monitored and mitigated while the image quality outside the implant region was preserved. CONCLUSION Small (<1.5 mm3 ) and low-cost (<1 €) RMS sensors embedded in an implant can provide all relevant information to predict, monitor and mitigate RF-induced heating in implants, while preserving image quality. The proposed pTx-based QS approach is independent of simulations or in vitro testing and therefore complements these existing safety assessments.
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Affiliation(s)
- Berk Silemek
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Frank Seifert
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Johannes Petzold
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Werner Hoffmann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Harald Pfeiffer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Oliver Speck
- Biomedical Magnetic Resonance, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Georg Rose
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.,Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Lukas Winter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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15
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Zhang C, Lai Y, Li J, He N, Liu Y, Li Y, Li H, Wei H, Yan F, Horn A, Li D, Sun B. Subthalamic and Pallidal Stimulations in Patients with Parkinson's Disease: Common and Dissociable Connections. Ann Neurol 2021; 90:670-682. [PMID: 34390280 PMCID: PMC9292442 DOI: 10.1002/ana.26199] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The subthalamic nucleus (STN) and internal globus pallidus (GPi) are the most effective targets in deep brain stimulation (DBS) for Parkinson's disease (PD). However, the common and specific effects on brain connectivity of stimulating the 2 nuclei remain unclear. METHODS Patients with PD receiving STN-DBS (n = 27, 6 women, mean age 64.8 years) or GPi-DBS (n = 28, 13 women, mean age 64.6 years) were recruited for resting-state functional magnetic resonance imaging to assess the effects of STN-DBS and GPi-DBS on brain functional dynamics. RESULTS The functional connectivity both between the somatosensory-motor cortices and thalamus, and between the somatosensory-motor cortices and cerebellum decreased in the DBS-on state compared with the off state (p < 0.05). The changes in thalamocortical connectivity correlated with DBS-induced motor improvement (p < 0.05) and were negatively correlated with the normalized intersection volume of tissues activated at both DBS targets (p < 0.05). STN-DBS modulated functional connectivity among a wider range of brain areas than GPi-DBS (p = 0.009). Notably, only STN-DBS affected connectivity between the postcentral gyrus and cerebellar vermis (p < 0.001) and between the somatomotor and visual networks (p < 0.001). INTERPRETATION Our findings highlight common alterations in the motor pathway and its relationship with the motor improvement induced by both STN- and GPi-DBS. The effects on cortico-cerebellar and somatomotor-visual functional connectivity differed between groups, suggesting differentiated neural modulation of the 2 target sites. Our results provide mechanistic insight and yield the potential to refine target selection strategies for focal brain stimulation in PD. ANN NEUROL 2021.
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Affiliation(s)
- Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China.,Department of Anatomy and Physiology, Collaborative Innovation Centre for Brain Science, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Information Science and Technology, Shanghai Tech University, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyang Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Hyder R, Højlund A, Jensen M, Johnsen EL, Østergaard K, Shtyrov Y. STN-DBS affects language processing differentially in Parkinson's disease: Multiple-case MEG study. Acta Neurol Scand 2021; 144:132-141. [PMID: 33961289 DOI: 10.1111/ane.13423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In this study, we investigated the effects of bilateral and unilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) in PD patients on neural responses associated with two aspects of spoken language processing: semantics of action-related verbs and morphosyntactic processing. MATERIALS AND METHODS Using a passive unattended paradigm to present spoken linguistic stimuli, we recorded magnetoencephalographic (MEG) responses in three PD patients in four DBS conditions: left unilateral STN-DBS, right unilateral STN-DBS, bilateral STN-DBS, and no STN-DBS. To ensure that any observed effects of DBS on the neuromagnetic responses could be attributed to the linguistic context per se and were not merely induced by the electrical stimulation, we assessed the effects of STN-DBS on linguistic contrasts within each stimulation condition. Hence, we contrasted the processing of action vs. abstract verbs as well as the processing of correct vs. incorrect morphosyntactic inflections within each DBS condition. RESULTS The results revealed that, compared to the DBS-off state, both bilateral and right unilateral stimulation of the STN yielded significant dissociations in the processing of action and abstract verbs, with greater neuromagnetic responses for action verbs compared to abstract verbs. For morphosyntax processing, only left unilateral stimulation yielded significant dissociations (relative to the DBS-off state), with greater neuromagnetic responses to the incorrect inflections compared to the correct inflections. CONCLUSION The results reflect differential effects of unilateral and bilateral STN-DBS on neuromagnetic responses associated with the processing of spoken language. They suggest that different specific aspects of linguistic information processing in PD are affected differently by STN-DBS.
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Affiliation(s)
- Rasha Hyder
- Center of Functionally Integrative Neuroscience (CFIN) Department of Clinical Medicine Aarhus University Aarhus Denmark
- Institute of Clinical Neuroscience and Medical Psychology Medical Faculty Heinrich‐Heine University Düsseldorf Germany
| | - Andreas Højlund
- Center of Functionally Integrative Neuroscience (CFIN) Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Mads Jensen
- Center of Functionally Integrative Neuroscience (CFIN) Department of Clinical Medicine Aarhus University Aarhus Denmark
- Research Unit for Robophilosophy and Integrative Social Robotics Interacting Minds Centre Aarhus University Aarhus Denmark
| | - Erik L. Johnsen
- Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Karen Østergaard
- Department of Neurology Aarhus University Hospital Aarhus Denmark
- Sano Private Hospital Denmark
| | - Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN) Department of Clinical Medicine Aarhus University Aarhus Denmark
- Centre for Cognition and Decision Making Institute for Cognitive Neuroscience HSE University Moscow Russian Federation
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17
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Predicting optimal deep brain stimulation parameters for Parkinson's disease using functional MRI and machine learning. Nat Commun 2021; 12:3043. [PMID: 34031407 PMCID: PMC8144408 DOI: 10.1038/s41467-021-23311-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Commonly used for Parkinson’s disease (PD), deep brain stimulation (DBS) produces marked clinical benefits when optimized. However, assessing the large number of possible stimulation settings (i.e., programming) requires numerous clinic visits. Here, we examine whether functional magnetic resonance imaging (fMRI) can be used to predict optimal stimulation settings for individual patients. We analyze 3 T fMRI data prospectively acquired as part of an observational trial in 67 PD patients using optimal and non-optimal stimulation settings. Clinically optimal stimulation produces a characteristic fMRI brain response pattern marked by preferential engagement of the motor circuit. Then, we build a machine learning model predicting optimal vs. non-optimal settings using the fMRI patterns of 39 PD patients with a priori clinically optimized DBS (88% accuracy). The model predicts optimal stimulation settings in unseen datasets: a priori clinically optimized and stimulation-naïve PD patients. We propose that fMRI brain responses to DBS stimulation in PD patients could represent an objective biomarker of clinical response. Upon further validation with additional studies, these findings may open the door to functional imaging-assisted DBS programming. Deep brain stimulation programming for Parkinson’s disease entails the assessment of a large number of possible simulation settings, requiring numerous clinic visits after surgery. Here, the authors show that patterns of functional MRI can predict the optimal stimulation settings.
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18
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Gibson WS, Rusheen AE, Oh Y, In MH, Gorny KR, Felmlee JP, Klassen BT, Jung SJ, Min HK, Lee KH, Jo HJ. Symptom-specific differential motor network modulation by deep brain stimulation in Parkinson's disease. J Neurosurg 2021; 135:1771-1779. [PMID: 33990083 PMCID: PMC10193504 DOI: 10.3171/2020.10.jns202277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/06/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established neurosurgical treatment for the motor symptoms of Parkinson's disease (PD). While often highly effective, DBS does not always yield optimal therapeutic outcomes, and stimulation-induced adverse effects, including paresthesia, muscle contractions, and nausea/lightheadedness, commonly occur and can limit the efficacy of stimulation. Currently, objective metrics do not exist for monitoring neural changes associated with stimulation-induced therapeutic and adverse effects. METHODS In the present study, the authors combined intraoperative functional MRI (fMRI) with STN DBS in 20 patients with PD to test the hypothesis that stimulation-induced blood oxygen level-dependent signals contained predictive information concerning the therapeutic and adverse effects of stimulation. RESULTS As expected, DBS resulted in blood oxygen level-dependent activation in myriad motor regions, including the primary motor cortex, caudate, putamen, thalamus, midbrain, and cerebellum. Across the patients, DBS-induced improvements in contralateral Unified Parkinson's Disease Rating Scale tremor subscores correlated with activation of thalamic, brainstem, and cerebellar regions. In addition, improvements in rigidity and bradykinesia subscores correlated with activation of the primary motor cortex. Finally, activation of specific sensorimotor-related subregions correlated with the presence of DBS-induced adverse effects, including paresthesia and nausea (cerebellar cortex, sensorimotor cortex) and unwanted muscle contractions (caudate and putamen). CONCLUSIONS These results suggest that DBS-induced activation patterns revealed by fMRI contain predictive information with respect to the therapeutic and adverse effects of DBS. The use of fMRI in combination with DBS therefore may hold translational potential to guide and improve clinical stimulator optimization in patients.
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Affiliation(s)
- William S. Gibson
- Departments of Neurologic Surgery
- Department of Neurological Surgery, Northwestern University, Evanston, Illinois; and
| | - Aaron E. Rusheen
- Departments of Neurologic Surgery
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota
| | - Yoonbae Oh
- Departments of Neurologic Surgery
- Biomedical Engineering
| | | | | | | | | | - Sung Jun Jung
- Department of Physiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | | | | | - Hang Joon Jo
- Departments of Neurologic Surgery
- Radiology, and
- Neurology, and
- Department of Physiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
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19
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DiMarzio M, Madhavan R, Hancu I, Fiveland E, Prusik J, Joel S, Gillogly M, Telkes I, Staudt MD, Durphy J, Shin D, Pilitsis JG. Use of Functional MRI to Assess Effects of Deep Brain Stimulation Frequency Changes on Brain Activation in Parkinson Disease. Neurosurgery 2021; 88:356-365. [PMID: 32985661 DOI: 10.1093/neuros/nyaa397] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/27/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Models have been developed for predicting ideal contact and amplitude for subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). Pulse-width is generally varied to modulate the size of the energy field produced. Effects of varying frequency in humans have not been systematically evaluated. OBJECTIVE To examine how altered frequencies affect blood oxygen level-dependent activation in PD. METHODS PD subjects with optimized DBS programming underwent functional magnetic resonance imaging (fMRI). Frequency was altered and fMRI scans/Unified Parkinson Disease Rating Scale motor subunit (UPDRS-III) scores were obtained. Analysis using DBS-OFF data was used to determine which regions were activated during DBS-ON. Peak activity utilizing T-values was obtained and compared. RESULTS At clinically optimized settings (n = 14 subjects), thalamic, globus pallidum externa (GPe), and posterior cerebellum activation were present. Activation levels significantly decreased in the thalamus, anterior cerebellum, and the GPe when frequency was decreased (P < .001). Primary somatosensory cortex activation levels significantly decreased when frequency was increased by 30 Hz, but not 60 Hz. Sex, age, disease/DBS duration, and bilaterality did not significantly affect the data. Retrospective analysis of fMRI activation patterns predicted optimal frequency in 11/14 subjects. CONCLUSION We show the first data with fMRI of STN DBS-ON while synchronizing cycling with magnetic resonance scanning. At clinically optimized settings, an fMRI signature of thalamic, GPe, and posterior cerebellum activation was seen. Reducing frequency significantly decreased thalamic, GPe, and anterior cerebellum activation. Current standard-of-care programming can take up to 6 mo using UPDRS-III testing alone. We provide preliminary evidence that using fMRI signature of frequency may have clinical utility and feasibility.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | | | | | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
| | | | - Michael Gillogly
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Damian Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurology, Albany Medical Center, Albany, New York
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
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20
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Tucker HR, Mahoney E, Akhtar K, Kao TJ, Mamone G, Mikkilineni S, Ravi M, Watkins H, Terrelonge DL, Martin C, Unger K, Kim G, Fiber K, Gupta M, Indajang J, Kochman EM, Sachs N, Feustel P, Molho ES, Pilitsis JG, Shin DS. Motor Thalamic Deep Brain Stimulation Alters Cortical Activity and Shows Therapeutic Utility for Treatment of Parkinson's Disease Symptoms in a Rat Model. Neuroscience 2021; 460:88-106. [PMID: 33631218 DOI: 10.1016/j.neuroscience.2021.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Deep brain stimulation (DBS) in Parkinson's disease (PD) alters neuronal function and network communication to improve motor symptoms. The subthalamic nucleus (STN) is the most common DBS target for PD, but some patients experience adverse effects on memory and cognition. Previously, we reported that DBS of the ventral anterior (VA) and ventrolateral (VL) nuclei of the thalamus and at the interface between the two (VA|VL), collectively VA-VL, relieved forelimb akinesia in the hemiparkinsonian 6-hydroxydopamine (6-OHDA) rat model. To determine the mechanism(s) underlying VA-VL DBS efficacy, we examined how motor cortical neurons respond to VA-VL DBS using single-unit recording electrodes in anesthetized 6-OHDA lesioned rats. VA-VL DBS increased spike frequencies of primary (M1) and secondary (M2) motor cortical pyramidal cells and M2, but not M1, interneurons. To explore the translational merits of VA-VL DBS, we compared the therapeutic window, rate of stimulation-induced dyskinesia onset, and effects on memory between VA-VL and STN DBS. VA-VL and STN DBS had comparable therapeutic windows, induced dyskinesia at similar rates in hemiparkinsonian rats, and adversely affected performance in the novel object recognition (NOR) test in cognitively normal and mildly impaired sham animals. Interestingly, a subset of sham rats with VA-VL implants showed severe cognitive deficits with DBS off. VA-VL DBS improved NOR test performance in these animals. We conclude that VA-VL DBS may exert its therapeutic effects by increasing pyramidal cell activity in the motor cortex and interneuron activity in the M2, with plausible potential to improve memory in PD.
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Affiliation(s)
- Heidi R Tucker
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Emily Mahoney
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kainat Akhtar
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | - Gianna Mamone
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Saisree Mikkilineni
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Maya Ravi
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Hanel Watkins
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Danielle-Lee Terrelonge
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Caryn Martin
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kristen Unger
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Gabrielle Kim
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kyra Fiber
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Megan Gupta
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Jonathan Indajang
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Eliyahu M Kochman
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Natasha Sachs
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Eric S Molho
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA; Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Damian S Shin
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA; Department of Neurology, Albany Medical Center, Albany, NY, USA.
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21
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Wang S, Zhang Y, Lei J, Guo S. Investigation of sensorimotor dysfunction in Parkinson disease by resting-state fMRI. Neurosci Lett 2020; 742:135512. [PMID: 33221477 DOI: 10.1016/j.neulet.2020.135512] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Functional MRI has played a fundamental role in Parkinson's disease(PD) study. In this paper, we performed an independent component analysis (ICA) based on functional networks to reveal the intricate variations on the morphology and functional properties of brain. Our analysis aims at discovering the differences between PD patients with sensorimotor function impairment and normal controls(NC), thus helping to understand the coordination neurological function degeneration in PD objectively. METHOD We investigated the blood oxygen level dependent(BOLD) functional MRI obtained at a 3.0 T MRI scanner. 30 PD patients and 28 NC subjects underwent the scan in resting state. The signals of sensory and motor coordinative control areas in the sensorimotor, insula and cerebellum networks acquired by ICA(Independent Component Analysis)were applied to analyze the functional alterations. Specifically, intra-network analysis was performed with signals in local networks, and inter-network analysis was conducted by functional network connectivity (FNC) with signals across different networks. Two sample T test was carried out to detect the significant (p < 0.05, FDR p < 0.05) functional abnormality in PD patients. CONCLUSION We identified an obvious increase in bilateral posterior insula, but decrease in bilateral cerebellum hemisphere, supplementary motor area(SMA) and precentral gyrus paracentral lobule of left postcentral gyrus. Besides, we found a significantly increased connection between independent component (IC) 13 which was located in right postcentral gyrus and cerebellum. Decreased connections were detected between sensory and motor cortex in sensorimotor network and between cerebellum and insula network by FNC analysis in PD patients as well. DISCUSSION Parkinson's disease derives from the degeneration of the dopaminergic neurons in substantia nigra, and results in decreased secretion of inhibitory neurotransmitter. The significant differences between PD and NC groups in our research maybe explain the clinical manifestations of prominent bradykinesia and multiple extrapyramidal symptoms.
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Affiliation(s)
- Shuaiwen Wang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China.
| | - Yanli Zhang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China
| | - Junqiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China
| | - Shunlin Guo
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China
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22
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Shen L, Jiang C, Hubbard CS, Ren J, He C, Wang D, Dahmani L, Guo Y, Liu Y, Xu S, Meng F, Zhang J, Liu H, Li L. Subthalamic Nucleus Deep Brain Stimulation Modulates 2 Distinct Neurocircuits. Ann Neurol 2020; 88:1178-1193. [PMID: 32951262 DOI: 10.1002/ana.25906] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Current understanding of the neuromodulatory effects of deep brain stimulation (DBS) on large-scale brain networks remains elusive, largely due to the lack of techniques that can reveal DBS-induced activity at the whole-brain level. Using a novel 3T magnetic resonance imaging (MRI)-compatible stimulator, we investigated whole-brain effects of subthalamic nucleus (STN) stimulation in patients with Parkinson disease. METHODS Fourteen patients received STN-DBS treatment and participated in a block-design functional MRI (fMRI) experiment, wherein stimulations were delivered during "ON" blocks interleaved with "OFF" blocks. fMRI responses to low-frequency (60Hz) and high-frequency(130Hz) STN-DBS were measured 1, 3, 6, and 12 months postsurgery. To ensure reliability, multiple runs (48 minutes) of fMRI data were acquired at each postsurgical visit. Presurgical resting-state fMRI (30 minutes) data were also acquired. RESULTS Two neurocircuits showed highly replicable, but distinct responses to STN-DBS. A circuit involving the globus pallidus internus (GPi), thalamus, and deep cerebellar nuclei was significantly activated, whereas another circuit involving the primary motor cortex (M1), putamen, and cerebellum showed DBS-induced deactivation. These 2 circuits were dissociable in terms of their DBS-induced responses and resting-state functional connectivity. The GPi circuit was frequency-dependent, selectively responding to high-frequency stimulation, whereas the M1 circuit was responsive in a time-dependent manner, showing enhanced deactivation over time. Finally, activation of the GPi circuit was associated with overall motor improvement, whereas M1 circuit deactivation was related to reduced bradykinesia. INTERPRETATION Concurrent DBS-fMRI using 3T revealed 2 distinct circuits that responded differentially to STN-DBS and were related to divergent symptoms, a finding that may provide novel insights into the neural mechanisms underlying DBS. ANN NEUROL 2020;88:1178-1193.
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Affiliation(s)
- Lunhao Shen
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Changqing Jiang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Catherine S Hubbard
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Jianxun Ren
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Changgeng He
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Louisa Dahmani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Yi Guo
- Peking Union Medical College Hospital, Beijing, China
| | - Yiming Liu
- Qilu Hospital of Shandong University, Jinan, China
| | - Shujun Xu
- Qilu Hospital of Shandong University, Jinan, China
| | - Fangang Meng
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China.,IDG(International Data Group)/McGovern Institute for Brain Research at Tsinghua University, Beijing, China.,Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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23
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Thompson WH, Nair R, Oya H, Esteban O, Shine JM, Petkov CI, Poldrack RA, Howard M, Adolphs R. A data resource from concurrent intracranial stimulation and functional MRI of the human brain. Sci Data 2020; 7:258. [PMID: 32759965 PMCID: PMC7406507 DOI: 10.1038/s41597-020-00595-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 11/08/2022] Open
Abstract
Mapping the causal effects of one brain region on another is a challenging problem in neuroscience that we approached through invasive direct manipulation of brain function together with concurrent whole-brain measurement of the effects produced. Here we establish a unique resource and present data from 26 human patients who underwent electrical stimulation during functional magnetic resonance imaging (es-fMRI). The patients had medically refractory epilepsy requiring surgically implanted intracranial electrodes in cortical and subcortical locations. One or multiple contacts on these electrodes were stimulated while simultaneously recording BOLD-fMRI activity in a block design. Multiple runs exist for patients with different stimulation sites. We describe the resource, data collection process, preprocessing using the fMRIPrep analysis pipeline and management of artifacts, and provide end-user analyses to visualize distal brain activation produced by site-specific electrical stimulation. The data are organized according to the brain imaging data structure (BIDS) specification, and are available for analysis or future dataset contributions on openneuro.org including both raw and preprocessed data.
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Affiliation(s)
- W H Thompson
- Department of Psychology, Stanford University, Stanford, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - R Nair
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - H Oya
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - O Esteban
- Department of Psychology, Stanford University, Stanford, USA
| | - J M Shine
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - C I Petkov
- Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - R A Poldrack
- Department of Psychology, Stanford University, Stanford, USA
| | - M Howard
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - R Adolphs
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
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24
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Boutet A, Chow CT, Narang K, Elias GJB, Neudorfer C, Germann J, Ranjan M, Loh A, Martin AJ, Kucharczyk W, Steele CJ, Hancu I, Rezai AR, Lozano AM. Improving Safety of MRI in Patients with Deep Brain Stimulation Devices. Radiology 2020; 296:250-262. [PMID: 32573388 DOI: 10.1148/radiol.2020192291] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
MRI is a valuable clinical and research tool for patients undergoing deep brain stimulation (DBS). However, risks associated with imaging DBS devices have led to stringent regulations, limiting the clinical and research utility of MRI in these patients. The main risks in patients with DBS devices undergoing MRI are heating at the electrode tips, induced currents, implantable pulse generator dysfunction, and mechanical forces. Phantom model studies indicate that electrode tip heating remains the most serious risk for modern DBS devices. The absence of adverse events in patients imaged under DBS vendor guidelines for MRI demonstrates the general safety of MRI for patients with DBS devices. Moreover, recent work indicates that-given adequate safety data-patients may be imaged outside these guidelines. At present, investigators are primarily focused on improving DBS device and MRI safety through the development of tools, including safety simulation models. Existing guidelines provide a standardized framework for performing safe MRI in patients with DBS devices. It also highlights the possibility of expanding MRI as a tool for research and clinical care in these patients going forward.
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Affiliation(s)
- Alexandre Boutet
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clement T Chow
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Keshav Narang
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Gavin J B Elias
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clemens Neudorfer
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Jürgen Germann
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Manish Ranjan
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Aaron Loh
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Alastair J Martin
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Walter Kucharczyk
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Christopher J Steele
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ileana Hancu
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ali R Rezai
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Andres M Lozano
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
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Multivariate pattern classification on BOLD activation pattern induced by deep brain stimulation in motor, associative, and limbic brain networks. Sci Rep 2020; 10:7528. [PMID: 32372021 PMCID: PMC7200672 DOI: 10.1038/s41598-020-64547-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/16/2020] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) has been shown to be an effective treatment for movement disorders and it is now being extended to the treatment of psychiatric disorders. Functional magnetic resonance imaging (fMRI) studies indicate that DBS stimulation targets dependent brain network effects, in networks that respond to stimulation. Characterizing these patterns is crucial for linking DBS-induced therapeutic and adverse effects. Conventional DBS-fMRI, however, lacks the sensitivity needed for decoding multidimensional information such as spatially diffuse patterns. We report here on the use of a multivariate pattern analysis (MVPA) to demonstrate that stimulation of three DBS targets (STN, subthalamic nucleus; GPi, globus pallidus internus; NAc, nucleus accumbens) evoked a sufficiently distinctive blood-oxygen-level-dependent (BOLD) activation in swine brain. The findings indicate that STN and GPi evoke a similar motor network pattern, while NAc shows a districted associative and limbic pattern. The findings show that MVPA could be effectively applied to overlapping or sparse BOLD patterns which are often found in DBS. Future applications are expected employ MVPA fMRI to identify the proper stimulation target dependent brain circuitry for a DBS outcome.
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DiMarzio M, Madhavan R, Joel S, Hancu I, Fiveland E, Prusik J, Gillogly M, Rashid T, MacDonell J, Ashe J, Telkes I, Feustel P, Staudt MD, Shin DS, Durphy J, Hwang R, Hanspal E, Pilitsis JG. Use of Functional Magnetic Resonance Imaging to Assess How Motor Phenotypes of Parkinson's Disease Respond to Deep Brain Stimulation. Neuromodulation 2020; 23:515-524. [PMID: 32369255 DOI: 10.1111/ner.13160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well-accepted treatment of Parkinson's disease (PD). Motor phenotypes include tremor-dominant (TD), akinesia-rigidity (AR), and postural instability gait disorder (PIGD). The mechanism of action in how DBS modulates motor symptom relief remains unknown. OBJECTIVE Blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) was used to determine whether the functional activity varies in response to DBS depending on PD phenotypes. MATERIALS AND METHODS Subjects underwent an fMRI scan with DBS cycling ON and OFF. The effects of DBS cycling on BOLD activation in each phenotype were documented through voxel-wise analysis. For each region of interest, ANOVAs were performed using T-values and covariate analyses were conducted. Further, a correlation analysis was performed comparing stimulation settings to T-values. Lastly, T-values of subjects with motor improvement were compared to those who worsened. RESULTS As a group, BOLD activation with DBS-ON resulted in activation in the motor thalamus (p < 0.01) and globus pallidus externa (p < 0.01). AR patients had more activation in the supplementary motor area (SMA) compared to PIGD (p < 0.01) and TD cohorts (p < 0.01). Further, the AR cohort had more activation in primary motor cortex (MI) compared to the TD cohort (p = 0.02). Implanted nuclei (p = 0.01) and phenotype (p = <0.01) affected activity in MI and phenotype alone affected SMA activity (p = <0.01). A positive correlation was seen between thalamic activation and pulse-width (p = 0.03) and between caudate and total electrical energy delivered (p = 0.04). CONCLUSIONS These data suggest that DBS modulates network activity differently based on patient motor phenotype. Improved understanding of these differences may further our knowledge about the mechanisms of DBS action on PD motor symptoms and to optimize treatment.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | | | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Michael Gillogly
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Tanweer Rashid
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Jacquelyn MacDonell
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Damian S Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Roy Hwang
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Era Hanspal
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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Noor MS, Yu L, Murari K, Kiss ZHT. Neurovascular coupling during deep brain stimulation. Brain Stimul 2020; 13:916-927. [DOI: 10.1016/j.brs.2020.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 02/29/2020] [Accepted: 03/09/2020] [Indexed: 12/30/2022] Open
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DiMarzio M, Rashid T, Hancu I, Fiveland E, Prusik J, Gillogly M, Madhavan R, Joel S, Durphy J, Molho E, Hanspal E, Shin D, Pilitsis JG. Functional MRI Signature of Chronic Pain Relief From Deep Brain Stimulation in Parkinson Disease Patients. Neurosurgery 2020; 85:E1043-E1049. [PMID: 31313816 DOI: 10.1093/neuros/nyz269] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/16/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic pain occurs in 83% of Parkinson disease (PD) patients and deep brain stimulation (DBS) has shown to result in pain relief in a subset of patients, though the mechanism is unclear. OBJECTIVE To compare functional magnetic resonance imaging (MRI) data in PD patients with chronic pain without DBS, those whose pain was relieved (PR) with DBS and those whose pain was not relieved (PNR) with DBS. METHODS Functional MRI (fMRI) with blood oxygen level-dependent activation data was obtained in 15 patients in control, PR, and PNR patients. fMRI was obtained in the presence and absence of a mechanical stimuli with DBS ON and DBS OFF. Voxel-wise analysis using pain OFF data was used to determine which regions were altered during pain ON periods. RESULTS At the time of MRI, pain was scored a 5.4 ± 1.2 out of 10 in the control, 4.25 ± 1.18 in PNR, and 0.8 ± 0.67 in PR cohorts. Group analysis of control and PNR groups showed primary somatosensory (SI) deactivation, whereas PR patients showed thalamic deactivation and SI activation. DBS resulted in more decreased activity in PR than PNR (P < .05) and more activity in anterior cingulate cortex (ACC) in PNR patients (P < .05). CONCLUSION Patients in the control and PNR groups showed SI deactivation at baseline in contrast to the PR patients who showed SI activation. With DBS ON, the PR cohort had less activity in SI, whereas the PNR had more anterior cingulate cortex activity. We provide pilot data that patients whose pain responds to DBS may have a different fMRI signature than those who do not, and PR and PNR cohorts produced different brain responses when DBS is employed.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Tanweer Rashid
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | | | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Michael Gillogly
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | | | | | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Eric Molho
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Era Hanspal
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Damian Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurology, Albany Medical Center, Albany, New York
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
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Abstract
OBJECTIVE Deep brain stimulation (DBS) was approved by Food and Drug Administration for Parkinson's disease, essential tremor, primary generalised or segmental dystonia and obsessive-compulsive disorder (OCD) treatment. The exact mechanism of DBS remains unclear which causes side effects. The aim of this review was to assess variables causing stimulation-induced chronic psychiatric/personality-changing side effects. METHODS The analysis of scientific database (PubMed, Cochrane Library, EMBASE) was conducted. The included articles had to be research study or case report and DBS to be conducted in therapeutic purposes. The researches with mental disorders in patients' medical histories were excluded. RESULTS Seventeen articles were used in the review. In the group of movement disorders the characteristic of side effects was strongly related to the placement of the electrode implantation. Tiredness/fatigue was correlated with DBS in thalamus. Implantations in subthalamic nucleus were mostly followed by affective side effects such as depression or suicide. The higher voltage of electrode was connected with more severe depression after implantation. The analysis of affective disorder contained only three articles - two about OCD and one about depression. Forgetfulness and word-finding problems as activities connected with cognition may be an inevitable side effect if obsessive thoughts are to be inhibited. CONCLUSION DBS of subthalamic nucleus should be seen as the most hazardous place of implantation. As a result there is a strong need of 'gold standards' based on the connectivity research and closer cooperation of scientists and clinicians.
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Saatçi Ö, Yılmaz NH, Zırh A, Yulug B. The therapeutic effect of deep brain stimulation on olfactory functions and clinical scores in Parkinson's disease. J Clin Neurosci 2019; 68:55-61. [PMID: 31383472 DOI: 10.1016/j.jocn.2019.07.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/07/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation (DBS) is still a highly effective treatment option that significantly improves motor function in advanced PD. Moreover, previous findings have shown that Olfactory dysfunction (OD) has been found in a majority of patients with Parkinson's Disease (PD). Despite this, the effect of DBS on the olfactory function is not fully understood. Here we aimed to determine the effect of STN DBS on OD by evaluating the olfactory functions in the preoperative and postoperative early stages (1st and 3rd months) in forty-five PD patients and 40 healthy controls. The therapeutic effect of DBS on the improvement of motor functions was parallelly investigated. We have observed that there was a significant improvement in OI in the 1st month and in all olfactory parameters (OT, ODI, OI, and TDI) in the 3rd month. In evaluating the motor functional scores, we have revealed a statistically significant (p < 0.001) difference between preoperative UPDRS-motor score (23 ± 7.3) and the postoperative 3rd month score (11.1 ± 5.1). Although Beck Depression and Anxiety scores were improved to a certain level in the 3rd month, this improvement was not at a statistically significant level (p > 0.05). As a conclusion, we have shown that STN-DBS improves the smell functions in PD within three months suggesting that the therapeutic effects of DBS might have a wide range of therapeutic spectrum. Despite some limitations (i.e., short follow-up period) our study gives a critical message that future studies are needed to evaluate the functional correlates of STN-DBS treatment in PD patients.
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Affiliation(s)
- Özlem Saatçi
- Istanbul Sancaktepe, Education and Research Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | | | - Ali Zırh
- Istanbul Medipol University, Department of Neurosurgery, Istanbul, Turkey
| | - Burak Yulug
- Alanya Alaaddin Keykubat University, Department of Neurology, Antalya/Alanya, Turkey.
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Apetz N, Kordys E, Simon M, Mang B, Aswendt M, Wiedermann D, Neumaier B, Drzezga A, Timmermann L, Endepols H. Effects of subthalamic deep brain stimulation on striatal metabolic connectivity in a rat hemiparkinsonian model. Dis Model Mech 2019; 12:dmm.039065. [PMID: 31064773 PMCID: PMC6550046 DOI: 10.1242/dmm.039065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/30/2019] [Indexed: 12/16/2022] Open
Abstract
Deep brain stimulation (DBS) in the subthalamic nucleus (STN) has been successfully used for the treatment of advanced Parkinson's disease, although the underlying mechanisms are complex and not well understood. There are conflicting results about the effects of STN-DBS on neuronal activity of the striatum, and its impact on functional striatal connectivity is entirely unknown. We therefore investigated how STN-DBS changes cerebral metabolic activity in general and striatal connectivity in particular. We used ipsilesional STN stimulation in a hemiparkinsonian rat model in combination with [18F]FDOPA-PET, [18F]FDG-PET and metabolic connectivity analysis. STN-DBS reversed ipsilesional hypometabolism and contralesional hypermetabolism in hemiparkinsonian rats by increasing metabolic activity in the ipsilesional ventrolateral striatum and by decreasing it in the contralesional hippocampus and brainstem. Other STN-DBS effects were subject to the magnitude of dopaminergic lesion severity measured with [18F]FDOPA-PET, e.g. activation of the infralimbic cortex was negatively correlated to lesion severity. Connectivity analysis revealed that, in healthy control animals, left and right striatum formed a bilateral functional unit connected by shared cortical afferents, which was less pronounced in hemiparkinsonian rats. The healthy striatum was metabolically connected to the ipsilesional substantia nigra in hemiparkinsonian rats only (OFF condition). STN-DBS (ON condition) established a new functional striatal network, in which interhemispheric striatal connectivity was strengthened, and both the dopamine-depleted and the healthy striatum were functionally connected to the healthy substantia nigra. We conclude that both unilateral dopamine depletion and STN-DBS affect the whole brain and alter complex interhemispheric networks. Summary: Deep brain stimulation in the subthalamic nucleus in rats with a unilateral dopaminergic lesion established a new functional interhemispheric striatal network.
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Affiliation(s)
- Nadine Apetz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Radiochemistry and Experimental Molecular Imaging, Kerpener Str. 62, 50937 Köln, Germany
| | - Elena Kordys
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Radiochemistry and Experimental Molecular Imaging, Kerpener Str. 62, 50937 Köln, Germany
| | - Mascha Simon
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Radiochemistry and Experimental Molecular Imaging, Kerpener Str. 62, 50937 Köln, Germany
| | - Britta Mang
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Radiochemistry and Experimental Molecular Imaging, Kerpener Str. 62, 50937 Köln, Germany
| | - Markus Aswendt
- Max Planck Institute for Metabolism Research, Department of In-vivo NMR, Gleueler Str. 50, 50931 Köln, Germany
| | - Dirk Wiedermann
- Max Planck Institute for Metabolism Research, Department of In-vivo NMR, Gleueler Str. 50, 50931 Köln, Germany
| | - Bernd Neumaier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Radiochemistry and Experimental Molecular Imaging, Kerpener Str. 62, 50937 Köln, Germany.,Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Straβe, 52428 Jülich, Germany
| | - Alexander Drzezga
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Kerpener Str. 62, 50937 Köln, Germany
| | - Lars Timmermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, 50937 Köln, Germany
| | - Heike Endepols
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Radiochemistry and Experimental Molecular Imaging, Kerpener Str. 62, 50937 Köln, Germany .,Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Straβe, 52428 Jülich, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Kerpener Str. 62, 50937 Köln, Germany
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Enhanced Motivational Modulation of Motor Behaviour with Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. PARKINSONS DISEASE 2019; 2019:3604372. [PMID: 30719276 PMCID: PMC6334333 DOI: 10.1155/2019/3604372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/27/2018] [Indexed: 01/24/2023]
Abstract
Background Motivational improvement of movement speed in Parkinson's disease (PD) is observed in life-threatening situations and has been empirically demonstrated in experimental studies using reaction time paradigms. Objectives To address two clinically relevant questions: first, if in PD, motivational modulation through provision of monetary incentive on a sorting task that approximates performance on everyday life tasks affects movement speed. Second, how this effect is compared between PD patients treated with medication or subthalamic deep brain stimulation. Methods We used the Card Arranging Reward Responsivity Objective Test that shares component processes with everyday life tasks to compare reward responsivity of movement speed in 10 PD patients with STN-DBS, 10 nonoperated medicated PD patients, both OFF and ON their usual medications/stimulation, and 11 age-matched healthy controls. Results Despite longer disease duration and more severe motor symptoms, STN-DBS PD patients with the stimulator turned ON showed greater improvement of movement speed with the prospect of monetary incentive compared to both medicated PD patients and healthy participants. Discussion The effect of monetary incentive on movement speed in PD patients is more pronounced with STN-DBS than dopaminergic medications, suggesting that motivational modulation of movement speed may be enhanced as a direct consequence of STN stimulation.
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Distinct cortical responses evoked by electrical stimulation of the thalamic ventral intermediate nucleus and of the subthalamic nucleus. NEUROIMAGE-CLINICAL 2018; 20:1246-1254. [PMID: 30420259 PMCID: PMC6308824 DOI: 10.1016/j.nicl.2018.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/27/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022]
Abstract
Objective To investigate the spatial and temporal pattern of cortical responses evoked by deep brain stimulation (DBS) of the subthalamic nucleus (STN) and ventral intermediate nucleus of the thalamus (VIM). Methods We investigated 7 patients suffering from Essential tremor (ET) and 7 patients with Parkinson's Disease (PD) following the implantation of DBS electrodes (VIM for ET patients, STN for PD patients). Magnetoencephalography (MEG) was used to record cortical responses evoked by electric stimuli that were applied via the DBS electrode in trains of 5 Hz. Dipole fitting was applied to reconstruct the origin of evoked responses. Results Both VIM and STN DBS led to short latency cortical responses at about 1 ms. The pattern of medium and long latency cortical responses following VIM DBS consisted of peaks at 13, 40, 77, and 116 ms. The associated equivalent dipoles were localized within the central sulcus, 3 patients showed an additional response in the cerebellum at 56 ms. STN DBS evoked cortical responses peaking at 4 ms, 11 ms, and 27 ms, respectively. While most dipoles were localized in the pre- or postcentral gyrus, the distribution was less homogenous compared to VIM stimulation and partially included prefrontal brain areas. Conclusion MEG enables localization of cortical responses evoked by DBS of the VIM and the STN, especially in the sensorimotor cortex. Short latency responses of 1 ms suggest cortical modulation which bypasses synaptic transmission, i.e. antidromic activation of corticofugal fiber pathways. Cortical responses evoked by VIM or STN DBS can be precisely described using MEG. Both STN and VIM DBS primarily evoke cortical responses within the sensorimotor region. Short latency responses of 1 ms both observed in VIM and STN DBS suggest antidromic activation of corticofugal fibers.
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Brain connectivity changes when comparing effects of subthalamic deep brain stimulation with levodopa treatment in Parkinson's disease. NEUROIMAGE-CLINICAL 2018; 19:1025-1035. [PMID: 30035027 PMCID: PMC6051673 DOI: 10.1016/j.nicl.2018.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/27/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022]
Abstract
Levodopa and, later, deep brain stimulation (DBS) have become the mainstays of therapy for motor symptoms associated with Parkinson's disease (PD). Although these therapeutic options lead to similar clinical outcomes, the neural mechanisms underlying their efficacy are different. Therefore, investigating the differential effects of DBS and levodopa on functional brain architecture and associated motor improvement is of paramount interest. Namely, we expected changes in functional brain connectivity patterns when comparing levodopa treatment with DBS. Clinical assessment and functional magnetic resonance imaging (fMRI) was performed before and after implanting electrodes for DBS in the subthalamic nucleus (STN) in 13 PD patients suffering from severe levodopa-induced motor fluctuations and peak-of-dose dyskinesia. All measurements were acquired in a within subject-design with and without levodopa treatment, and with and without DBS. Brain connectivity changes were computed using eigenvector centrality (EC) that offers a data-driven and parameter-free approach—similarly to Google's PageRank algorithm—revealing brain regions that have an increased connectivity to other regions that are highly connected, too. Both levodopa and DBS led to comparable improvement of motor symptoms as measured with the Unified Parkinson's Disease Rating Scale motor score (UPDRS-III). However, this similar therapeutic effect was underpinned by different connectivity modulations within the motor system. In particular, EC revealed a major increase of interconnectedness in the left and right motor cortex when comparing DBS to levodopa. This was accompanied by an increase of connectivity of these motor hubs with the thalamus and cerebellum. We observed, for the first time, significant functional connectivity changes when comparing the effects of STN DBS and oral levodopa administration, revealing different treatment-specific mechanisms linked to clinical benefit in PD. Specifically, in contrast to levodopa treatment, STN DBS was associated with increased connectivity within the cortico-thalamo-cerebellar network. Moreover, given the favorable effects of STN DBS on motor complications, the changes in the patients' clinical profile might also contribute to connectivity changes associated with STN-DBS. Understanding the observed connectivity changes may be essential for enhancing the effectiveness of DBS treatment, and for better defining the pathophysiology of the disrupted motor network in PD. Functional MRI was done before and after implanting DBS electrodes in same patients. Impacts of DBS and levodopa administration on brain motor circuitry are different. Comparison between DBS and levodopa treatment shows a major connectivity increase. Treatment related connectivity changes can be disentangled from electrode implantation.
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Pan H, Zhao Y, Zhai Z, Zheng J, Zhou Y, Zhai Q, Cao X, Tian J, Zhao L. Role of plasminogen activator inhibitor-1 in the diagnosis and prognosis of patients with Parkinson's disease. Exp Ther Med 2018; 15:5517-5522. [PMID: 29844807 DOI: 10.3892/etm.2018.6076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/18/2018] [Indexed: 11/06/2022] Open
Abstract
Parkinson's disease is a neurodegenerative disease that frequently results in memory disorders, cognitive decline and dementia. Previous studies have reported that plasminogen activator inhibitor-1 (PAI-1) serves an important role in cardiovascular disease risk, adiposity, insulin resistance and inflammation. However, the role of PAI-1 in diagnosis and prognosis of patients with Parkinson's disease following deep brain stimulation (DBS) has not reported, to the best of our knowledge. Therefore, the purpose of the present study was to investigate the clinical significance of PAI-1 in patients with Parkinson's disease. Plasma PAI-1 levels were measured in 102 patients with Parkinson's disease who underwent DBS. It was demonstrated that plasma PAI-1 levels were significantly increased in patients with Parkinson's disease compared with healthy individuals (P<0.01). Patients with Parkinson's disease received DBS presented significantly improved cognitive competence compared with controls (P<0.01). DBS significantly decreased plasma PAI-1 levels in patients with Parkinson's disease compared with controls (P<0.05). It was also observed that plasma PAI-1 levels were significantly negatively associated with cognitive function for patients with Parkinson's disease (P<0.01). In conclusion, these findings demonstrated that the degree of Parkinson's disease severity is positively associated with circulating levels of plasma PAI-1 levels, which suggests that PAI-1 may be a potential diagnostic and prognostic marker for patients with Parkinson's disease.
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Affiliation(s)
- Hong Pan
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Ying Zhao
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Zhengping Zhai
- Department of Neurology, Lianshui County People's Hospital, Huai'an, Jiangsu 223002, P.R. China
| | - Jinyu Zheng
- Department of Neurosurgery, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Yong Zhou
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Qijin Zhai
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Xiangyang Cao
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Jisha Tian
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
| | - Liandong Zhao
- Department of Neurology, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu 223002, P.R. China
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Dafsari HS, Weiß L, Silverdale M, Rizos A, Reddy P, Ashkan K, Evans J, Reker P, Petry-Schmelzer JN, Samuel M, Visser-Vandewalle V, Antonini A, Martinez-Martin P, Ray-Chaudhuri K, Timmermann L. Short-term quality of life after subthalamic stimulation depends on non-motor symptoms in Parkinson's disease. Brain Stimul 2018; 11:867-874. [PMID: 29655587 DOI: 10.1016/j.brs.2018.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome. HYPOTHESIS We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome. METHODS In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and -activities of daily living, levodopa equivalent daily dose. We dichotomized patients into "QoL responders"/"non-responders" and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned "responders/non-responders" as dependent variable. RESULTS All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as "QoL non-responders". Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome. CONCLUSIONS Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS.
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Affiliation(s)
- Haidar Salimi Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.
| | - Luisa Weiß
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Alexandra Rizos
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Prashanth Reddy
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Keyoumars Ashkan
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Paul Reker
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | | | - Michael Samuel
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - K Ray-Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Department of Basic and Clinical Neurosciences, King's College, London, United Kingdom
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany
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Jo HJ, McCairn KW, Gibson WS, Testini P, Zhao CZ, Gorny KR, Felmlee JP, Welker KM, Blaha CD, Klassen BT, Min HK, Lee KH. Global network modulation during thalamic stimulation for Tourette syndrome. NEUROIMAGE-CLINICAL 2018; 18:502-509. [PMID: 29560306 PMCID: PMC5857897 DOI: 10.1016/j.nicl.2018.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/09/2018] [Accepted: 02/18/2018] [Indexed: 12/14/2022]
Abstract
Background and objectives Deep brain stimulation (DBS) of the thalamus is a promising therapeutic alternative for treating medically refractory Tourette syndrome (TS). However, few human studies have examined its mechanism of action. Therefore, the networks that mediate the therapeutic effects of thalamic DBS remain poorly understood. Methods Five participants diagnosed with severe medically refractory TS underwent bilateral thalamic DBS stereotactic surgery. Intraoperative fMRI characterized the blood oxygen level-dependent (BOLD) response evoked by thalamic DBS and determined whether the therapeutic effectiveness of thalamic DBS, as assessed using the Modified Rush Video Rating Scale test, would correlate with evoked BOLD responses in motor and limbic cortical and subcortical regions. Results Our results reveal that thalamic stimulation in TS participants has wide-ranging effects that impact the frontostriatal, limbic, and motor networks. Thalamic stimulation induced suppression of motor and insula networks correlated with motor tic reduction, while suppression of frontal and parietal networks correlated with vocal tic reduction. These regions mapped closely to major regions of interest (ROI) identified in a nonhuman primate model of TS. Conclusions Overall, these findings suggest that a critical factor in TS treatment should involve modulation of both frontostriatal and motor networks, rather than be treated as a focal disorder of the brain. Using the novel combination of DBS-evoked tic reduction and fMRI in human subjects, we provide new insights into the basal ganglia-cerebellar-thalamo-cortical network-level mechanisms that influence the effects of thalamic DBS. Future translational research should identify whether these network changes are cause or effect of TS symptoms.
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Affiliation(s)
- Hang Joon Jo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kevin W McCairn
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Aichi 484-8506, Japan
| | - William S Gibson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Paola Testini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Cong Zhi Zhao
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kirk M Welker
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Charles D Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
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Edwards CA, Kouzani A, Lee KH, Ross EK. Neurostimulation Devices for the Treatment of Neurologic Disorders. Mayo Clin Proc 2017; 92:1427-1444. [PMID: 28870357 DOI: 10.1016/j.mayocp.2017.05.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/16/2017] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
Abstract
Rapid advancements in neurostimulation technologies are providing relief to an unprecedented number of patients affected by debilitating neurologic and psychiatric disorders. Neurostimulation therapies include invasive and noninvasive approaches that involve the application of electrical stimulation to drive neural function within a circuit. This review focuses on established invasive electrical stimulation systems used clinically to induce therapeutic neuromodulation of dysfunctional neural circuitry. These implantable neurostimulation systems target specific deep subcortical, cortical, spinal, cranial, and peripheral nerve structures to modulate neuronal activity, providing therapeutic effects for a myriad of neuropsychiatric disorders. Recent advances in neurotechnologies and neuroimaging, along with an increased understanding of neurocircuitry, are factors contributing to the rapid rise in the use of neurostimulation therapies to treat an increasingly wide range of neurologic and psychiatric disorders. Electrical stimulation technologies are evolving after remaining fairly stagnant for the past 30 years, moving toward potential closed-loop therapeutic control systems with the ability to deliver stimulation with higher spatial resolution to provide continuous customized neuromodulation for optimal clinical outcomes. Even so, there is still much to be learned about disease pathogenesis of these neurodegenerative and psychiatric disorders and the latent mechanisms of neurostimulation that provide therapeutic relief. This review provides an overview of the increasingly common stimulation systems, their clinical indications, and enabling technologies.
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Affiliation(s)
- Christine A Edwards
- School of Engineering, Deakin University, Geelong, Victoria, Australia; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Abbas Kouzani
- School of Engineering, Deakin University, Geelong, Victoria, Australia
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Erika K Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN.
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Fiveland E, Madhavan R, Prusik J, Linton R, Dimarzio M, Ashe J, Pilitsis J, Hancu I. EKG‐based detection of deep brain stimulation in fMRI studies. Magn Reson Med 2017; 79:2432-2439. [DOI: 10.1002/mrm.26868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/11/2023]
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Blume J, Lange M, Rothenfusser E, Doenitz C, Bogdahn U, Brawanski A, Schlaier J. The impact of white matter lesions on the cognitive outcome of subthalamic nucleus deep brain stimulation in Parkinson's disease. Clin Neurol Neurosurg 2017; 159:87-92. [PMID: 28582689 DOI: 10.1016/j.clineuro.2017.05.023] [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: 03/05/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES White Matter lesions (WML) are a risk factor for cognitive impairment in Parkinson's disease. There is no clear evidence of reduced general cognitive function after DBS. However, a subgroup of patients develops dementia rapidly after DBS despite careful patient selection processes. The aim of this study was to evaluate the load of WML as a possible risk factor for cognitive decline following STN DBS. PATIENTS AND METHODS 40 PD-patients receiving bilateral STN-DBS were followed at least three years after surgery to detect dementia. All patients underwent comprehensive neuropsychological assessment and MRI before surgery. The extent of WML was assessed using an automated approach. WML volume was correlated to the onset of dementia and the decline of a cognitive composite score retrospectively. RESULTS Patients with a rapid onset of dementia within one, respective three following DBS showed significant higher WML volumes compared to cognitive normal and MCI patients (55.8cm3±18.836 vs. 9.3cm3±12.2; p=0.002). The same significant association was found in a multivariable model, including the covariables age, gender and PD disease duration (p=0.01). WML volume was associated to the rate of decline in cognitive composite score within three years after DBS surgery (p=0.006; R2=0.40) after correction for age. CONCLUSIONS Damaged white matter may lead to a reduced compensation of disconnections in cognitive circuits caused by the implantation of the DBS electrodes or by chronic stimulation. The role of WML as a prognostic factor for the cognitive outcome after DBS may be underestimated. The WML burden should be taken seriously in preoperative risk stratification.
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Affiliation(s)
- J Blume
- Department of Neurology, University of Regensburg, Medical Center, Germany; Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany.
| | - M Lange
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - E Rothenfusser
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany
| | - C Doenitz
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - U Bogdahn
- Department of Neurology, University of Regensburg, Medical Center, Germany
| | - A Brawanski
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - J Schlaier
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany
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Ryczko D, Dubuc R. Dopamine and the Brainstem Locomotor Networks: From Lamprey to Human. Front Neurosci 2017; 11:295. [PMID: 28603482 PMCID: PMC5445171 DOI: 10.3389/fnins.2017.00295] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
In vertebrates, dopamine neurons are classically known to modulate locomotion via their ascending projections to the basal ganglia that project to brainstem locomotor networks. An increased dopaminergic tone is associated with increase in locomotor activity. In pathological conditions where dopamine cells are lost, such as in Parkinson's disease, locomotor deficits are traditionally associated with the reduced ascending dopaminergic input to the basal ganglia. However, a descending dopaminergic pathway originating from the substantia nigra pars compacta was recently discovered. It innervates the mesencephalic locomotor region (MLR) from basal vertebrates to mammals. This pathway was shown to increase locomotor output in lampreys, and could very well play an important role in mammals. Here, we provide a detailed account on the newly found dopaminergic pathway in lamprey, salamander, rat, monkey, and human. In lampreys and salamanders, dopamine release in the MLR is associated with the activation of reticulospinal neurons that carry the locomotor command to the spinal cord. Dopamine release in the MLR potentiates locomotor movements through a D1-receptor mechanism in lampreys. In rats, stimulation of the substantia nigra pars compacta elicited dopamine release in the pedunculopontine nucleus, a known part of the MLR. In a monkey model of Parkinson's disease, a reduced dopaminergic innervation of the brainstem locomotor networks was reported. Dopaminergic fibers are also present in human pedunculopontine nucleus. We discuss the conserved locomotor role of this pathway from lamprey to mammals, and the hypothesis that this pathway could play a role in the locomotor deficits reported in Parkinson's disease.
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Affiliation(s)
- Dimitri Ryczko
- Groupe de Recherche sur le Système Nerveux Central, Département de Neurosciences, Université de MontréalMontréal, QC, Canada
| | - Réjean Dubuc
- Groupe de Recherche sur le Système Nerveux Central, Département de Neurosciences, Université de MontréalMontréal, QC, Canada.,Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l'Activité Physique, Université du Québec à MontréalMontréal, QC, Canada
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Sridharan KS, Højlund A, Johnsen EL, Sunde NA, Johansen LG, Beniczky S, Østergaard K. Differentiated effects of deep brain stimulation and medication on somatosensory processing in Parkinson's disease. Clin Neurophysiol 2017; 128:1327-1336. [PMID: 28570866 DOI: 10.1016/j.clinph.2017.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/14/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) and dopaminergic medication effectively alleviate the motor symptoms in Parkinson's disease (PD) patients, but their effects on the sensory symptoms of PD are still not well understood. To explore early somatosensory processing in PD, we recorded magnetoencephalography (MEG) from thirteen DBS-treated PD patients and ten healthy controls during median nerve stimulation. METHODS PD patients were measured during DBS-treated, untreated and dopaminergic-medicated states. We focused on early cortical somatosensory processing as indexed by N20m, induced gamma augmentation (31-45Hz and 55-100Hz) and induced beta suppression (13-30Hz). PD patients' motor symptoms were assessed by UPDRS-III. RESULTS Using Bayesian statistics, we found positive evidence for differentiated effects of treatments on the induced gamma augmentation (31-45Hz) with highest gamma in the dopaminergic-medicated state and lowest in the DBS-treated and untreated states. In contrast, UPDRS-III scores showed beneficial effects of both DBS and dopaminergic medication on the patients' motor symptoms. Furthermore, treatments did not affect the amplitude of N20m. CONCLUSIONS Our results suggest differentiated effects of DBS and dopaminergic medication on cortical somatosensory processing in PD patients despite consistent ameliorating effects of both treatments on PD motor symptoms. SIGNIFICANCE The differentiated effect suggests differences in the effect mechanisms of the two treatments.
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Affiliation(s)
- Kousik Sarathy Sridharan
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Nørrebrogade 44, 8000 Aarhus, Denmark.
| | - Andreas Højlund
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - Erik Lisbjerg Johnsen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - Niels Aagaard Sunde
- Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | | | - Sándor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Department of Clinical Neurophysiology, Danish Epilepsy Center, Kolonivej 1, 4293 Dianalund, Denmark
| | - Karen Østergaard
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Nørrebrogade 44, 8000 Aarhus, Denmark
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Gibson WS, Cho S, Abulseoud OA, Gorny KR, Felmlee JP, Welker KM, Klassen BT, Min HK, Lee KH. The Impact of Mirth-Inducing Ventral Striatal Deep Brain Stimulation on Functional and Effective Connectivity. Cereb Cortex 2017; 27:2183-2194. [PMID: 27001680 DOI: 10.1093/cercor/bhw074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is an investigational therapy for treatment-resistant obsessive-compulsive disorder. The ability of VC/VS DBS to evoke spontaneous mirth in patients, often accompanied by smiling and laughter, is clinically well documented. However, the neural correlates of DBS-evoked mirth remain poorly characterized. Patients undergoing VC/VS DBS surgery underwent intraoperative evaluation in which mirth-inducing and non-mirth-inducing stimulation localizations were identified. Using dynamic causal modeling (DCM) for fMRI, the effect of mirth-inducing DBS on functional and effective connectivity among established nodes in limbic cortico-striato-thalamo-cortical (CSTC) circuitry was investigated. Both mirth-inducing and non-mirth-inducing VC/VS DBS consistently resulted (conjunction, global null, family-wise error-corrected P < 0.05) in activation of amygdala, ventral striatum, and mediodorsal thalamus. However, only mirth-inducing DBS resulted in functional inhibition of anterior cingulate cortex. Dynamic causal modeling revealed that mirth-inducing DBS enhanced effective connectivity from anterior cingulate to ventral striatum, while attenuating connectivity from thalamus to ventral striatum relative to non-mirth-inducing stimulation. These results suggest that DBS-evoked mood elevation is accompanied by distinct patterns of limbic thalamocortical connectivity. Using the novel combination of DBS-evoked mood alteration and functional MRI in human subjects, we provide new insights into the network-level mechanisms that influence affect.
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Affiliation(s)
| | | | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55906, USA.,National Institute on Drug Abuse, Baltimore, MD 21224, USA
| | | | | | | | | | - Hoon-Ki Min
- Department of Neurologic Surgery.,Department of Radiology.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, US.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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Rajan R, Popa T, Quartarone A, Ghilardi MF, Kishore A. Cortical plasticity and levodopa-induced dyskinesias in Parkinson's disease: Connecting the dots in a multicomponent network. Clin Neurophysiol 2017; 128:992-999. [PMID: 28454042 DOI: 10.1016/j.clinph.2017.03.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/11/2017] [Accepted: 03/22/2017] [Indexed: 01/18/2023]
Abstract
Levodopa-induced dyskinesias are motor complications following long term dopaminergic therapy in Parkinson's disease (PD). Impaired brain plasticity resulting in the creation of aberrant motor maps intended to encode normal voluntary movement is proposed to result in the development of dyskinesias. Traditionally, the various nodes in the motor network like the striato-cortical and the cerebello-thalamic loops were thought to function independent of each other with little communication among them. Anatomical evidence from primates revealed the existence of reciprocal loops between the basal ganglia and the cerebellum providing an anatomical basis for communication between the motor network loops. Dyskinetic PD patients reveal impaired brain plasticity within the motor cortex which may be modulated by cortico-cortical, cerebello-cortical or striato-cortical connections. In this article, we review the evidence for altered plasticity in the multicomponent motor network in the context of levodopa induced dyskinesias in PD. Current evidence suggests a pivotal role for the cerebellum in the larger motor network with the ability to integrate sensorimotor information and independently influence multiple nodes in this network. Targeting the cerebellum seems to be a justified approach for future interventions aimed at attenuating levodopa-induced dyskinesias.
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Affiliation(s)
- Roopa Rajan
- Comprehensive Care Center for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
| | - Traian Popa
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, USA.
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy; IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo, Messina, Italy.
| | - Maria Felice Ghilardi
- Department of Physiology and Pharmacology, City University of New York Medical School, New York, NY, USA.
| | - Asha Kishore
- Comprehensive Care Center for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
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Cao C, Zhang H, Li D, Zhan S, Zhang J, Zhang X, Zuo C, Sun B. Modified Fluorodeoxyglucose Metabolism in Motor Circuitry by Subthalamic Deep Brain Stimulation. Stereotact Funct Neurosurg 2017; 95:93-101. [DOI: 10.1159/000455930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/08/2017] [Indexed: 11/19/2022]
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Settell ML, Testini P, Cho S, Lee JH, Blaha CD, Jo HJ, Lee KH, Min HK. Functional Circuitry Effect of Ventral Tegmental Area Deep Brain Stimulation: Imaging and Neurochemical Evidence of Mesocortical and Mesolimbic Pathway Modulation. Front Neurosci 2017; 11:104. [PMID: 28316564 PMCID: PMC5334355 DOI: 10.3389/fnins.2017.00104] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/20/2017] [Indexed: 12/20/2022] Open
Abstract
Background: The ventral tegmental area (VTA), containing mesolimbic and mesocortical dopaminergic neurons, is implicated in processes involving reward, addiction, reinforcement, and learning, which are associated with a variety of neuropsychiatric disorders. Electrical stimulation of the VTA or the medial forebrain bundle and its projection target the nucleus accumbens (NAc) is reported to improve depressive symptoms in patients affected by severe, treatment-resistant major depressive disorder (MDD) and depressive-like symptoms in animal models of depression. Here we sought to determine the neuromodulatory effects of VTA deep brain stimulation (DBS) in a normal large animal model (swine) by combining neurochemical measurements with functional magnetic resonance imaging (fMRI). Methods: Animals (n = 8 swine) were implanted with a unilateral DBS electrode targeting the VTA. During stimulation (130 Hz frequency, 0.25 ms pulse width, and 3 V amplitude), fMRI was performed. Following fMRI, fast-scan cyclic voltammetry in combination with carbon fiber microelectrodes was performed to quantify VTA-DBS-evoked dopamine release in the ipsilateral NAc. In a subset of swine, the blood oxygen level-dependent (BOLD) percent change evoked by stimulation was performed at increasing voltages (1, 2, and 3 V). Results: A significant increase in VTA-DBS-evoked BOLD signal was found in the following regions: the ipsilateral dorsolateral prefrontal cortex, anterior and posterior cingulate, insula, premotor cortex, primary somatosensory cortex, and striatum. A decrease in the BOLD signal was also observed in the contralateral parahippocampal cortex, dorsolateral and anterior prefrontal cortex, insula, inferior temporal gyrus, and primary somatosensory cortex (Bonferroni-corrected < 0.001). During neurochemical measurements, stimulation time-locked changes in dopamine release were recorded in the NAc, confirming that mesolimbic dopaminergic neurons were stimulated by DBS. In the parametric study, BOLD signal changes were positively correlated with stimulation amplitude. Conclusions: In this study, the modulation of the neural circuitry associated with VTA-DBS was characterized in a large animal. Our findings suggest that VTA-DBS could affect the activity of neural systems and brain regions implicated in reward, mood regulation, and in the pathophysiology of MDD. In addition, we showed that a combination of fMRI and electrochemically-based neurochemical detection platform is an effective investigative tool for elucidating the circuitry involved in VTA-DBS.
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Affiliation(s)
- Megan L. Settell
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Mayo Graduate School, Mayo ClinicRochester, MN, USA
| | - Paola Testini
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Surgery, Mayo ClinicRochester, MN, USA
| | - Shinho Cho
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | - Jannifer H. Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | | | - Hang J. Jo
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
- Department of Radiology, Mayo ClinicRochester, MN, USA
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Cossu G, Pau M. Subthalamic nucleus stimulation and gait in Parkinson's Disease: a not always fruitful relationship. Gait Posture 2017; 52:205-210. [PMID: 27915226 DOI: 10.1016/j.gaitpost.2016.11.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/19/2016] [Accepted: 11/24/2016] [Indexed: 02/02/2023]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with advanced Parkinson's disease (PD), but its specific effects on gait is sometimes less successful as it may even lead to an aggravation of freezing of gait. To better understand when axial symptoms can be expected to improve and when they may worsen or be resistant to STN-DBS, we propose here a narrative review that considers the recent literature evidences based on instrumental gait analysis data. Our aim is to report about the efficacy of STN-DBS on PD gait, analyzing the clinical and procedural factors involved, and discussing the strategies for optimizing such effectiveness in patients with advanced PD.
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Affiliation(s)
- Giovanni Cossu
- "G. Brotzu" General Hospital, Department of Neurology, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy.
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Arbuthnott GW, Garcia-Munoz M. Are the Symptoms of Parkinsonism Cortical in Origin? Comput Struct Biotechnol J 2016; 15:21-25. [PMID: 28694933 PMCID: PMC5484763 DOI: 10.1016/j.csbj.2016.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/23/2022] Open
Abstract
We present three reasons to suspect that the major deleterious consequence of dopamine loss from the striatum is a cortical malfunction. We suggest that it is cortex, rather than striatum, that should be considered as the source of the debilitating symptoms of Parkinson's disease (PD) since:Cortical synapses onto striatal dendritic spines are lost in PD. All known treatments of the symptoms of PD disrupt beta oscillations. Oscillations that are also disrupted following antidromic activation of cortical neurons. The final output of basal ganglia directly modulates thalamic connections to layer I of frontal cortical areas, regions intimately associated with motor behaviour.
These three reasons combined with evidence that the current summary diagram of the basal ganglia involvement in PD is imprecise at best, suggest that a re-orientation of the treatment strategies towards cortical, rather than striatal malfunction, is overdue. Suggested experimental contributions support the proposal of a cortical participation in PD. DBS produces antidromic activation of motor cortex and desynchronizes beta oscillations. Loss of dopamine decreases dendritic spines in the striatal D2 projection neurons. Motor thalamus distributes terminals into frontal cortex layer I. Thalamocortical-layer I activity increases with locomotion.
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Affiliation(s)
- Gordon W Arbuthnott
- OIST Graduate University, Brain Mechanisms for Behaviour Unit, Okinawa, Japan
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