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Olaru M, Cernera S, Hahn A, Wozny TA, Anso J, de Hemptinne C, Little S, Neumann WJ, Abbasi-Asl R, Starr PA. Motor network gamma oscillations in chronic home recordings predict dyskinesia in Parkinson's disease. Brain 2024; 147:2038-2052. [PMID: 38195196 PMCID: PMC11146421 DOI: 10.1093/brain/awae004] [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: 08/09/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
In Parkinson's disease, imbalances between 'antikinetic' and 'prokinetic' patterns of neuronal oscillatory activity are related to motor dysfunction. Invasive brain recordings from the motor network have suggested that medical or surgical therapy can promote a prokinetic state by inducing narrowband gamma rhythms (65-90 Hz). Excessive narrowband gamma in the motor cortex promotes dyskinesia in rodent models, but the relationship between narrowband gamma and dyskinesia in humans has not been well established. To assess this relationship, we used a sensing-enabled deep brain stimulator system, attached to both motor cortex and basal ganglia (subthalamic or pallidal) leads, paired with wearable devices that continuously tracked motor signs in the contralateral upper limbs. We recorded 984 h of multisite field potentials in 30 hemispheres of 16 subjects with Parkinson's disease (2/16 female, mean age 57 ± 12 years) while at home on usual antiparkinsonian medications. Recordings were done 2-4 weeks after implantation, prior to starting therapeutic stimulation. Narrowband gamma was detected in the precentral gyrus, subthalamic nucleus or both structures on at least one side of 92% of subjects with a clinical history of dyskinesia. Narrowband gamma was not detected in the globus pallidus. Narrowband gamma spectral power in both structures co-fluctuated similarly with contralateral wearable dyskinesia scores (mean correlation coefficient of ρ = 0.48 with a range of 0.12-0.82 for cortex, ρ = 0.53 with a range of 0.5-0.77 for subthalamic nucleus). Stratification analysis showed the correlations were not driven by outlier values, and narrowband gamma could distinguish 'on' periods with dyskinesia from 'on' periods without dyskinesia. Time lag comparisons confirmed that gamma oscillations herald dyskinesia onset without a time lag in either structure when using 2-min epochs. A linear model incorporating the three oscillatory bands (beta, theta/alpha and narrowband gamma) increased the predictive power of dyskinesia for several subject hemispheres. We further identified spectrally distinct oscillations in the low gamma range (40-60 Hz) in three subjects, but the relationship of low gamma oscillations to dyskinesia was variable. Our findings support the hypothesis that excessive oscillatory activity at 65-90 Hz in the motor network tracks with dyskinesia similarly across both structures, without a detectable time lag. This rhythm may serve as a promising control signal for closed-loop deep brain stimulation using either cortical or subthalamic detection.
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Affiliation(s)
- Maria Olaru
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Amelia Hahn
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Juan Anso
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida Gainesville, Gainesville, FL 32611, USA
| | - Simon Little
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Reza Abbasi-Asl
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
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Babeliowsky WA, Bot M, Potters WV, van den Munckhof P, Blok ER, de Bie RM, Schuurman R, van Rootselaar A. Deep Brain Stimulation for Orthostatic Tremor: An Observational Study. Mov Disord Clin Pract 2024; 11:676-685. [PMID: 38586984 PMCID: PMC11145120 DOI: 10.1002/mdc3.14035] [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: 05/01/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Primary orthostatic tremor (OT) can affect patients' life. Treatment of OT with deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (Vim) is described in a limited number of patients. The Vim and posterior subthalamic area (PSA) can be targeted in a single trajectory, allowing both stimulation of the Vim and/or dentatorubrothalamic tract (DRT). In essential tremor this is currently often used with positive effects. OBJECTIVE To evaluate the efficacy of Vim/DRT-DBS in OT-patients, based on standing time and Quality of Life (QoL), also on the long-term. Furthermore, to relate stimulation of the Vim and DRT, medial lemniscus (ML) and pyramidal tract (PT) to beneficial clinical and side-effects. METHODS Nine severely affected OT-patients received bilateral Vim/DRT-DBS. Primary outcome measure was standing time; secondary measures included self-reported measures, neurophysiological measures, structural analyses, surgical complications, stimulation-induced side-effects, and QoL up to 56 months. Stimulation of volume of tissue activated (VTA) were related to outcome measures. RESULTS Average maximum standing time increased from 41.0 s ± 51.0 s to 109.3 s ± 65.0 s after 18 months, with improvements measured in seven of nine patients. VTA (n = 7) overlapped with the DRT in six patients and with the ML and/or PT in six patients. All patients experienced side-effects and QoL worsened during the first year after surgery, which improved again during long-term follow-up, although remaining below age-related normal values. Most patients reported a positive effect of DBS. CONCLUSION Vim/DRT-DBS improved standing time in patients with severe OT. Observed side-effects are possibly related to stimulation of the ML and PT.
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Affiliation(s)
- Wietske A. Babeliowsky
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Maarten Bot
- NeurosurgeryAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Wouter V. Potters
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | | | - Edwin R. Blok
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Rob M.A. de Bie
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Rick Schuurman
- NeurosurgeryAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Anne‐Fleur van Rootselaar
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
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Semenova U, Dzhalagoniya I, Gamaleya A, Tomskiy A, Shaikh AG, Sedov A. Pallidal multifractal complexity is a new potential physiomarker of dystonia. Clin Neurophysiol 2024; 162:31-40. [PMID: 38555665 DOI: 10.1016/j.clinph.2024.03.012] [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: 05/30/2023] [Revised: 01/11/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Low-frequency 4-12 Hz pallidal oscillations are being considered as potential physiomarkers for dystonia. We suggest investigating the multifractal properties of pallidal activity as an additional marker. METHODS We employed local field potentials (LFP) recordings from 23 patients with dystonia who were undergoing deep brain stimulation (DBS) surgery to explore the connection between disease severity and the multifractal characteristics of pallidal activity. Furthermore, we performed an analysis of LFP recordings from four patients, following the externalization of DBS lead electrodes, to investigate the impact of DBS and neck muscle vibration on multifractal parameters. RESULTS Greater dystonia severity exhibited a correlation with a narrower multifractal spectrum width but higher multifractal spectral asymmetry. Both GPi DBS and muscle vibration in dystonia patients expanded the multifractal spectrum width while restoring multifractal spectral symmetry. Notably, the threshold peak intensities for an increase in multifractal spectrum width substantially overlapped with the optimal volume of tissue activated. A broader multifractal spectrum during DBS corresponded to more favorable clinical outcomes. CONCLUSIONS Multifractal properties of pallidal neuronal activity serve as indicators of neural dysfunction in dystonia. SIGNIFICANCE These findings suggest the potential of utilizing multifractal characteristics as predictive factors for the DBS outcome in dystonia.
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Affiliation(s)
- Ulia Semenova
- N.N.Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russian Federation.
| | - Indiko Dzhalagoniya
- N.N.Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russian Federation
| | - Anna Gamaleya
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russian Federation
| | - Alexey Tomskiy
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russian Federation
| | - Aasef G Shaikh
- Departments of Neurology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Neurological Institute, University Hospitals, Cleveland, OH, USA; Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Alexey Sedov
- N.N.Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russian Federation; Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region, Russian Federation
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Rajamani N, Friedrich H, Butenko K, Dembek T, Lange F, Navrátil P, Zvarova P, Hollunder B, de Bie RMA, Odekerken VJJ, Volkmann J, Xu X, Ling Z, Yao C, Ritter P, Neumann WJ, Skandalakis GP, Komaitis S, Kalyvas A, Koutsarnakis C, Stranjalis G, Barbe M, Milanese V, Fox MD, Kühn AA, Middlebrooks E, Li N, Reich M, Neudorfer C, Horn A. Deep brain stimulation of symptom-specific networks in Parkinson's disease. Nat Commun 2024; 15:4662. [PMID: 38821913 PMCID: PMC11143329 DOI: 10.1038/s41467-024-48731-1] [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: 03/14/2023] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
Deep Brain Stimulation can improve tremor, bradykinesia, rigidity, and axial symptoms in patients with Parkinson's disease. Potentially, improving each symptom may require stimulation of different white matter tracts. Here, we study a large cohort of patients (N = 237 from five centers) to identify tracts associated with improvements in each of the four symptom domains. Tremor improvements were associated with stimulation of tracts connected to primary motor cortex and cerebellum. In contrast, axial symptoms are associated with stimulation of tracts connected to the supplementary motor cortex and brainstem. Bradykinesia and rigidity improvements are associated with the stimulation of tracts connected to the supplementary motor and premotor cortices, respectively. We introduce an algorithm that uses these symptom-response tracts to suggest optimal stimulation parameters for DBS based on individual patient's symptom profiles. Application of the algorithm illustrates that our symptom-tract library may bear potential in personalizing stimulation treatment based on the symptoms that are most burdensome in an individual patient.
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Affiliation(s)
- Nanditha Rajamani
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Helen Friedrich
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- University of Würzburg, Faculty of Medicine, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Till Dembek
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Florian Lange
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Pavel Navrátil
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Patricia Zvarova
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
| | - Barbara Hollunder
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
- Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhipei Ling
- Department of Neurosurgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, 572000, China
| | - Chen Yao
- Department of Neurosurgery, The National Key Clinic Specialty, Shenzhen Key Laboratory of Neurosurgery, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Petra Ritter
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
- Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany
- Bernstein center for Computational Neuroscience Berlin, Berlin, 10117, Germany
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georgios P Skandalakis
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
| | - Spyridon Komaitis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aristotelis Kalyvas
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Christos Koutsarnakis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
| | - Michael Barbe
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Vanessa Milanese
- Neurosurgical Division, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Mayo Clinic, Florida, USA
- Movement Disorders and Neuromodulation Unit, DOMMO Clinic, São Paulo, Brazil
| | - Michael D Fox
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02114, USA
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
- Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany
| | | | - Ningfei Li
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Reich
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Clemens Neudorfer
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02114, USA
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02114, USA
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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Wu Y, Li Y, Li H, Wang T, Huang P, Wu Y, Sun B, Pan Y, Li D. Prediction of subthalamic stimulation efficacy on isolated dystonia via support vector regression. Heliyon 2024; 10:e31475. [PMID: 38818146 PMCID: PMC11137530 DOI: 10.1016/j.heliyon.2024.e31475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Deep brain stimulation (DBS) of subthalamic nucleus (STN) has been well-established and increasingly applied in patients with isolated dystonia. Nevertheless, the surgical efficacy varies among patients. This study aims to explore the factors affecting clinical outcomes of STN-DBS on isolated dystonia and establish a well-performed prediction model. Methods In this prospective study, thirty-two dystonia patients were recruited and received bilateral STN-DBS at our center. Their baseline characteristics and up to one-year follow-up outcomes were assessed. Implanted electrodes of each subject were reconstructed with their contact coordinates and activated volumes calculated. We explored correlations between distinct clinical characteristics and surgical efficacy. Those features were then trained for the model in outcome prediction via support vector regression (SVR) algorithm and testified through cross-validation. Results Patients demonstrated an average clinical improvement of 56 ± 25 % after STN-DBS, significantly affected by distinct symptom forms and activated volumes. The optimal targets and activated volumes were concentratedly located at the dorsal posterior region to STN. Most patients had a rapid response to STN-DBS, and their motor score improvement within one week was highly associated with long-term outcomes. The trained SVR model, contributed by distinct weights of features, could reach a maximum prediction accuracy with mean errors of 11 ± 7 %. Conclusion STN-DBS demonstrated significant and rapid therapeutic effects in patients with isolated dystonia, by possibly affecting the pallidofugal fibers. Early improvement highly indicates the ultimate outcomes. SVR proves valid in outcome prediction. Patients with predominant phasic and generalized symptoms, shorter disease duration, and younger onset age may be more favorable to STN-DBS in the long run.
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Affiliation(s)
- Yunhao Wu
- Department of Neurosurgery, Center for Functional Neurosurgery, 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
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Filip P, Lasica A, Uhrová T, Mana J, Růžička F, Keller J, Mueller K, Burdová K, Kiakou D, Jech R. Mixed anxiety-depressive disorder in Parkinson's disease associated with worse resting state functional response to deep brain stimulation of subthalamic nucleus. Heliyon 2024; 10:e30698. [PMID: 38778942 PMCID: PMC11109721 DOI: 10.1016/j.heliyon.2024.e30698] [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: 09/12/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Background Parkinson's disease (PD), even though generally perceived as a dominantly motor disorder, is associated with a wide range of non-motor symptoms, including mixed anxiety-depressive disorder (MADD). Objectives The aim of the presented study was to determine whether deep brain stimulation (DBS) of the subthalamic nucleus (STN) brings the functional characteristics of non-motor networks closer to the condition detected in healthy population and whether pre-DBS presence of MADD in PD patients was associated with different reaction to this therapeutic modality. Methods Resting-state fMRI signature elicited by STN DBS activation and deactivation in 81 PD patients was compared against healthy controls, with the focus on measures of efficiency of information processing and localised subnetwork differences. Results While all the MRI metrics showed statistically significant differences between PD patients in DBS OFF condition and healthy controls, none were detected in such a comparison against DBS ON condition. Furthermore, in the post-DBS evaluation, PD patients with MADD in the pre-DBS stage showed no differences in depression scales compared to pre-DBS psychiatrically intact PD patients, but still exhibited lower DBS-related connectivity in a subnetwork encompassing anterior and posterior cingulate, dorsolateral prefrontal and medial temporal cortices. Conclusions STN DBS improved all the metrics of interest towards the healthy state, normalising the resting-state MRI signature of PD. Furthermore, pre-DBS presence of MADD, even though clinically silent at post-DBS MRI acquisition, was associated with lower DBS effect in areas highly relevant for depression. This finding points to a possibly latent nature of post-DBS MADD, calling for caution in further follow-up of these patients.
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Affiliation(s)
- Pavel Filip
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Andrej Lasica
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Tereza Uhrová
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Josef Mana
- Department of Science and Research, Prague College of Psychosocial Studies, Prague, Czech Republic
| | - Filip Růžička
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Karsten Mueller
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Kristína Burdová
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Dimitra Kiakou
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Robert Jech
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
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Steinhardt J, Zittel S, Tadic V, Tronnier V, Moll C, Bäumer T, Münchau A, Rasche D, Brüggemann N. GPi/GPe borderland- a potential sweet spot for deep brain stimulation for chorea in Huntington's disease? Neurol Res Pract 2024; 6:28. [PMID: 38778367 PMCID: PMC11112842 DOI: 10.1186/s42466-024-00316-5] [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: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Pallidal deep brain stimulation (GPi-DBS) has been considered as an effective treatment option for medication-refractory Huntington's disease (HD). OBJECTIVES To identify stimulation-dependent effects on motor symptoms and to determine if these alterations are associated with the local impact of DBS on different pallidal parcellations. METHODS We prospectively evaluated the effects of bilateral GPi-DBS within one year in 5 HD patients. We evaluated the effects of GPi-DBS on choreatic symptoms and UHDRS. Electrode placement in the pallidum was localized, and the local impact of DBS was estimated. RESULTS The chorea subscore (p < 0.001) and UHDRS total motor score was significantly reduced postoperatively (p = 0.019). Pallidal DBS did not improve other motor symptoms. Activation of the lateral GPi/GPe was associated with improvement in choreatic symptoms (p = 0.048; r = 0.90). CONCLUSIONS Our findings indicate that stimulation of the lateral GPi has a stable effect on choreatic symptoms. The modulation of the electrical field is relevant for motor outcome.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology and Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vera Tadic
- Department of Neurology and Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Volker Tronnier
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Christian Moll
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Bäumer
- Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Sciences, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Sciences, University of Lübeck, Lübeck, Germany
| | - Dirk Rasche
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology and Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany.
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
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Filip P, Mana J, Lasica A, Keller J, Urgošík D, May J, Mueller K, Jech R, Bezdicek O, Růžička F. Structural and microstructural predictors of cognitive decline in deep brain stimulation of subthalamic nucleus in Parkinson's disease. Neuroimage Clin 2024; 42:103617. [PMID: 38749145 PMCID: PMC11112358 DOI: 10.1016/j.nicl.2024.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/22/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The intricate relationship between deep brain stimulation (DBS) in Parkinson's disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients. METHODS Pre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and follow-up for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population - Dementia Rating Scale 2. RESULTS PD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups. CONCLUSIONS Our findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.
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Affiliation(s)
- Pavel Filip
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic; Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Josef Mana
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Andrej Lasica
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromír May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Karsten Mueller
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Robert Jech
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.
| | - Ondrej Bezdicek
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Filip Růžička
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
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9
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Griffiths BJ, Schreiner T, Schaefer JK, Vollmar C, Kaufmann E, Quach S, Remi J, Noachtar S, Staudigl T. Electrophysiological signatures of veridical head direction in humans. Nat Hum Behav 2024:10.1038/s41562-024-01872-1. [PMID: 38710766 DOI: 10.1038/s41562-024-01872-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024]
Abstract
Information about heading direction is critical for navigation as it provides the means to orient ourselves in space. However, given that veridical head-direction signals require physical rotation of the head and most human neuroimaging experiments depend upon fixing the head in position, little is known about how the human brain is tuned to such heading signals. Here we adress this by asking 52 healthy participants undergoing simultaneous electroencephalography and motion tracking recordings (split into two experiments) and 10 patients undergoing simultaneous intracranial electroencephalography and motion tracking recordings to complete a series of orientation tasks in which they made physical head rotations to target positions. We then used a series of forward encoding models and linear mixed-effects models to isolate electrophysiological activity that was specifically tuned to heading direction. We identified a robust posterior central signature that predicts changes in veridical head orientation after regressing out confounds including sensory input and muscular activity. Both source localization and intracranial analysis implicated the medial temporal lobe as the origin of this effect. Subsequent analyses disentangled head-direction signatures from signals relating to head rotation and those reflecting location-specific effects. Lastly, when directly comparing head direction and eye-gaze-related tuning, we found that the brain maintains both codes while actively navigating, with stronger tuning to head direction in the medial temporal lobe. Together, these results reveal a taxonomy of population-level head-direction signals within the human brain that is reminiscent of those reported in the single units of rodents.
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Affiliation(s)
- Benjamin J Griffiths
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Thomas Schreiner
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia K Schaefer
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian Vollmar
- Epilepsy Center, Department of Neurology, Ludwig-Maximilians-Universität University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology, Ludwig-Maximilians-Universität University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, University Hospital Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jan Remi
- Epilepsy Center, Department of Neurology, Ludwig-Maximilians-Universität University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, Ludwig-Maximilians-Universität University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tobias Staudigl
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.
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10
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Xiao H, Lang L, Ye Z, Wu J. Subthalamic Nucleus Stimulation Modulates Cognitive Theory of Mind in Parkinson's Disease. Mov Disord 2024. [PMID: 38696281 DOI: 10.1002/mds.29830] [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: 10/14/2023] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Theory of mind (ToM), the ability to infer others' mental state, is essential for social interaction among human beings. It has been widely reported that both cognitive (inference of knowledge) and affective (inference of emotion) components of ToM are disrupted in Parkinson's disease (PD). Previous studies usually focused on the involvement of the prefrontal cortex. OBJECTIVE This study investigated the causal role of the subthalamic nucleus (STN), a key hub of the fronto-basal ganglia loops, in ToM. METHODS Thirty-four patients with idiopathic PD (15 women, aged 62.2 ± 8.3 years) completed a Yoni task with deep brain stimulation (DBS) ON and OFF. The Yoni task was designed to separate the cognitive and affective components of ToM. Volumes of tissue activated (VTA) were computed for three subregions of the STN. RESULTS DBS showed insignificant effects on ToM inference costs at the group level, which may be due to the large interindividual variability. The associative VTA correlated with the cognitive inference cost change but not the affective inference cost change. Patients with greater associative STN stimulation infer more slowly on cognitive ToM. Stimulating associative STN can adversely affect cognitive ToM in PD patients, especially in patients with a wide range of stimulation (≥0.157) or cognitive decline (Montreal Cognitive Assessment < 26). CONCLUSIONS The associative STN plays a causal role in cognitive ToM in patients with PD. However, stimulating the associative STN likely impairs cognitive ToM and potentially leads to social interaction deficits in PD. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Haoyun Xiao
- Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Liqin Lang
- Department of Neurology and National Research Center for Aging and Medicine and National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zheng Ye
- Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Jianjun Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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11
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Choi JW, Malekmohammadi M, Niketeghad S, Cross KA, Ebadi H, Alijanpourotaghsara A, Aron A, Rutishauser U, Pouratian N. Prefrontal-subthalamic theta signaling mediates delayed responses during conflict processing. Prog Neurobiol 2024; 236:102613. [PMID: 38631480 PMCID: PMC11149786 DOI: 10.1016/j.pneurobio.2024.102613] [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: 11/06/2023] [Revised: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
While medial frontal cortex (MFC) and subthalamic nucleus (STN) have been implicated in conflict monitoring and action inhibition, respectively, an integrated understanding of the spatiotemporal and spectral interaction of these nodes and how they interact with motor cortex (M1) to definitively modify motor behavior during conflict is lacking. We recorded neural signals intracranially across presupplementary motor area (preSMA), M1, STN, and globus pallidus internus (GPi), during a flanker task in 20 patients undergoing deep brain stimulation implantation surgery for Parkinson disease or dystonia. Conflict is associated with sequential and causal increases in local theta power from preSMA to STN to M1 with movement delays directly correlated with increased STN theta power, indicating preSMA is the MFC locus that monitors conflict and signals STN to implement a 'break.' Transmission of theta from STN-to-M1 subsequently results in a transient increase in M1-to-GPi beta flow immediately prior to movement, modulating the motor network to actuate the conflict-related action inhibition (i.e., delayed response). Action regulation during conflict relies on two distinct circuits, the conflict-related theta and movement-related beta networks, that are separated spatially, spectrally, and temporally, but which interact dynamically to mediate motor performance, highlighting complex parallel yet interacting networks regulating movement.
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Affiliation(s)
- Jeong Woo Choi
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Mahsa Malekmohammadi
- Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA
| | - Soroush Niketeghad
- Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA
| | - Katy A Cross
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
| | - Hamasa Ebadi
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Adam Aron
- Department of Psychology, University of California, San Diego, CA 92093, USA
| | - Ueli Rutishauser
- Departments of Neurosurgery and Neurology, and Center for Neural Science and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA.
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12
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Cummins DD, Sandoval-Pistorius SS, Cernera S, Fernandez-Gajardo R, Hammer LH, Starr PA. Physiological effects of dual target DBS in an individual with Parkinson's disease and a sensing-enabled pulse generator. Parkinsonism Relat Disord 2024; 122:106089. [PMID: 38460490 DOI: 10.1016/j.parkreldis.2024.106089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus (GP) is an established therapy for Parkinson's disease (PD). Novel DBS devices can record local field potential (LFP) physiomarkers from the STN or GP. While beta (13-30 Hz) and gamma (40-90 Hz) STN and GP LFP oscillations correlate with PD motor severity and with therapeutic effects of treatments, STN-GP interactions in electrophysiology in patients with PD are not well characterized. METHODS Simultaneous bilateral STN and GP LFPs were recorded in a patient with PD who received bilateral STN-DBS and GP-DBS. Power spectra in each target and STN-GP coherence were assessed in various ON- and OFF-levodopa and DBS states, both at rest and with voluntary movement. RESULTS OFF-levodopa and OFF-DBS, beta peaks were present at bilateral STN and GP, coincident with prominent STN-GP beta coherence. Levodopa and dual-target-DBS (simultaneous STN-DBS and GP-DBS) completely suppressed STN-GP coherence. Finely-tuned gamma (FTG) activity at half the stimulation frequency (62.5 Hz) was seen in the STN during GP-DBS at rest. To assess the effects of movement on FTG activity, we recorded LFPs during instructed movement. We observed FTG activity in bilateral GP and bilateral STN during contralateral body movements while on GP-DBS and ON-levodopa. No FTG was seen with STN-DBS or dual-target-DBS. CONCLUSION Dual-target-DBS and levodopa suppressed STN-GP coherence. FTG throughout the basal ganglia was induced by GP-DBS in the presence of levodopa and movement. This bilateral STN-FTG and GP-FTG corresponded with the least severe bradykinesia state, suggesting a pro-kinetic role for FTG.
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Affiliation(s)
- Daniel D Cummins
- School of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, United States.
| | - Stephanie S Sandoval-Pistorius
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
| | - Rodrigo Fernandez-Gajardo
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
| | - Lauren H Hammer
- Department of Neurology, University of California San Francisco, 1651 4th Street, East Care Center, San Francisco, CA, 94143, United States
| | - Philip A Starr
- School of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, United States; Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
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13
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Fetterhoff D, Costa M, Hellerstedt R, Johannessen R, Imbach L, Sarnthein J, Strange BA. Neuronal population representation of human emotional memory. Cell Rep 2024; 43:114071. [PMID: 38592973 PMCID: PMC11063625 DOI: 10.1016/j.celrep.2024.114071] [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: 06/13/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Understanding how emotional processing modulates learning and memory is crucial for the treatment of neuropsychiatric disorders characterized by emotional memory dysfunction. We investigate how human medial temporal lobe (MTL) neurons support emotional memory by recording spiking activity from the hippocampus, amygdala, and entorhinal cortex during encoding and recognition sessions of an emotional memory task in patients with pharmaco-resistant epilepsy. Our findings reveal distinct representations for both remembered compared to forgotten and emotional compared to neutral scenes in single units and MTL population spiking activity. Additionally, we demonstrate that a distributed network of human MTL neurons exhibiting mixed selectivity on a single-unit level collectively processes emotion and memory as a network, with a small percentage of neurons responding conjointly to emotion and memory. Analyzing spiking activity enables a detailed understanding of the neurophysiological mechanisms underlying emotional memory and could provide insights into how emotion alters memory during healthy and maladaptive learning.
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Affiliation(s)
- Dustin Fetterhoff
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain.
| | - Manuela Costa
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain
| | - Robin Hellerstedt
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain
| | - Rebecca Johannessen
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland; Department of Psychology, University of Zurich, Switzerland
| | - Lukas Imbach
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, IdISSC, Madrid, Spain; Reina Sofia Centre for Alzheimer's Research, Madrid, Spain
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14
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Steiner LA, Crompton D, Sumarac S, Vetkas A, Germann J, Scherer M, Justich M, Boutet A, Popovic MR, Hodaie M, Kalia SK, Fasano A, Hutchison Wd WD, Lozano AM, Lankarany M, Kühn AA, Milosevic L. Neural signatures of indirect pathway activity during subthalamic stimulation in Parkinson's disease. Nat Commun 2024; 15:3130. [PMID: 38605039 PMCID: PMC11009243 DOI: 10.1038/s41467-024-47552-6] [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: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) produces an electrophysiological signature called evoked resonant neural activity (ERNA); a high-frequency oscillation that has been linked to treatment efficacy. However, the single-neuron and synaptic bases of ERNA are unsubstantiated. This study proposes that ERNA is a subcortical neuronal circuit signature of DBS-mediated engagement of the basal ganglia indirect pathway network. In people with Parkinson's disease, we: (i) showed that each peak of the ERNA waveform is associated with temporally-locked neuronal inhibition in the STN; (ii) characterized the temporal dynamics of ERNA; (iii) identified a putative mesocircuit architecture, embedded with empirically-derived synaptic dynamics, that is necessary for the emergence of ERNA in silico; (iv) localized ERNA to the dorsal STN in electrophysiological and normative anatomical space; (v) used patient-wise hotspot locations to assess spatial relevance of ERNA with respect to DBS outcome; and (vi) characterized the local fiber activation profile associated with the derived group-level ERNA hotspot.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
- Berlin Institute of Health (BIH), Berlin, 10178, Germany
| | - David Crompton
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Srdjan Sumarac
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Artur Vetkas
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Jürgen Germann
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Maximilian Scherer
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Maria Justich
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, M5G 1×6, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - William D Hutchison Wd
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Milad Lankarany
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada.
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada.
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15
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Blanpain LT, Cole ER, Chen E, Park JK, Walelign MY, Gross RE, Cabaniss BT, Willie JT, Singer AC. Multisensory flicker modulates widespread brain networks and reduces interictal epileptiform discharges. Nat Commun 2024; 15:3156. [PMID: 38605017 PMCID: PMC11009358 DOI: 10.1038/s41467-024-47263-y] [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: 07/25/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Modulating brain oscillations has strong therapeutic potential. Interventions that both non-invasively modulate deep brain structures and are practical for chronic daily home use are desirable for a variety of therapeutic applications. Repetitive audio-visual stimulation, or sensory flicker, is an accessible approach that modulates hippocampus in mice, but its effects in humans are poorly defined. We therefore quantified the neurophysiological effects of flicker with high spatiotemporal resolution in patients with focal epilepsy who underwent intracranial seizure monitoring. In this interventional trial (NCT04188834) with a cross-over design, subjects underwent different frequencies of flicker stimulation in the same recording session with the effect of sensory flicker exposure on local field potential (LFP) power and interictal epileptiform discharges (IEDs) as primary and secondary outcomes, respectively. Flicker focally modulated local field potentials in expected canonical sensory cortices but also in the medial temporal lobe and prefrontal cortex, likely via resonance of stimulated long-range circuits. Moreover, flicker decreased interictal epileptiform discharges, a pathological biomarker of epilepsy and degenerative diseases, most strongly in regions where potentials were flicker-modulated, especially the visual cortex and medial temporal lobe. This trial met the scientific goal and is now closed. Our findings reveal how multi-sensory stimulation may modulate cortical structures to mitigate pathological activity in humans.
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Affiliation(s)
- Lou T Blanpain
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
| | - Eric R Cole
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
| | - Emily Chen
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - James K Park
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Y Walelign
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Neurosurgery and Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, New Brunswick and New Jersey Medical School, Newark, NJ, USA
| | - Brian T Cabaniss
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jon T Willie
- Departments of Neurological Surgery, Neurology, Psychiatry, and Biomedical Engineering, Washington University, St. Louis, MO, USA.
| | - Annabelle C Singer
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA.
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Fu S, Yang Z, He X, Liu D, Yang Z, Zhang J, Du L. Long-term Efficacy of Bilateral Globus Pallidus Stimulation in the Treatment of Meige Syndrome. Neuromodulation 2024:S1094-7159(24)00058-8. [PMID: 38597859 DOI: 10.1016/j.neurom.2024.02.002] [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: 09/27/2023] [Revised: 01/12/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to investigate the long-term efficacy and prognosis of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) in patients with benign essential blepharospasm (BEB) and complete Meige syndrome, and to search for the best therapeutic subregion within the GPi. MATERIALS AND METHODS Data were collected for 36 patients with Meige syndrome who underwent bilateral GPi-DBS surgery at our hospital between March 2014 and February 2022. Using the Burk-Fahn-Marsden Dystonia Rating Scale (BFMDRS)-Movement (BFMDRS-M) and BFMDRS-Disability (BFMDRS-D), the severity of the symptoms of patients with complete Meige syndrome was evaluated before surgery and at specific time points after surgery. Patients with BEB were clinically evaluated for the severity of blepharospasm using BFMDRS-M, the Blepharospasm Disability Index (BDI), and Jankovic Rating Scale (JRS). Three-dimensional reconstruction of the GPi-electrode was performed in some patients using the lead-DBS software, and the correlation between GPi subregion volume of tissue activated (VTA) and symptom improvement was analyzed in patients six months after surgery. The follow-up duration ranged from six to 99 months. RESULTS Compared with preoperative scores, the results of all patients at six months after surgery and final follow-up showed a significant decrease (p < 0.05) in the mean BFMDRS-M score. Among them, the average BFMDRS-M improvement rates in patients with BEB at six months after surgery and final follow-up were 60.3% and 69.7%, respectively, whereas those in patients with complete Meige syndrome were 54.5% and 58.3%, respectively. The average JRS and BDI scores of patients with BEB also decreased significantly (p < 0.05) at six months after surgery and at the final follow-up (JRS improvement: 38.6% and 49.1%, respectively; BDI improvement: 42.6% and 57.4%, respectively). We were unable to identify significantly correlated prognostic factors. There was a significant correlation between GPi occipital VTA and symptom improvement in patients at six months after surgery (r = 0.34, p = 0.025). CONCLUSIONS Our study suggests that bilateral GPi-DBS is an effective treatment for Meige syndrome, with no serious postoperative complications. The VTA in the GPi subregion may be related to the movement score improvement. In addition, further research is needed to predict patients with poor surgical outcomes.
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Elias GJB, Germann J, Joel SE, Li N, Horn A, Boutet A, Lozano AM. A large normative connectome for exploring the tractographic correlates of focal brain interventions. Sci Data 2024; 11:353. [PMID: 38589407 PMCID: PMC11002007 DOI: 10.1038/s41597-024-03197-0] [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: 09/25/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
Diffusion-weighted MRI (dMRI) is a widely used neuroimaging modality that permits the in vivo exploration of white matter connections in the human brain. Normative structural connectomics - the application of large-scale, group-derived dMRI datasets to out-of-sample cohorts - have increasingly been leveraged to study the network correlates of focal brain interventions, insults, and other regions-of-interest (ROIs). Here, we provide a normative, whole-brain connectome in MNI space that enables researchers to interrogate fiber streamlines that are likely perturbed by given ROIs, even in the absence of subject-specific dMRI data. Assembled from multi-shell dMRI data of 985 healthy Human Connectome Project subjects using generalized Q-sampling imaging and multispectral normalization techniques, this connectome comprises ~12 million unique streamlines, the largest to date. It has already been utilized in at least 18 peer-reviewed publications, most frequently in the context of neuromodulatory interventions like deep brain stimulation and focused ultrasound. Now publicly available, this connectome will constitute a useful tool for understanding the wider impact of focal brain perturbations on white matter architecture going forward.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
- Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
- Krembil Research Institute, University of Toronto, Toronto, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
| | | | - Ningfei Li
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
- Krembil Research Institute, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.
- Krembil Research Institute, University of Toronto, Toronto, Canada.
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18
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Leserri S, Segura-Amil A, Nowacki A, Debove I, Petermann K, Schäppi L, Preti MG, Van De Ville D, Pollo C, Walther S, Nguyen TAK. Linking connectivity of deep brain stimulation of nucleus accumbens area with clinical depression improvements: a retrospective longitudinal case series. Eur Arch Psychiatry Clin Neurosci 2024; 274:685-696. [PMID: 37668723 PMCID: PMC10994999 DOI: 10.1007/s00406-023-01683-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
Treatment-resistant depression is a severe form of major depressive disorder and deep brain stimulation is currently an investigational treatment. The stimulation's therapeutic effect may be explained through the functional and structural connectivities between the stimulated area and other brain regions, or to depression-associated networks. In this longitudinal, retrospective study, four female patients with treatment-resistant depression were implanted for stimulation in the nucleus accumbens area at our center. We analyzed the structural and functional connectivity of the stimulation area: the structural connectivity was investigated with probabilistic tractography; the functional connectivity was estimated by combining patient-specific stimulation volumes and a normative functional connectome. These structural and functional connectivity profiles were then related to four clinical outcome scores. At 1-year follow-up, the remission rate was 66%. We observed a consistent structural connectivity to Brodmann area 25 in the patient with the longest remission phase. The functional connectivity analysis resulted in patient-specific R-maps describing brain areas significantly correlated with symptom improvement in this patient, notably the prefrontal cortex. But the connectivity analysis was mixed across patients, calling for confirmation in a larger cohort and over longer time periods.
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Affiliation(s)
- Simona Leserri
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University Bern, Bern, Switzerland
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alba Segura-Amil
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katrin Petermann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lea Schäppi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Maria Giulia Preti
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology and Medical InformaticsFaculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dimitri Van De Ville
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology and Medical InformaticsFaculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - T A Khoa Nguyen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- ARTORG Center for Biomedical Engineering Research, University Bern, Bern, Switzerland.
- ARTORG IGT, Murtenstrasse 50, 3008, Bern, Switzerland.
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19
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Remore LG, Tariciotti L, Fiore G, Pirola E, Borellini L, Cogiamanian F, Ampollini AM, Schisano L, Gagliano D, Borsa S, Pluderi M, Bertani GA, Barbieri S, Locatelli M. The role of SWI sequence during the preoperative targeting of the subthalamic nucleus for deep brain stimulation in Parkinson's disease: A retrospective cohort study. World Neurosurg X 2024; 22:100342. [PMID: 38469384 PMCID: PMC10926353 DOI: 10.1016/j.wnsx.2024.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Luigi Gianmaria Remore
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan LA STATALE, Milan, Italy
| | - Leonardo Tariciotti
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan LA STATALE, Milan, Italy
| | - Giorgio Fiore
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan LA STATALE, Milan, Italy
| | - Elena Pirola
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Linda Borellini
- Department of Neuropathophysiology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Cogiamanian
- Department of Neuropathophysiology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Luigi Schisano
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Gagliano
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan LA STATALE, Milan, Italy
| | - Stefano Borsa
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulio Andrea Bertani
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Barbieri
- Department of Neuropathophysiology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
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20
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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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21
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Calvano A, Kleinholdermann U, Heun AS, Bopp MHA, Nimsky C, Timmermann L, Pedrosa DJ. Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson's disease. Neuroimage Clin 2024; 42:103591. [PMID: 38507954 PMCID: PMC10965492 DOI: 10.1016/j.nicl.2024.103591] [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: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND A reduction in stride length is considered a key characteristic of gait kinematics in Parkinson's disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. OBJECTIVE This study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). METHODS Objective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. RESULTS LFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. CONCLUSION These findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Urs Kleinholdermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | | | - Miriam H A Bopp
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany.
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22
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Chinichian N, Lindner M, Yanchuk S, Schwalger T, Schöll E, Berner R. Modeling brain network flexibility in networks of coupled oscillators: a feasibility study. Sci Rep 2024; 14:5713. [PMID: 38459077 PMCID: PMC10923875 DOI: 10.1038/s41598-024-55753-8] [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: 09/19/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
Modeling the functionality of the human brain is a major goal in neuroscience for which many powerful methodologies have been developed over the last decade. The impact of working memory and the associated brain regions on the brain dynamics is of particular interest due to their connection with many functions and malfunctions in the brain. In this context, the concept of brain flexibility has been developed for the characterization of brain functionality. We discuss emergence of brain flexibility that is commonly measured by the identification of changes in the cluster structure of co-active brain regions. We provide evidence that brain flexibility can be modeled by a system of coupled FitzHugh-Nagumo oscillators where the network structure is obtained from human brain Diffusion Tensor Imaging (DTI). Additionally, we propose a straightforward and computationally efficient alternative macroscopic measure, which is derived from the Pearson distance of functional brain matrices. This metric exhibits similarities to the established patterns of brain template flexibility that have been observed in prior investigations. Furthermore, we explore the significance of the brain's network structure and the strength of connections between network nodes or brain regions associated with working memory in the observation of patterns in networks flexibility. This work enriches our understanding of the interplay between the structure and function of dynamic brain networks and proposes a modeling strategy to study brain flexibility.
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Affiliation(s)
- Narges Chinichian
- Institut für Theoretische Physik, Technische Universität Berlin, Berlin, Germany.
- Psychiatry Department, Charité-Universitätsmedizin, Berlin, Germany.
- Bernstein Center for Computational Neuroscience, Berlin, Germany.
| | - Michael Lindner
- Institut für Theoretische Physik, Technische Universität Berlin, Berlin, Germany
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Serhiy Yanchuk
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Institute of Mathematics, Humboldt Universität zu Berlin, Berlin, Germany
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - Tilo Schwalger
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Institute of Mathematics, Technische Universität Berlin, Berlin, Germany
| | - Eckehard Schöll
- Institut für Theoretische Physik, Technische Universität Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Rico Berner
- Institut für Theoretische Physik, Technische Universität Berlin, Berlin, Germany
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
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23
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Deuter D, Mederer T, Kohl Z, Forras P, Rosengarth K, Schlabeck M, Röhrl D, Wendl C, Fellner C, Schmidt NO, Schlaier J. Amelioration of Parkinsonian tremor evoked by DBS: which role play cerebello-(sub)thalamic fiber tracts? J Neurol 2024; 271:1451-1461. [PMID: 38032372 PMCID: PMC10896868 DOI: 10.1007/s00415-023-12095-1] [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: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Current pathophysiological models of Parkinson's disease (PD) assume a malfunctioning network being adjusted by the DBS signal. As various authors showed a main involvement of the cerebellum within this network, cerebello-cerebral fiber tracts are gaining special interest regarding the mediation of DBS effects. OBJECTIVES The crossing and non-decussating fibers of the dentato-rubro-thalamic tract (c-DRTT/nd-DRTT) and the subthalamo-ponto-cerebellar tract (SPCT) are thought to build up an integrated network enabling a bidimensional communication between the cerebellum and the basal ganglia. The aim of this study was to investigate the influence of these tracts on clinical control of Parkinsonian tremor evoked by DBS. METHODS We analyzed 120 electrode contacts from a cohort of 14 patients with tremor-dominant or equivalence-type PD having received bilateral STN-DBS. Probabilistic tractography was performed to depict the c-DRTT, nd-DRTT, and SPCT. Distance maps were calculated for the tracts and correlated to clinical tremor control for each electrode pole. RESULTS A significant difference between "effective" and "less-effective" contacts was only found for the c-DRTT (p = 0.039), but not for the SPCT, nor the nd-DRTT. In logistic and linear regressions, significant results were also found for the c-DRTT only (pmodel logistic = 0.035, ptract logistic = 0,044; plinear = 0.027). CONCLUSIONS We found a significant correlation between the distance of the DBS electrode pole to the c-DRTT and the clinical efficacy regarding tremor reduction. The c-DRTT might therefore play a major role in the mechanisms of alleviation of Parkinsonian tremor and could eventually serve as a possible DBS target for tremor-dominant PD in future.
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Affiliation(s)
- Daniel Deuter
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Tobias Mederer
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Zacharias Kohl
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, Regensburg Medbo District Hospital, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Patricia Forras
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, Regensburg Medbo District Hospital, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Katharina Rosengarth
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Mona Schlabeck
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Daniela Röhrl
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christina Wendl
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Radiology, Regensburg Medbo District Hospital, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Nils-Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Jürgen Schlaier
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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24
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Rifi Z, Remore LG, Tolossa M, Wei W, Sun XR, Bari AA. Somatotopic organization of the ventral nuclear group of the dorsal thalamus: deep brain stimulation for neuropathic pain reveals new insights into the facial homunculus. Brain Struct Funct 2024; 229:349-358. [PMID: 38172466 DOI: 10.1007/s00429-023-02733-9] [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: 09/01/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
Deep Brain Stimulation (DBS) is an experimental treatment for medication-refractory neuropathic pain. The ventral posteromedial (VPM) and ventral posterolateral (VPL) nuclei of the thalamus are popular targets for the treatment of facial and limb pain, respectively. While intraoperative testing is used to adjust targeting of patient-specific pain locations, a better understanding of thalamic somatotopy may improve targeting of specific body regions including the individual trigeminal territories, face, arm, and leg. To elucidate the somatotopic organization of the ventral nuclear group of the dorsal thalamus using in vivo macrostimulation data from patients undergoing DBS for refractory neuropathic pain. In vivo macrostimulation data was retrospectively collected for 14 patients who underwent DBS implantation for neuropathic pain syndromes at our institution. 56 contacts from 14 electrodes reconstructed with LeadDBS were assigned to macrostimulation-related body regions: tongue, face, arm, or leg. 33 contacts from 9 electrodes were similarly assigned to one of three trigeminal territories: V1, V2, or V3. MNI coordinates in the x, y, and z axes were compared by using MANOVA. Across the horizontal plane of the ventral nuclear group of the dorsal thalamus, the tongue was represented significantly medially, followed by the face, arm, and leg most laterally (p < 0.001). The trigeminal territories displayed significant mediolateral distribution, proceeding from V1 and V2 most medial to V3 most lateral (p < 0.001). Along the y-axis, V2 was also significantly anterior to V3 (p = 0.014). While our results showed that the ventral nuclear group of the dorsal thalamus displayed mediolateral somatotopy of the tongue, face, arm, and leg mirroring the cortical homunculus, the mediolateral distribution of trigeminal territories did not mirror the established cortical homunculus. This finding suggests that the facial homunculus may be inverted in the ventral nuclear group of the dorsal thalamus.
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Affiliation(s)
- Ziad Rifi
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Luigi Gianmaria Remore
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
- University of Milan "LA STATALE", Milan, Italy
| | - Meskerem Tolossa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Wenxin Wei
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Xiaonan R Sun
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Ausaf A Bari
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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25
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Hollunder B, Ostrem JL, Sahin IA, Rajamani N, Oxenford S, Butenko K, Neudorfer C, Reinhardt P, Zvarova P, Polosan M, Akram H, Vissani M, Zhang C, Sun B, Navratil P, Reich MM, Volkmann J, Yeh FC, Baldermann JC, Dembek TA, Visser-Vandewalle V, Alho EJL, Franceschini PR, Nanda P, Finke C, Kühn AA, Dougherty DD, Richardson RM, Bergman H, DeLong MR, Mazzoni A, Romito LM, Tyagi H, Zrinzo L, Joyce EM, Chabardes S, Starr PA, Li N, Horn A. Mapping dysfunctional circuits in the frontal cortex using deep brain stimulation. Nat Neurosci 2024; 27:573-586. [PMID: 38388734 PMCID: PMC10917675 DOI: 10.1038/s41593-024-01570-1] [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: 03/02/2023] [Accepted: 01/05/2024] [Indexed: 02/24/2024]
Abstract
Frontal circuits play a critical role in motor, cognitive and affective processing, and their dysfunction may result in a variety of brain disorders. However, exactly which frontal domains mediate which (dys)functions remains largely elusive. We studied 534 deep brain stimulation electrodes implanted to treat four different brain disorders. By analyzing which connections were modulated for optimal therapeutic response across these disorders, we segregated the frontal cortex into circuits that had become dysfunctional in each of them. Dysfunctional circuits were topographically arranged from occipital to frontal, ranging from interconnections with sensorimotor cortices in dystonia, the primary motor cortex in Tourette's syndrome, the supplementary motor area in Parkinson's disease, to ventromedial prefrontal and anterior cingulate cortices in obsessive-compulsive disorder. Our findings highlight the integration of deep brain stimulation with brain connectomics as a powerful tool to explore couplings between brain structure and functional impairments in the human brain.
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Affiliation(s)
- Barbara Hollunder
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jill L Ostrem
- Movement Disorders and Neuromodulation Centre, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ilkem Aysu Sahin
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nanditha Rajamani
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simón Oxenford
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Reinhardt
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Zvarova
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mircea Polosan
- Université Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut des Neurosciences, Grenoble, France
- Department of Psychiatry, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Harith Akram
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Matteo Vissani
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Chencheng Zhang
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pavel Navratil
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin M Reich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till A Dembek
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carsten Finke
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hagai Bergman
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University, Hadassah Medical School, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Luigi M Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Himanshu Tyagi
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Eileen M Joyce
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Stephan Chabardes
- Université Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut des Neurosciences, Grenoble, France
- Department of Neurosurgery, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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26
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Tsolaki E, Kashanian A, Chiu K, Bari A, Pouratian N. Connectivity-based segmentation of the thalamic motor region for deep brain stimulation in essential tremor: A comparison of deterministic and probabilistic tractography. Neuroimage Clin 2024; 41:103587. [PMID: 38422832 PMCID: PMC10944185 DOI: 10.1016/j.nicl.2024.103587] [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: 11/13/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Deep brain stimulation (DBS) studies have shown that stimulation of the motor segment of the thalamus based on probabilistic tractography is predictive of improvement in essential tremor (ET). However, probabilistic methods are computationally demanding, requiring the need for alternative tractography methods for use in the clinical setting. The purpose of this study was to compare probabilistic vs deterministic tractography methods for connectivity-based targeting in patients with ET. METHODS Probabilistic and deterministic tractography methods were retrospectively applied to diffusion-weighted data sets in 36 patients with refractory ET. The thalamus and precentral gyrus were selected as regions of interest and fiber tracking was performed between these regions to produce connectivity-based thalamic segmentations, per prior methods. The resultant deterministic target maps were compared with those of thresholded probabilistic maps. The center of gravity (CG) of each connectivity map was determined and the differences in spatial distribution between the tractography methods were characterized. Furthermore, the intersection between the connectivity maps and CGs with the therapeutic volume of tissue activated (VTA) was calculated. A mixed linear model was then used to assess clinical improvement in tremor with volume of overlap. RESULTS Both tractography methods delineated the region of the thalamus with connectivity to the precentral gyrus to be within the posterolateral aspect of the thalamus. The average CG of deterministic maps was more medial-posterior in both the left (3.7 ± 1.3 mm3) and the right (3.5 ± 2.2 mm3) hemispheres when compared to 30 %-thresholded probabilistic maps. Mixed linear model showed that the volume of overlap between CGs of deterministic and probabilistic targeting maps and therapeutic VTAs were significant predictors of clinical improvement. CONCLUSIONS Deterministic tractography can reconstruct DBS thalamic target maps in approximately 5 min comparable to those produced by probabilistic methods that require > 12 h to generate. Despite differences in CG between the methods, both deterministic-based and probabilistic targeting were predictive of clinical improvement in ET.
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Affiliation(s)
- Evangelia Tsolaki
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Alon Kashanian
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kevin Chiu
- Brainlab, Inc., 5 Westbrook Corporate Center, Suite 1000, Westchester, IL 60154, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Bočková M, Lamoš M, Chrastina J, Daniel P, Kupcová S, Říha I, Šmahovská L, Baláž M, Rektor I. Coupling between beta band and high frequency oscillations as a clinically useful biomarker for DBS. NPJ Parkinsons Dis 2024; 10:40. [PMID: 38383550 PMCID: PMC10882016 DOI: 10.1038/s41531-024-00656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Beta hypersynchrony was recently introduced into clinical practice in Parkinson's disease (PD) to identify the best stimulation contacts and for adaptive deep brain stimulation (aDBS) sensing. However, many other oscillopathies accompany the disease, and beta power sensing may not be optimal for all patients. The aim of this work was to study the potential clinical usefulness of beta power phase-amplitude coupling (PAC) with high frequency oscillations (HFOs). Subthalamic nucleus (STN) local field potentials (LFPs) from externalized DBS electrodes were recorded and analyzed in PD patients (n = 19). Beta power and HFOs were evaluated in a resting-state condition; PAC was then studied and compared with the electrode contact positions, structural connectivity, and medication state. Beta-HFO PAC (mainly in the 200-500 Hz range) was observed in all subjects. PAC was detectable more specifically in the motor part of the STN compared to beta power and HFOs. Moreover, the presence of PAC better corresponds to the stimulation setup based on the clinical effect. PAC is also sensitive to the laterality of symptoms and dopaminergic therapy, where the greater PAC cluster reflects the more affected side and medication "off" state. Coupling between beta power and HFOs is known to be a correlate of the PD "off" state. Beta-HFO PAC seems to be more sensitive than beta power itself and could be more helpful in the selection of the best clinical stimulation contact and probably also as a potential future input signal for aDBS.
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Affiliation(s)
- Martina Bočková
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Martin Lamoš
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jan Chrastina
- Department of Neurosurgery, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Pavel Daniel
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Silvia Kupcová
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivo Říha
- Department of Neurosurgery, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Lucia Šmahovská
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Baláž
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Ivan Rektor
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic.
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28
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Peng C, Wang Z, Sun Y, Mo Y, Hu K, Li Q, Hou X, Zhu Z, He X, Xue S, Zhang S. Subthalamic nucleus dynamics track microlesion effect in Parkinson's disease. Front Cell Dev Biol 2024; 12:1370287. [PMID: 38434618 PMCID: PMC10906266 DOI: 10.3389/fcell.2024.1370287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Parkinson's Disease (PD) is characterized by the temporary alleviation of motor symptoms following electrode implantation (or nucleus destruction), known as the microlesion effect (MLE). Electrophysiological studies have explored different PD stages, but understanding electrophysiological characteristics during the MLE period remains unclear. The objective was to examine the characteristics of local field potential (LFP) signals in the subthalamic nucleus (STN) during the hyperacute period following implantation (within 2 days) and 1 month post-implantation. 15 patients diagnosed with PD were enrolled in this observational study, with seven simultaneous recordings of bilateral STN-LFP signals using wireless sensing technology from an implantable pulse generator. Recordings were made in both on and off medication states over 1 month after implantation. We used a method to parameterize the neuronal power spectrum to separate periodic oscillatory and aperiodic components effectively. Our results showed that beta power exhibited a significant increase in the off medication state 1 month after implantation, compared to the postoperative hyperacute period. Notably, this elevation was effectively attenuated by levodopa administration. Furthermore, both the exponents and offsets displayed a decrease at 1 month postoperatively when compared to the hyperacute postoperative period. Remarkably, levodopa medication exerted a modulatory effect on these aperiodic parameters, restoring them back to levels observed during the hyperacute period. Our findings suggest that both periodic and aperiodic components partially capture distinct electrophysiological characteristics during the MLE. It is crucial to adequately evaluate such discrepancies when exploring the mechanisms of MLE and optimizing adaptive stimulus protocols.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sha Xue
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shizhong Zhang
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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29
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Carl B, Bopp M, SAß B, Waldthaler J, Timmermann L, Nimsky C. Visualization of volume of tissue activated modeling in a clinical planning system for deep brain stimulation. J Neurosurg Sci 2024; 68:59-69. [PMID: 32031356 DOI: 10.23736/s0390-5616.19.04827-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pathway activating models try to describe stimulation spread in deep brain stimulation (DBS). Volume of tissue activated (VTA) models are simplified model variants allowing faster and easier computation. Our study aimed to investigate, how VTA visualization can be integrated into a clinical workflow applying directional electrodes using a standard clinical DBS planning system. METHODS Twelve patients underwent DBS, using directional electrodes for bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease. Preoperative 3T magnetic resonance imaging was used for automatic visualization of the STN outline, as well as for fiber tractography. Intraoperative computed tomography was used for automatic lead detection. The Guide XT software, closely integrated into the DBS planning software environment, was used for VTA calculation and visualization. RESULTS VTA visualization was possible in all cases. The percentage of VTA covering the STN volume ranged from 25% to 100% (mean: 60±25%) on the left side and from 0% to 98% (51±30%) on the right side. The mean coordinate of all VTA centers was: 12.6±1.2 mm lateral, 2.1±1.2 mm posterior, and 2.3±1.4 mm inferior in relation to the midcommissural point. Stimulation effects can be compared to the VTA visualization in relation to surrounding structures, potentially facilitating programming, which might be especially beneficial in case of suboptimal lead placement. CONCLUSIONS VTA visualization in a clinical planning system allows an intuitive adjustment of the stimulation parameters, supports programming, and enhances understanding of effects and side effects of DBS.
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Affiliation(s)
- Barbara Carl
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin SAß
- Department of Neurosurgery, University of Marburg, Marburg, Germany
| | | | - Lars Timmermann
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
- Department of Neurology, University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Marburg, Germany -
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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30
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Sun X, Shen R, Lin Z, Wang T, Wang L, Huang P, Feng T, Liu J, Ding J, Zhang C, Li D, Wu Y. Optimizing Deep Brain Stimulation in Essential Tremor: A Randomized Controlled Trial for Target Consideration. Neurosurgery 2024; 95:00006123-990000000-01032. [PMID: 38270451 PMCID: PMC11155559 DOI: 10.1227/neu.0000000000002839] [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: 09/29/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The thalamic ventral intermediate nucleus (VIM) is a well-established target for deep brain stimulation (DBS) in the treatment of essential tremor (ET). Increasing data indicate that the posterior subthalamic area (PSA) may be superior, but high-level evidence is limited. We aimed at further comparing the intraindividual efficacy and side effect profile of PSA vs VIM DBS in ET. METHODS In this randomized, double-blind, crossover trial, 4-contact DBS leads were bilaterally implanted with single-trajectory covering the VIM and PSA. Patients were randomized postsurgery to 2 groups, receiving VIM stimulation (4-7 months) and then PSA stimulation (8-11 months) or vice versa. The primary end point was the difference in improvement from baseline to the end of the VIM vs PSA DBS period in the total score of the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). RESULTS Ten patients with medically refractory ET were enrolled, and 9 completed the study. The difference between reduction of FTM-TRS total score in the PSA vs VIM DBS period was -7.4 (95% CI: -28.5 to 13.7, P = .328). Clinical benefit was achieved at significantly lower stimulation intensity under PSA DBS. Furthermore, PSA DBS provided greater improvement in head tremor subscore of FTM-TRS (PSA vs VIM: -2.2, P = .020) and disease-specific quality of life (PSA vs VIM: -13.8, P = .046) and induced fewer speech (Dysphonia Severity Index score: P = .043; diadochokinetic rate: P = .007; VDI score: P = .005) and gait disturbances compared with VIM DBS. Seven patients remained with PSA DBS after the crossover phase. CONCLUSION Our study confirms that PSA-DBS is comparable with VIM-DBS in suppressing tremors, superior in improving disease-specific quality of life, and possibly more effective in reducing head tremor.
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Affiliation(s)
- Xiaoyu Sun
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Ruinan Shen
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Zhengyu Lin
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Lingbing Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Jun Liu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Jianqing Ding
- Department of Neurology & Institute of Neurology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
- Clinical Neuroscience Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
- Clinical Neuroscience Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;
- Clinical Neuroscience Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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31
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Spiliotis K, Butenko K, Starke J, van Rienen U, Köhling R. Towards an optimised deep brain stimulation using a large-scale computational network and realistic volume conductor model. J Neural Eng 2024; 20:066045. [PMID: 37988747 DOI: 10.1088/1741-2552/ad0e7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/21/2023] [Indexed: 11/23/2023]
Abstract
Objective. Constructing a theoretical framework to improve deep brain stimulation (DBS) based on the neuronal spatiotemporal patterns of the stimulation-affected areas constitutes a primary target.Approach. We develop a large-scale biophysical network, paired with a realistic volume conductor model, to estimate theoretically efficacious stimulation protocols. Based on previously published anatomically defined structural connectivity, a biophysical basal ganglia-thalamo-cortical neuronal network is constructed using Hodgkin-Huxley dynamics. We define a new biomarker describing the thalamic spatiotemporal activity as a ratio of spiking vs. burst firing. The per cent activation of the different pathways is adapted in the simulation to minimise the differences of the biomarker with respect to its value under healthy conditions.Main results.This neuronal network reproduces spatiotemporal patterns that emerge in Parkinson's disease. Simulations of the fibre per cent activation for the defined biomarker propose desensitisation of pallido-thalamic synaptic efficacy, induced by high-frequency signals, as one possible crucial mechanism for DBS action. Based on this activation, we define both an optimal electrode position and stimulation protocol using pathway activation modelling.Significance. A key advantage of this research is that it combines different approaches, i.e. the spatiotemporal pattern with the electric field and axonal response modelling, to compute the optimal DBS protocol. By correlating the inherent network dynamics with the activation of white matter fibres, we obtain new insights into the DBS therapeutic action.
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Affiliation(s)
| | - Konstantin Butenko
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Starke
- Institute of Mathematics, University of Rostock, Rostock, Germany
| | - Ursula van Rienen
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
- Department of Ageing of Individuals and Society, University of Rostock, Rostock, Germany
| | - Rüdiger Köhling
- Department of Ageing of Individuals and Society, University of Rostock, Rostock, Germany
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
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Bobin M, Sulzer N, Bründler G, Staib M, Imbach LL, Stieglitz LH, Krauss P, Bichsel O, Baumann CR, Frühholz S. Direct subthalamic nucleus stimulation influences speech and voice quality in Parkinson's disease patients. Brain Stimul 2024; 17:112-124. [PMID: 38272256 DOI: 10.1016/j.brs.2024.01.006] [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: 07/26/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND DBS of the subthalamic nucleus (STN) considerably ameliorates cardinal motor symptoms in PD. Reported STN-DBS effects on secondary dysarthric (speech) and dysphonic symptoms (voice), as originating from vocal tract motor dysfunctions, are however inconsistent with rather deleterious outcomes based on post-surgical assessments. OBJECTIVE To parametrically and intra-operatively investigate the effects of deep brain stimulation (DBS) on perceptual and acoustic speech and voice quality in Parkinson's disease (PD) patients. METHODS We performed an assessment of instantaneous intra-operative speech and voice quality changes in PD patients (n = 38) elicited by direct STN stimulations with variations of central stimulation features (depth, laterality, and intensity), separately for each hemisphere. RESULTS First, perceptual assessments across several raters revealed that certain speech and voice symptoms could be improved with STN-DBS, but this seems largely restricted to right STN-DBS. Second, computer-based acoustic analyses of speech and voice features revealed that both left and right STN-DBS could improve dysarthric speech symptoms, but only right STN-DBS can considerably improve dysphonic symptoms, with left STN-DBS being restricted to only affect voice intensity features. Third, several subareas according to stimulation depth and laterality could be identified in the motoric STN proper and close to the associative STN with optimal (and partly suboptimal) stimulation outcomes. Fourth, low-to-medium stimulation intensities showed the most optimal and balanced effects compared to high intensities. CONCLUSIONS STN-DBS can considerably improve both speech and voice quality based on a carefully arranged stimulation regimen along central stimulation features.
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Affiliation(s)
- Marine Bobin
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Neil Sulzer
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland
| | - Gina Bründler
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland
| | - Matthias Staib
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Lukas L Imbach
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Swiss Epilepsy Center, Klinik Lengg, 8008 Zurich, Switzerland
| | - Lennart H Stieglitz
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Philipp Krauss
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; Department of Neurosurgery, University Hospital Augsburg, 86159 Augsburg, Germany
| | - Oliver Bichsel
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sascha Frühholz
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Psychology, University of Oslo, 0373 Oslo, Norway.
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Todorov D, Schnitzler A, Hirschmann J. Parkinsonian rest tremor can be distinguished from voluntary hand movements based on subthalamic and cortical activity. Clin Neurophysiol 2024; 157:146-155. [PMID: 38030516 DOI: 10.1016/j.clinph.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To distinguish Parkinsonian rest tremor and different voluntary hand movements by analyzing brain activity. METHODS We re-analyzed magnetoencephalography and local field potential recordings from the subthalamic nucleus of six patients with Parkinson's disease. Data were obtained after withdrawal from dopaminergic medication (Med Off) and after administration of levodopa (Med On). Using gradient-boosted tree learning, we classified epochs as tremor, fist-clenching, forearm extension or tremor-free rest. RESULTS Subthalamic activity alone was insufficient for distinguishing the four different motor states (balanced accuracy mean: 38%, std: 7%). The combination of cortical and subthalamic features, in contrast, allowed for a much more accurate classification (balanced accuracy mean: 75%, std: 17%). Adding a single cortical area improved balanced accuracy by 17% on average, as compared to classification based on subthalamic activity alone. In most patients, the most informative cortical areas were sensorimotor cortical regions. Decoding performance was similar in Med On and Med Off. CONCLUSIONS Electrophysiological recordings allow for distinguishing several motor states, provided that cortical signals are monitored in addition to subthalamic activity. SIGNIFICANCE By combining cortical recordings, subcortical recordings and machine learning, adaptive deep brain stimulation systems might be able to detect tremor specifically and to respond adequately to several motor states.
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Affiliation(s)
- Dmitrii Todorov
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany; Centre de Recherche en Neurosciences de Lyon - Inserm U1028, 69675 Bron, France; Centre de Recerca Matemática, Campus UAB edifici C, 08193 Bellaterra, Barcelona, Spain
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany; Center for Movement Disorders and Neuromodulation, Department of Neurology Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Jan Hirschmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany.
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Bougou V, Vanhoyland M, Decramer T, Van Hoylandt A, Smeijers S, Nuttin B, De Vloo P, Vandenberghe W, Nieuwboer A, Janssen P, Theys T. Active and Passive Cycling Decrease Subthalamic β Oscillations in Parkinson's Disease. Mov Disord 2024; 39:85-93. [PMID: 37860957 DOI: 10.1002/mds.29632] [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: 03/10/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Preserved cycling capabilities in patients with Parkinson's disease, especially in those with freezing of gait are still poorly understood. Previous research with invasive local field potential recordings in the subthalamic nucleus has shown that cycling causes a stronger suppression of β oscillations compared to walking, which facilitates motor continuation. METHODS We recorded local field potentials from 12 patients with Parkinson's disease (six without freezing of gait, six with freezing of gait) who were bilaterally implanted with deep brain stimulation electrodes in the subthalamic nucleus. We investigated β (13-30 Hz) and high γ (60-100 Hz) power during both active and passive cycling with different cadences and compared patients with and without freezing of gait. The passive cycling experiment, where a motor provided a fixed cadence, allowed us to study the effect of isolated sensory inputs without physical exercise. RESULTS We found similarly strong suppression of pathological β activity for both active and passive cycling. In contrast, there was stronger high γ band activity for active cycling. Notably, the effects of active and passive cycling were all independent of cadence. Finally, β suppression was stronger for patients with freezing of gait, especially during passive cycling. CONCLUSIONS Our results provide evidence for a link between proprioceptive input during cycling and β suppression. These findings support the role of continuous external sensory input and proprioceptive feedback during rhythmic passive cycling movements and suggest that systematic passive mobilization might hold therapeutic potential. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vasiliki Bougou
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Laboratory for Neuro- and Psychophysiology, Research Group Neurophysiology, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Michaël Vanhoyland
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Laboratory for Neuro- and Psychophysiology, Research Group Neurophysiology, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Decramer
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Laboratory for Neuro- and Psychophysiology, Research Group Neurophysiology, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Anaïs Van Hoylandt
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Steven Smeijers
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Nuttin
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Philippe De Vloo
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Laboratory for Parkinson Research, Research Group Experimental Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Research Group of Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Peter Janssen
- Laboratory for Neuro- and Psychophysiology, Research Group Neurophysiology, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
| | - Tom Theys
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Meyer GM, Hollunder B, Li N, Butenko K, Dembek TA, Hart L, Nombela C, Mosley P, Akram H, Acevedo N, Borron BM, Chou T, Castaño Montoya JP, Strange B, Barcia JA, Tyagi H, Castle DJ, Smith AH, Choi KS, Kopell BH, Mayberg HS, Sheth SA, Goodman W, Leentjens AFG, Richardson RM, Rossell SL, Bosanac P, Cosgrove GR, Kuhn J, Visser-Vandewalle V, Figee M, Dougherty DD, Siddiqi SH, Zrinzo L, Joyce E, Baldermann JC, Fox MD, Neudorfer C, Horn A. Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal Stimulation Sites. Biol Psychiatry 2023:S0006-3223(23)01785-7. [PMID: 38141909 DOI: 10.1016/j.biopsych.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Several stimulation targets have been used, mostly in and around the anterior limb of the internal capsule and ventral striatum. However, the precise target within this region remains a matter of debate. METHODS Here, we retrospectively studied a multicenter cohort of 82 patients with OCD who underwent DBS of the ventral capsule/ventral striatum and mapped optimal stimulation sites in this region. RESULTS DBS sweet-spot mapping performed on a discovery set of 58 patients revealed 2 optimal stimulation sites associated with improvements on the Yale-Brown Obsessive Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from 2 additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements in depression. CONCLUSIONS Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.
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Affiliation(s)
- Garance M Meyer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Barbara Hollunder
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ningfei Li
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lauren Hart
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristina Nombela
- Biological and Health Psychology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Philip Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia; Neurosciences Queensland, St. Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Brisbane, Queensland, Australia; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Herston, Queensland, Australia
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Nicola Acevedo
- Centre for Mental Health, Swinburne University, Melbourne, Victoria, Australia; St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Benjamin M Borron
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juan Pablo Castaño Montoya
- Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Bryan Strange
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Juan A Barcia
- Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Himanshu Tyagi
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - David J Castle
- University of Tasmania and Centre for Mental Health Service Innovation, Tasmania, Australia; State-wide Mental Health Service, Tasmania, Australia
| | - Andrew H Smith
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ki Sueng Choi
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian H Kopell
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sameer A Sheth
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas
| | - Wayne Goodman
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Melbourne, Victoria, Australia; St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Bosanac
- St. Vincent's Hospital, Melbourne, Victoria, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - G Rees Cosgrove
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Oberhausen, EVKLN, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Eileen Joyce
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andreas Horn
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Liu B, Xu J, Feng Z, Hui R, Zhang Y, Liu D, Chang Q, Yu X, Mao Z. One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson's disease. Front Aging Neurosci 2023; 15:1289183. [PMID: 38187361 PMCID: PMC10768017 DOI: 10.3389/fnagi.2023.1289183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Tremor-dominant Parkinson's disease (TD-PD) can be further separated into levodopa-responsive and levodopa-resistant types, the latter being considered to have a different pathogenesis. Previous studies indicated that deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus internus (GPi) individually was not sufficient for tremor control, especially for the levodopa-resistant TD-PD (LRTD-PD). The thalamic ventral intermediate nucleus (VIM) has been regarded as a potent DBS target for different kinds of tremors. Therefore, we focused on the LRTD-PD subgroup and performed one-pass combined DBSs of STN and VIM to treat refractory tremors, aiming to investigate the safety and effectiveness of this one-trajectory dual-target DBS scheme. Methods We retrospectively collected five LRTD-PD patients who underwent a one-pass combined DBS of STN and VIM via a trans-frontal approach. The targeting of VIM was achieved by probabilistic tractography. Changes in severity of symptoms (measured by the Unified Parkinson Disease Rating Scale part III, UPDRS-III), levodopa equivalent daily doses (LEDD), and disease-specific quality of life (measured by the 39-item Parkinson's Disease Questionnaire, PDQ-39) were evaluated. Results Three-dimensional reconstruction of electrodes illustrated that all leads were successfully implanted into predefined positions. The mean improvement rates (%) were 53 ± 6.2 (UPDRS-III), 82.6 ± 11.4 (tremor-related items of UPDRS), and 52.1 ± 11.4 (PDQ-39), respectively, with a mean follow-up of 11.4 months. Conclusion One-pass combined DBS of STN and VIM via the trans-frontal approach is an effective and safe strategy to alleviate symptoms for LRTD-PD patients.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhebin Feng
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rui Hui
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Chang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Kim MJ, Shi Y, Lee J, Salimpour Y, Anderson WS, Mills KA. Anatomical substrates and connectivity for bradykinesia motor features in Parkinson's disease after subthalamic nucleus deep brain stimulation. Brain Commun 2023; 5:fcad337. [PMID: 38130840 PMCID: PMC10733813 DOI: 10.1093/braincomms/fcad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Parkinsonian bradykinesia is rated using a composite scale incorporating the slowed frequency of repetitive movements, decrement amplitude and arrhythmicity. Differential localization of these movement components within the basal ganglia will drive the development of more personalized network-targeted symptomatic therapies. In this study, using an optical motion sensor, we evaluated the amplitude and frequency of hand movements during a grasping task with subthalamic nucleus deep brain stimulation 'on' or 'off' in 15 patients with Parkinson's disease. The severity of bradykinesia was assessed blindly using the Unified Parkinson's Disease Rating Part III scale. The volumes of activated tissue of each subject were estimated where changes in amplitude and frequency were mapped to identify distinct anatomical substrates of each component in the subthalamic nucleus. The volumes of activated tissue were used to seed a normative functional connectome to generate connectivity maps associated with amplitude and frequency changes. Deep brain stimulation-induced change in amplitude was negatively correlated with a change in Unified Parkinson's Disease Rating Part III scale for right (r = -0.65, P < 0.05) and left hand grasping scores (r = -0.63, P < 0.05). The change in frequency was negatively correlated with amplitude for both right (r = -0.63, P < 0.05) and left hands (r = -0.57, P < 0.05). The amplitude and frequency changes were represented as a spatial gradient with overlapping and non-overlapping regions spanning the anteromedial-posterolateral axis of the subthalamic nucleus. Whole-brain correlation maps between functional connectivity and motor changes were also inverted between amplitude and frequency changes. Deep brain stimulation-associated changes in frequency and amplitude were topographically and distinctly represented both locally in the subthalamic nucleus and in whole-brain functional connectivity.
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Affiliation(s)
- Min Jae Kim
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, Baltimore, MD 21218, USA
| | - Yiwen Shi
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Jasmine Lee
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Yousef Salimpour
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, Baltimore, MD 21218, USA
| | - Kelly A Mills
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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38
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Hidding U, Lezius S, Schaper M, Buhmann C, Gerloff C, Pötter-Nerger M, Hamel W, Moll CKE, Choe CU. Combined Short-Pulse and Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor. Neuromodulation 2023; 26:1680-1688. [PMID: 36369082 DOI: 10.1016/j.neurom.2022.09.009] [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: 01/31/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Novel deep brain stimulation (DBS) systems allow directional and short-pulse stimulation to potentially improve symptoms and reduce side effects. The aim of this study was to investigate the effect of short-pulse and directional stimulation, in addition to a combination of both, in the ventral intermediate thalamus (VIM)/posterior subthalamic area (PSA) on tremor and stimulation-induced side effects in patients with essential tremor. MATERIALS AND METHODS We recruited 11 patients with essential tremor and VIM/PSA-DBS. Tremor severity (Fahn-Tolosa-Marin), ataxia (International Cooperative Ataxia Rating Scale), and paresthesia (visual analog scale) were assessed with conventional omnidirectional and directional stimulation with pulse width of 60 μs and 30 μs. RESULTS All stimulation conditions reduced tremor. The best directional stimulation with 60 μs reduced more tremor than did most other stimulation settings. The best directional stimulation, regardless of pulse width, effectively reduced stimulation-induced ataxia compared with the conventional stimulation (ring 60 μs) or worst directional stimulation with 60 μs. All new stimulation modes reduced occurrence of paresthesia, but only the best directional stimulation with 30 μs attenuated paresthesia compared with the conventional stimulation (ring 60 μs) or worst directional stimulation with 60 μs. The best directional stimulation with 30 μs reduced tremor, ataxia, and paresthesia compared with conventional stimulation in most patients. Correlation analyses indicated that more anterior stimulation sites are associated with stronger ataxia reduction with directional 30 μs than with conventional 60 μs stimulation. CONCLUSION Directional and short-pulse stimulation, and a combination of both, revealed beneficial effects on stimulation-induced adverse effects.
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Affiliation(s)
- Ute Hidding
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Deuter D, Torka E, Kohl Z, Schmidt NO, Schlaier J. Mediation of Tremor Control by the Decussating and Nondecussating Part of the Dentato-Rubro-Thalamic Tract in Deep Brain Stimulation in Essential Tremor: Which Part Should Be Stimulated? Neuromodulation 2023; 26:1668-1679. [PMID: 35715283 DOI: 10.1016/j.neurom.2022.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The dentato-rubro-thalamic tract (DRTT) has been found to play a major role in the mechanisms of tremor alleviation by deep brain stimulation (DBS) in essential tremor (ET). Still, the influence of the two different parts of the DRTT, consisting of crossing and nondecussating fibers, is not yet clear with respect to tremor reduction. The aim of this study was to assess the influence of the crossing and the nondecussating part of the DRTT on tremor control in ET. MATERIALS AND METHODS We investigated 80 electrode contacts in ten patients with ET who received bilateral DBS of the Nucleus ventralis intermedius of the thalamus (VIM). Preoperatively and with patients under general anesthesia, 3T magnetic resonance imaging scans were performed, including Diffusion Tensor Imaging scans with 64 gradient directions. We calculated the course of the two parts of the DRTT based on a workflow for probabilistic fiber tracking including protocols for correction of susceptibility- and eddy current-induced distortions. Distances of electrode contacts were correlated with clinical data from neurologic single pole testing. RESULTS Voltage- and current-steered systems were analyzed separately. Regarding postural tremor, effective contacts showed significantly lower distances to both parts of the DRTT (crossing p < 0.001, nondecussating p < 0.05) in voltage-steered systems. Regarding intentional tremor, significant results were only found for the crossing part (p < 0.01). Regarding both tremor types, effective contacts were closer to the crossing part, unlike less effective contacts. Nonlinear regression analyses using a logistic model showed higher coefficients for the crossing part of the DRTT. Multivariate regression models including distances to both parts of the DRTT showed a significant influence of only the crossing part. Analysis of current-steered systems showed unstable data, probably because of the small number of analyzed patients. CONCLUSIONS Our data suggest an involvement of both parts of the DRTT in tremor reduction, indicating mediation of DBS effects by both fiber bundles, although the crossing part showed stronger correlations with good clinical responses. Nevertheless, special attention should be paid to methodologic aspects when using probabilistic tractography for patient-specific targeting to avoid uncertain and inaccurate results.
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Affiliation(s)
- Daniel Deuter
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany; Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany.
| | - Elisabeth Torka
- Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany; Department of Neurology, University of Regensburg Medical Center, Regensburg, Germany
| | - Zacharias Kohl
- Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany; Department of Neurology, University of Regensburg Medical Center, Regensburg, Germany
| | - Nils-Ole Schmidt
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany
| | - Juergen Schlaier
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany; Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany
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Parisi V, Gregg NM, Lundstrom BN, Alcala-Zermeno JL, Worrell G, Kerezoudis P, Grewal SS, Brinkmann BH, Middlebrooks EH, Van Gompel JJ. Temporo-Parietal Extraventricular Approach for Deep Brain Stimulation Targeting the Anterior Nucleus of the Thalamus: Institutional Experience. Neurosurgery 2023; 93:1393-1406. [PMID: 37477444 DOI: 10.1227/neu.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/18/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anterior nucleus of the thalamus (ANT) is a common target for deep brain stimulation (DBS) for drug-resistant epilepsy (DRE). However, the surgical approach to the ANT remains challenging because of its unique anatomy. This study aims to summarize our experience with the posterior temporo-parietal extraventricular (TPEV) approach targeting the ANT for DBS in DRE. METHODS We performed a retrospective analysis of patients with DRE who underwent ANT-DBS using the TPEV approach between January 2011 and February 2021. Subjects with at least 6-month follow-up were eligible. The final lead position and number of active contacts targeting the anteroventral nucleus (AV) of the ANT were assessed using Lead-DBS. Mean seizure frequency reduction percentage and responder rate (≥50% decrease in seizure frequency) were determined. RESULTS Thirty-one patients (mean age: 32.9 years; 52% female patients) were included. The mean follow-up period was 27.6 months ± 13.9 (29, 16-36). The mean seizure frequency reduction percentage was 65% ± 26 (75, 50-82). Twenty-six of 31 participants (83%) were responders, P < .001. Two subjects (6%) were seizure-free for at least 6 months at the last evaluation. Antiepileptic drugs dose and/or number decreased in 17/31 subjects (55%). The success rate for placing at least 1 contact at AV was 87% (27/31 patients) bilaterally. The number of active contacts at the AV was significantly greater in the responder group, 3.1 ± 1.3 (3, 2-4) vs 1.8 ± 1.1 (2, 1-2.5); P = .041 with a positive correlation between the number of active contacts and seizure reduction percentage; r = 0.445, R 2 = 0.198, P = .012. CONCLUSION The TPEV trajectory is a safe and effective approach to target the ANT for DBS. Future studies are needed to compare the clinical outcomes and target accuracy with the standard approaches.
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Affiliation(s)
- Veronica Parisi
- Department of Neurosurgery, AORN "Antonio Cardarelli", Naples , Italy
| | - Nicholas M Gregg
- Department of Neurology, Mayo Clinic, Rochester , Minnesota , USA
| | | | - Juan Luis Alcala-Zermeno
- Department of Neurology, Mayo Clinic, Rochester , Minnesota , USA
- Department of Neurology, Thomas Jefferson University, Philadelphia , Pennsylvania, USA
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester , Minnesota , USA
| | | | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville , Florida , USA
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Li J, Li N, Wang X, Wang J, Wang X, Wang W. Long-Term Outcome of Subthalamic Deep Brain Stimulation for Generalized Isolated Dystonia. Neuromodulation 2023; 26:1653-1660. [PMID: 36028445 DOI: 10.1016/j.neurom.2022.07.003] [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: 10/26/2021] [Revised: 06/01/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Few studies have focused on subthalamic nucleus deep brain stimulation for refractory isolated dystonia, and the long-term outcomes are unclear. In this study, we evaluated the efficacy of subthalamic stimulation for generalized isolated dystonia for more than five years and explored the factors predicting clinical outcomes. MATERIALS AND METHODS A total of 16 patients with generalized isolated dystonia underwent a two-phase procedure for stimulation system implantation. After implanting the leads, we performed a test stimulation and observed the stimulation response. The severity of dystonia was assessed using a blinded rating of the Burke-Fahn-Marsden Dystonia Rating Scale based on videos recorded at scheduled times. RESULTS The mean follow-up time was 7.4 ± 2.2 years (5-12.5 years). The severity of dystonia improved significantly one year after surgery. The movement score decreased from 49.3 (40.9) points at baseline to 26.5 (43.5) points (-44.6%) at six months, 12.0 (22.5) points (-66.8%) at one year, 11.25 (17.6) points (-72.7%) at three years, and 12.5 (21.0) points (-72.6%) at the last follow-up. The improvement in motor symptoms resulted in a corresponding improvement in activities of daily living. Greater long-term outcomes were correlated with early stimulation responses, lower baseline movement scores, and female sex. When analyzed comprehensively, only the baseline movement score had meaningful predictive value for the outcome. CONCLUSIONS Our results indicate that subthalamic stimulation is effective and durable in treating generalized isolated dystonia. The subthalamic nucleus may be an alternative target for the treatment of refractory dystonia. Patients with less severe motor symptoms may benefit more from this treatment.
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Affiliation(s)
- Jiaming Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Nan Li
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xin Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Jing Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xuelian Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Nowacki A, Zhang D, Barlatey S, Ai-Schläppi J, Rosner J, Arnold M, Pollo C. Deep Brain Stimulation of the Central Lateral and Ventral Posterior Thalamus for Central Poststroke Pain Syndrome: Preliminary Experience. Neuromodulation 2023; 26:1747-1756. [PMID: 36266180 DOI: 10.1016/j.neurom.2022.09.005] [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: 07/31/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The beneficial effects of thalamic deep brain stimulation (DBS) at various target sites in treating chronic central neuropathic pain (CPSP) remain unclear. This study aimed to evaluate the effectiveness of DBS at a previously untested target site in the central lateral (CL) thalamus, together with classical sensory thalamic stimulation (ventral posterior [VP] complex). MATERIALS AND METHODS We performed a monocentric retrospective study of a consecutive series of six patients with CPSP who underwent combined DBS lead implantation of the CL and VP. Patient-reported outcome measures were recorded before and after surgery using the numeric rating scale (NRS), short-form McGill pain questionnaire (sf-MPQ), EuroQol 5-D quality-of-life questionnaire, and Beck Depression Inventory. DBS leads were reconstructed and projected onto a three-dimensional stereotactic atlas. RESULTS NRS-but not sf-MPQ-rated pain intensity-was significantly reduced throughout the follow-up period of 12 months compared with baseline (p = 0.005, and p = 0.06 respectively, Friedman test). At the last available follow-up (12 to 30 months), three patients described a more than 50% reduction. Two of the three long-term responders were stimulated in the CL (1000 Hz, 90 μs, 3.5-5.0 mA), whereas the third preferred VP complex stimulation (50 Hz, 200 μs, 0.7-1.2 mA). No persistent procedure- or stimulation-associated side effects were noted. CONCLUSIONS These preliminary findings suggest that DBS of the CL might constitute a promising alternative target in cases in which classical VP complex stimulation does not yield satisfactory postoperative pain reduction. The results need to be confirmed in larger, prospective series of patients.
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Affiliation(s)
- Andreas Nowacki
- Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland.
| | - David Zhang
- Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Sabry Barlatey
- Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Janine Ai-Schläppi
- Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Jan Rosner
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
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Chudy D, Deletis V, Paradžik V, Dubroja I, Marčinković P, Orešković D, Chudy H, Raguž M. Deep brain stimulation in disorders of consciousness: 10 years of a single center experience. Sci Rep 2023; 13:19491. [PMID: 37945710 PMCID: PMC10636144 DOI: 10.1038/s41598-023-46300-y] [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: 05/20/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
Disorders of consciousness (DoC), namely unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), represent severe conditions with significant consequences for patients and their families. Several studies have reported the regaining of consciousness in such patients using deep brain stimulation (DBS) of subcortical structures or brainstem nuclei. Our study aims to present the 10 years' experience of a single center using DBS as a therapy on a cohort of patients with DoC. Eighty Three consecutive patients were evaluated between 2011 and 2022; entry criteria consisted of neurophysiological and neurological evaluations and neuroimaging examinations. Out of 83, 36 patients were considered candidates for DBS implantation, and 32 patients were implanted: 27 patients had UWS, and five had MCS. The stimulation target was the centromedian-parafascicular complex in the left hemisphere in hypoxic brain lesion or the one better preserved in patients with traumatic brain injury. The level of consciousness was improved in seven patients. Three out of five MCS patients emerged to full awareness, with the ability to interact and communicate. Two of them can live largely independently. Four out of 27 UWS patients showed consciousness improvement with two patients emerging to full awareness, and the other two reaching MCS. In patients with DoC lasting longer than 12 months following traumatic brain injury or 6 months following anoxic-ischemic brain lesion, spontaneous recovery is rare. Thus, DBS of certain thalamic nuclei could be recommended as a treatment option for patients who meet neurological, neurophysiological and neuroimaging criteria, especially in earlier phases, before occurrence of irreversible musculoskeletal changes. Furthermore, we emphasize the importance of cooperation between centers worldwide in studies on the potentials of DBS in treating patients with DoC.
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Affiliation(s)
- Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.
- Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Vedran Deletis
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- Albert Einstein College of Medicine, New York, USA
| | - Veronika Paradžik
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Ivan Dubroja
- Brain Trauma Unit, Specialty Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia
| | - Petar Marčinković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Hana Chudy
- Department of Neurology, Dubrava University Hospital, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
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Zhao G, Cheng Y, Wang M, Wu Y, Yan J, Feng K, Yin S. Exploring the network effects of deep brain stimulation for rapid eye movement sleep behavior disorder in Parkinson's disease. Acta Neurochir (Wien) 2023; 165:3375-3384. [PMID: 37770797 DOI: 10.1007/s00701-023-05806-0] [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: 07/03/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The research findings on the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) with Rapid Eye Movement Sleep Behavior Disorder (RBD) are inconsistent, and there is a lack of research on DBS electrode sites and their network effects for the explanation of the differences. Our objective is to explore the optimal stimulation sites (that is the sweet spot) and the brain network effects of STN-DBS for RBD in PD. METHODS In this study, among the 50 PD patients who underwent STN-DBS treatment, 24 PD patients with RBD were screened. According to clinical scores and imaging data, the sweet spot of STN-DBS was analyzed in PD patients with RBD, and the optimal structure and functional network models of subthalamic stimulation were constructed. RESULTS Bilateral STN-DBS can effectively improve the symptoms of RBD and other non-motor symptoms in 24 PD patients with RBD. RBD Questionnaire-Hong Kong (RBDQ-HK) score was 41.33 ± 17.45 at baseline and 30.83 ± 15.83 at 1-year follow-up, with statistical significance between them (P < 0.01). However, the MoCA score was an exception with a baseline of 22.04 ± 4.28 and a 1-year follow-up of 21.58 ± 4.33, showing no statistical significance (P = 0.12). The sweet spot and optimal network connectivity models for RBD improvement have been validated as effective. CONCLUSIONS Bilateral STN-DBS can improve the symptoms of RBD in PD. There exist the sweet spot and brain network effects of bilateral STN-DBS in the treatment of PD with RBD. Our study also demonstrates that RBD is a brain network disease.
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Affiliation(s)
- Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
- Department of Neurosurgery, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, 237000, China
| | - Yifeng Cheng
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Min Wang
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Yuzhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Jingtao Yan
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Keke Feng
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
| | - Shaoya Yin
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China.
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
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Yearley AG, Chua M, Horn A, Cosgrove GR, Rolston JD. Deep Brain Stimulation Lead Localization Variability Comparing Intraoperative MRI Versus Postoperative Computed Tomography. Oper Neurosurg (Hagerstown) 2023; 25:441-448. [PMID: 37584483 DOI: 10.1227/ons.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/02/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Commercially available lead localization software for deep brain stimulation (DBS) often relies on postoperative computed tomography (CT) scans to define electrode positions. When cases are performed with intraoperative MRI, another imaging set exists with which to perform these localizations. To compare DBS localization error between postoperative CT scans and intraoperative MRI. METHODS A retrospective cohort of patients who underwent MRI-guided placement of DBS electrodes using the ClearPoint platform was identified. Using Brainlab Elements, postoperative CT scans were coregistered to intraoperative magnetic resonance images visualizing the ClearPoint guidance sheaths and ceramic stylets. DBS electrodes were identified in CT scans using Brainlab's lead localization tool. Trajectory and vector errors were quantified between scans for each lead in each patient. RESULTS Eighty patients with a total of 157 implanted DBS electrodes were included. We observed mean trajectory and vector errors of 0.78 ± 0.44 mm (range 0.1-2.0 mm) and 1.57 ± 0.79 mm (range 0.2-4.2 mm), respectively, between postoperative CT and intraoperative MRI. There were 7 patients with CT scans collected at multiple time points. Trajectory error increased by 0.15 ± 0.42 mm ( P = .31), and vector error increased by 0.22 ± 0.53 mm ( P = .13) in the later scans. Across all scans, there was no significant association between trajectory ( P = .053) or vector ( P = .98) error and the date of CT acquisition. DBS electrodes targeting the subthalamic nucleus had significantly greater trajectory errors ( P = .02) than those targeting the globus pallidus pars internus nucleus. CONCLUSION Commercially available software produced largely concordant lead localizations when comparing intraoperative MRIs with postoperative CT scans, with trajectory errors on average <1 mm. CT scans tend to be more comparable with intraoperative MRI in the immediate postoperative period, with increased time intervals associated with a greater magnitude of error between modalities.
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Affiliation(s)
- Alexander G Yearley
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Schlemm E, Cheng B, Thomalla G, Kessner SS. Functional Lesion Network Mapping of Sensory Deficits After Ischemic Stroke. Stroke 2023; 54:2918-2922. [PMID: 37795591 DOI: 10.1161/strokeaha.123.044470] [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: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Sensory deficits are common after stroke, leading to disability and poor quality of life. Although lesion locations and patterns of structural brain network disruption have been associated with sensory disturbances, the relation with functional lesion connectivity has not yet been established. METHODS Retrospective analysis of a prospective cohort study of patients with acute ischemic stroke. Indirect functional lesion network mapping to identify brain regions remote from the primary lesion associated with deficits on the Rivermead Assessment of Somatosensory Performance test. Associations between Rivermead Assessment of Somatosensory Performance scores and functional connectivity of the lesion site with prespecified components of the somatosensory system. RESULTS One hundred one patients (mean age, 62 years; 32% women) from the TOPOS study (Topological and Clinical Prospective Study About Somatosensation in Stroke). Lesion network mapping identified a bilateral fronto-parietal network associated with sensory deficits in the acute phase after stroke. There were graded associations between deficits and functional lesion connectivity to sensory cortices, but not the thalamus. CONCLUSIONS Infarcts in brain regions remote from, but functionally connected, to the somatosensory network are associated with somatosensory deficits measured by the Rivermead Assessment of Somatosensory Performance test, reflecting the hierarchical functional anatomy of sensory processing. Further research is needed to translate these findings into improved prognosis and personalized rehabilitation strategies.
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Affiliation(s)
- Eckhard Schlemm
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
| | - Bastian Cheng
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
| | - Götz Thomalla
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
| | - Simon S Kessner
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
- Department of Psychosomatic Medicine and Psychotherapy (S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
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Glowinsky S, Bergman H, Zarchi O, Fireman S, Reiner J, Tamir I. Electrophysiology-aided DBS targeting the ventral intermediate nucleus in an essential tremor patient with MRI-incompatible lead: A case report. Physiol Rep 2023; 11:e15730. [PMID: 37786936 PMCID: PMC10546088 DOI: 10.14814/phy2.15730] [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: 04/11/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 10/04/2023] Open
Abstract
Essential tremor (ET) is a common disease in the elderly population. Severe, medication-refractory ET may require surgical intervention via ablation or deep brain stimulation (DBS). Thalamic Vim (Ventral intermediate nucleus), targeted indirectly using atlas-based coordinates, is the classical target in these procedures. We present a case of an ET patient with a non-MR-compatible cardiac orphaned leads who was a candidate for DBS surgery. Due to the lead constraints of MR use, we used a head computed tomography (CT) with contrast media as the reference exam to define the AC, PC, and midline, and to register and indirectly target the Vim. For target validation, we used intraoperative electrophysiological recordings and intraoperative CT. We implanted bilateral directional leads at the target location. We used the-essential-tremor-rating-assessment-scale (TETRAS) pre and postoperatively to clinically evaluate tremor. Intraoperative micro-electrode recordings (MERs) showed individual tremor cells and a robust increase in normalized root mean square (NRMS) indicating entry to the Vim. Postoperative visualization using lead-DBS along with dramatic clinical improvements show that we were able to accurately target the Vim. Our results show that CT-only registration and planning for thalamic Vim DBS is feasible, and that MERs and intraoperative CT are useful adjuncts for Vim target validation.
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Affiliation(s)
- Stefanie Glowinsky
- The Edmond and Lily Safra Center for Brain SciencesHebrew UniversityJerusalemIsrael
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain SciencesHebrew UniversityJerusalemIsrael
- Department of Medical NeurobiologyHebrew UniversityJerusalemIsrael
- Department of NeurosurgeryHadassah Medical Center, Hebrew UniversityJerusalemIsrael
| | - Omer Zarchi
- Intraoperative Neurophysiology UnitRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
| | - Shlomo Fireman
- Department of AnesthesiologyRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
| | - Johnathan Reiner
- Department of NeurologyRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
| | - Idit Tamir
- Department of NeurosurgeryRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
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48
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Wang Z, Magnotti JF, Zhang X, Beauchamp MS. YAEL: Your Advanced Electrode Localizer. eNeuro 2023; 10:ENEURO.0328-23.2023. [PMID: 37857509 PMCID: PMC10591275 DOI: 10.1523/eneuro.0328-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
Intracranial electroencephalography (iEEG) provides a unique opportunity to record and stimulate neuronal populations in the human brain. A key step in neuroscience inference from iEEG is localizing the electrodes relative to individual subject anatomy and identified regions in brain atlases. We describe a new software tool, Your Advanced Electrode Localizer (YAEL), that provides an integrated solution for every step of the electrode localization process. YAEL is compatible with all common data formats to provide an easy-to-use, drop-in replacement for problematic existing workflows that require users to grapple with multiple programs and interfaces. YAEL's automatic extrapolation and interpolation functions speed localization, especially important in patients with many implanted stereotactic (sEEG) electrode shafts. The graphical user interface is presented in a web browser for broad compatibility and includes an interactive 3D viewer for easier localization of nearby sEEG contacts. After localization is complete, users may enter or import data into YAEL's 3D viewer to create publication-ready visualizations of electrodes and brain anatomy, including identified brain areas from atlases; the response to experimental tasks measured with iEEG; and clinical measures such as epileptiform activity or the results of electrical stimulation mapping. YAEL is free and open source and does not depend on any commercial software. Installation instructions for Mac, Windows, and Linux are available at https://yael.wiki.
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Affiliation(s)
- Zhengjia Wang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - John F Magnotti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Xiang Zhang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Michael S Beauchamp
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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49
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Lin J, Kang X, Lu H, Zhang D, Bian X, Zhou J, Hu J, Zhang D, Sepulcre J, Pan L, Lou X. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy Rebalances Atypical Functional Hierarchy in Patients with Essential Tremor. Neurotherapeutics 2023; 20:1755-1766. [PMID: 37843768 PMCID: PMC10684443 DOI: 10.1007/s13311-023-01442-9] [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] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) has brought thalamotomy back to the frontline for essential tremor (ET). As functional organization of human brain strictly follows hierarchical principles which are frequently deficient in neurological diseases, whether additional damage from MRgFUS thalamotomy induces further disruptions of ET functional scaffolds are still controversial. This study was to examine the alteration features of brain functional frameworks following MRgFUS thalamotomy in patients with ET. We retrospectively obtained preoperative (ETpre) and postoperative 6-month (ET6m) data of 30 ET patients underwent MRgFUS thalamotomy from 2018 to 2020. Their archived functional MR images were used to functional gradient comparison. Both supervised pattern learning and stepwise linear regression were conducted to associate gradient features to tremor symptoms with additional neuropathophysiological analysis. MRgFUS thalamotomy relieved 78.19% of hand tremor symptoms and induced vast global framework alteration (ET6m vs. ETpre: Cohen d = - 0.80, P < 0.001). Multiple robust alterations were identified especially in posterior cingulate cortex ([Formula: see text] ET6m vs. [Formula: see text] ETpre: Cohen d = 0.87, P = 0.048). Compared with matched health controls (HCs), its gradient distances to primary communities were significantly increased in [Formula: see text] ETpre patients with anomalous stepwise connectivity (P < 0.05 in ETpre vs. HCs), which were restored after MRgFUS thalamotomy. Both global and regional gradient features could be used for tremor symptom prediction and were linked to neuropathophysiological features of Parkinson disease and oxidative phosphorylation. MRgFUS thalamotomy not only suppress tremor symptoms but also rebalances atypical functional hierarchical architecture of ET patients.
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Affiliation(s)
- Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Xiaopeng Kang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100876, China
| | - Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Xianbing Bian
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jiayou Zhou
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jianxing Hu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Dong Zhang
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Harvard Medical School, No.55 Fruit Street, Boston, 02114, USA
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
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50
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Calvano A, Beccaria L, Timmermann L, Bopp MHA, Gjorgjevski M, Nimsky C, Pedrosa DJ. Case report: Unilateral GPi DBS in secondary myoclonus-dystonia syndrome after acute disseminated encephalomyelitis. Front Neurol 2023; 14:1238743. [PMID: 37822522 PMCID: PMC10562570 DOI: 10.3389/fneur.2023.1238743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is an established and effective therapy for movement disorders. Here, we present a case of secondary myoclonus-dystonia syndrome following acute disseminated encephalomyelitis (ADEM) in childhood, which was alleviated by DBS. Using a patient-specific connectome analysis, we sought to characterise the fibres and circuits affected by stimulation. Case report We report a case of a 20-year-old man with progressive dystonia, myoclonic jerks, and impaired concentration following childhood ADEM. Motor assessments utilising the Unified Myoclonus Rating Scale (UMRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) revealed a greater improvement in dystonia compared to myoclonus following adjustments of DBS parameters. These adjustments were based on visualisation of electrode position and volume of tissue activated (VTA) 3 years after surgery. A patient-specific connectome analysis using the VTA as a region of interest revealed fibre tracts connecting to the cerebello-thalamo-cortical network and the superior frontal gyrus in addition to basal ganglia circuits as particularly effective. Conclusion Globus pallidus internus (GPi) DBS shows promise as a treatment for secondary myoclonus-dystonia syndromes. Personalised structural considerations, tailored to individual symptoms and clinical characteristics, can provide significant benefits. Patient-specific connectome analysis, specifically, offers insights into the structures involved and may enable a favourable treatment response.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Laura Beccaria
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
| | - Miriam H. A. Bopp
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Marko Gjorgjevski
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - David J. Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
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