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Welton T, Chew G, Mai AS, Ng JH, Chan LL, Tan EK. Association of Gene Expression and Tremor Network Structure. Mov Disord 2024. [PMID: 38769620 DOI: 10.1002/mds.29831] [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: 09/17/2023] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Transcriptomic changes in the essential tremor (ET)-associated cerebello-thalamo-cortical "tremor network" and their association to brain structure have not been investigated. OBJECTIVE The aim was to characterize molecular changes associated with network-level imaging-derived phenotypes (IDP) found in ET. METHODS We performed an imaging-transcriptomic study in British adults using imaging-genome-wide association study summary statistics (UK Biobank "BIG40" cohort; n = 33,224, aged 40-69 years). We imputed imaging-transcriptomic associations for 184 IDPs and analyzed functional enrichment of gene modules and aggregate network-level phenotypes. Validation was performed in cerebellar-tissue RNA-sequencing data from ET patients and controls (n = 55). RESULTS Among 237,896 individual predicted gene expression levels for 6063 unique genes/transcripts, we detected 2269 genome-wide significant associations (Bonferroni P < 2.102e-7, 0.95%). These were concentrated in intracellular volume fraction measures of white matter pathways and in genes with putative links to tremor (MAPT, ARL17A, KANSL1, SPPL2C, LRRC37A4P, PLEKHM1, and FMNL1). Whole-tremor-network cortical thickness was associated with a gene module linked to mitochondrial organization and protein quality control (r = 0.91, P = 2e-70), whereas white-gray T1-weighted magnetic resonance imaging (MRI) contrast in the tremor network was associated with a gene module linked to sphingolipid synthesis and ethanolamine metabolism (r = -0.90, P = 2e-68). Imputed association effect sizes and RNA-sequencing log-fold change in the validation dataset were significantly correlated for cerebellar peduncular diffusion MRI phenotypes, and there was a close overlap of significant associations between both datasets for gray matter phenotypes (χ2 = 6.40, P = 0.006). CONCLUSIONS The identified genes and processes are potential treatment targets for ET, and our results help characterize molecular changes that could in future be used for patient treatment selection or prognosis prediction. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Welton
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Gabriel Chew
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing Han Ng
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - Ling Ling Chan
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Eng-King Tan
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
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Moon HC, Kim A, Park YS. Brain structure comparison among Parkinson disease, essential tremor, and healthy controls using 7T MRI. Medicine (Baltimore) 2024; 103:e38139. [PMID: 38728497 PMCID: PMC11081548 DOI: 10.1097/md.0000000000038139] [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: 11/07/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Both Parkinson disease (PD) and Essential tremor (ET) are movement disorders causing tremors in elderly individuals. Although PD and ET are different disease, they often present with similar initial symptoms, making their differentiation challenging with magnetic resonance imaging (MRI) techniques. This study aimed to identify structural brain differences among PD, ET, and health controls (HCs) using 7-Tesla (T) MRI. We assessed the whole-brain parcellation in gray matter volume, thickness, subcortical volume, and small regions of basal ganglia in PD (n = 18), ET (n = 15), and HCs (n = 18), who were matched for age and sex. Brain structure analysis was performed automatic segmentation through Freesurfer software. Small regions of basal ganglia were manually segmented by ITK-SNAP. Additionally, we examined the associations between clinical indicators (symptom duration, unified Parkinson diseases rating scale (UPDRS), and clinical rating scale for tremor (CRST)) and brain structure. PD showed a significant reduction in gray matter volume in the postcentral region compared to ET. ET showed a significant reduction in cerebellum volume compared to HCs. There was a negative correlation between CRST scores (B and C) and gray matter thickness in right superior frontal in ET. This study demonstrated potential of 7T MRI in differentiating brain structure differences among PD, ET, and HCs. Specific findings, such as parietal lobe atrophy in PD compared to ET and cerebellum atrophy in ET compared to HCs, the importance of advanced imaging techniques in accurately diagnosing and distinguishing between movement disorders that present with similar initial symptoms.
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Affiliation(s)
- Hyeong Cheol Moon
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Young Seok Park
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Neurosurgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Guehl D, Guillaud E, Langbour N, Doat E, Auzou N, Courtin E, Branchard O, Engelhardt J, Benazzouz A, Eusebio A, Cuny E, Burbaud P. Usefulness of thalamic beta activity for closed-loop therapy in essential tremor. Sci Rep 2023; 13:22332. [PMID: 38102180 PMCID: PMC10724233 DOI: 10.1038/s41598-023-49511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
A partial loss of effectiveness of deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) has been reported in some patients with essential tremor (ET), possibly due to habituation to permanent stimulation. This study focused on the evolution of VIM local-field potentials (LFPs) data over time to assess the long-term feasibility of closed-loop therapy based on thalamic activity. We performed recordings of thalamic LFPs in 10 patients with severe ET using the ACTIVA™ PC + S (Medtronic plc.) allowing both recordings and stimulation in the same region. Particular attention was paid to describing the evolution of LFPs over time from 3 to 24 months after surgery when the stimulation was Off. We demonstrated a significant decrease in high-beta LFPs amplitude during movements inducing tremor in comparison to the rest condition 3 months after surgery (1.91 ± 0.89 at rest vs. 1.27 ± 1.37 µV2/Hz during posture/action for N = 8/10 patients; p = 0.010), 12 months after surgery (2.92 ± 1.75 at rest vs. 2.12 ± 1.78 µV2/Hz during posture/action for N = 7/10 patients; p = 0.014) and 24 months after surgery (2.32 ± 0.35 at rest vs 0.75 ± 0.78 µV2/Hz during posture/action for 4/6 patients; p = 0.017). Among the patients who exhibited a significant decrease of high-beta LFP amplitude when stimulation was Off, this phenomenon was observed at least twice during the follow-up. Although the extent of this decrease in high-beta LFPs amplitude during movements inducing tremor may vary over time, this thalamic biomarker of movement could potentially be usable for closed-loop therapy in the long term.
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Affiliation(s)
- Dominique Guehl
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France.
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France.
| | - Etienne Guillaud
- Institute of Cognitive and Integrative Neurosciences, Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Nicolas Langbour
- Centre de Recherche en Psychiatrie, CH de la Milétrie, 86000, Poitiers, France
| | - Emilie Doat
- Institute of Cognitive and Integrative Neurosciences, Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Nicolas Auzou
- Institut des Maladies Neurodégénératives Clinique (IMNc), Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Edouard Courtin
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | | | | | - Abdelhamid Benazzouz
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpitaux Universitaire de Marseille, Marseille, France
- Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Univ, CNRS, Marseille, France
| | - Emmanuel Cuny
- Service de Neurochirurgie, CHU de Bordeaux, Bordeaux, France
| | - Pierre Burbaud
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France
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4
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Sharifi S, Buijink AWG, Luft F, Scheijbeler EP, Potters WV, van Wingen G, Heida T, Bour LJ, van Rootselaar AF. Differences in Olivo-Cerebellar Circuit and Cerebellar Network Connectivity in Essential Tremor: a Resting State fMRI Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1123-1136. [PMID: 36214998 PMCID: PMC10657290 DOI: 10.1007/s12311-022-01486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
The olivo-cerebellar circuit is thought to play a crucial role in the pathophysiology of essential tremor (ET). Whether olivo-cerebellar circuit dysfunction is also present at rest, in the absence of clinical tremor and linked voluntary movement, remains unclear. Assessing this network in detail with fMRI is challenging, considering the brainstem is close to major arteries and pulsatile cerebrospinal fluid-filled spaces obscuring signals of interest. Here, we used methods tailored to the analysis of infratentorial structures. We hypothesize that the olivo-cerebellar circuit shows altered intra-network connectivity at rest and decreased functional coupling with other parts of the motor network in ET. In 17 ET patients and 19 healthy controls, we investigated using resting state fMRI intracerebellar functional and effective connectivity on a dedicated cerebellar atlas. With independent component analysis, we investigated data-driven cerebellar motor network activations during rest. Finally, whole-brain connectivity of cerebellar motor structures was investigated using identified components. In ET, olivo-cerebellar pathways show decreased functional connectivity compared with healthy controls. Effective connectivity analysis showed an increased inhibitory influence of the dentate nucleus towards the inferior olive. Cerebellar independent component analyses showed motor resting state networks are less strongly connected to the cerebral cortex compared to controls. Our results indicate the olivo-cerebellar circuit to be affected at rest. Also, the cerebellum is "disconnected" from the rest of the motor network. Aberrant activity, generated within the olivo-cerebellar circuit could, during action, spread towards other parts of the motor circuit and potentially underlie the characteristic tremor of this patient group.
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Affiliation(s)
- Sarvi Sharifi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Arthur W G Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Frauke Luft
- Department of Biomedical Signals and Systems, University of Twente, TechMed Centre, Enschede, The Netherlands
| | - Elliz P Scheijbeler
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Wouter V Potters
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tjitske Heida
- Department of Biomedical Signals and Systems, University of Twente, TechMed Centre, Enschede, The Netherlands
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Bal N, Şengül Y, Behmen MB, Powell A, Louis ED. Vestibular reflexes in essential tremor: abnormalities of ocular and cervical vestibular-evoked myogenic potentials are associated with the cerebellum and brainstem involvement. J Neural Transm (Vienna) 2023; 130:1553-1559. [PMID: 37199795 DOI: 10.1007/s00702-023-02652-3] [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: 03/29/2023] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
This study utilized cervical vestibular-evoked myogenic potentials tests (cVEMP) and ocular vestibular-evoked myogenic potentials tests (oVEMP) to investigate the vestibulocollic and vestibuloocular reflex arcs and to evaluate cerebellar and brainstem involvement) in essential tremor (ET). Eighteen cases with ET and 16 age- and gender-matched healthy control subjects (HCS) were included in the present study. Otoscopic and neurologic examinations were performed on all participants, and both cervical and ocular VEMP tests were performed. Pathological cVEMP results were increased in the ET group (64.7%) compared to the HCS (41,2%; p > 0.05). The latencies of P1 and N1 waves were shorter in the ET group than in HCS (p = 0.01 and p = 0.001). Pathological oVEMP responses were significantly higher in the ET group (72.2%) compared to the HCS (37.5%; p = 0.01). There was no statistically significant difference in oVEMP N1-P1 latencies between groups (p > 0.05). Because the ET group had high pathological responses to the oVEMP, but not the cVEMP, the upper brainstem pathways may be more affected by ET.
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Affiliation(s)
- Nilüfer Bal
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.
- Subdepartment of Audiology, Department of Otolarygology, Faculty of Medicine, Subdepartment of Audiology, Marmara University, Istanbul, Turkey.
| | - Yıldızhan Şengül
- Department of Neurology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Meliha Başöz Behmen
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Allison Powell
- Department of Neurology, University Texas Southwestern Med. Center, Dallas, Texas, USA
| | - Elan D Louis
- Department of Neurology, University Texas Southwestern Med. Center, Dallas, Texas, USA
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6
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Rizzo G, Martino D, Avanzino L, Avenanti A, Vicario CM. Social cognition in hyperkinetic movement disorders: a systematic review. Soc Neurosci 2023; 18:331-354. [PMID: 37580305 DOI: 10.1080/17470919.2023.2248687] [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: 07/30/2022] [Revised: 07/10/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
Numerous lines of research indicate that our social brain involves a network of cortical and subcortical brain regions that are responsible for sensing and controlling body movements. However, it remains unclear whether movement disorders have a systematic impact on social cognition. To address this question, we conducted a systematic review examining the influence of hyperkinetic movement disorders (including Huntington disease, Tourette syndrome, dystonia, and essential tremor) on social cognition. Following the PRISMA guidelines and registering the protocol in the PROSPERO database (CRD42022327459), we analyzed 50 published studies focusing on theory of mind (ToM), social perception, and empathy. The results from these studies provide evidence of impairments in ToM and social perception in all hyperkinetic movement disorders, particularly during the recognition of negative emotions. Additionally, individuals with Huntington's Disease and Tourette syndrome exhibit empathy disorders. These findings support the functional role of subcortical structures (such as the basal ganglia and cerebellum), which are primarily responsible for movement disorders, in deficits related to social cognition.
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Affiliation(s)
- Gaetano Rizzo
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - Davide Martino
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Alessio Avenanti
- Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Campus di Cesena, Alma Mater Studiorum Università di Bologna, Cesena, Italy
- Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica del Maule, Talca, Chile
| | - Carmelo Mario Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
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Kumar A, Lin CC, Kuo SH, Pan MK. Physiological Recordings of the Cerebellum in Movement Disorders. CEREBELLUM (LONDON, ENGLAND) 2023; 22:985-1001. [PMID: 36070135 PMCID: PMC10354710 DOI: 10.1007/s12311-022-01473-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
The cerebellum plays an important role in movement disorders, specifically in symptoms of ataxia, tremor, and dystonia. Understanding the physiological signals of the cerebellum contributes to insights into the pathophysiology of these movement disorders and holds promise in advancing therapeutic development. Non-invasive techniques such as electroencephalogram and magnetoencephalogram can record neural signals with high temporal resolution at the millisecond level, which is uniquely suitable to interrogate cerebellar physiology. These techniques have recently been implemented to study cerebellar physiology in healthy subjects as well as individuals with movement disorders. In the present review, we focus on the current understanding of cerebellar physiology using these techniques to study movement disorders.
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Affiliation(s)
- Ami Kumar
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 650 W 168thStreet, Room 305, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Chih-Chun Lin
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 650 W 168thStreet, Room 305, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 650 W 168thStreet, Room 305, New York, NY, 10032, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA.
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taiwan.
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10051, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, 11529, Taiwan.
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Franco G, Trujillo P, Lopez AM, Aumann MA, Englot DJ, Hainline A, Kang H, Konrad PE, Dawant BM, Claassen DO, Bick SK. Structural brain differences in essential tremor and Parkinson's disease deep brain stimulation patients. J Clin Neurosci 2023; 115:121-128. [PMID: 37549435 PMCID: PMC10530137 DOI: 10.1016/j.jocn.2023.08.001] [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: 05/22/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Essential tremor (ET) and Parkinson's disease (PD) are the most common tremor disorders and are common indications for deep brain stimulation (DBS). In some patients, PD and ET symptoms overlap and diagnosis can be challenging based on clinical criteria alone. The objective of this study was to identify structural brain differences between PD and ET DBS patients to help differentiate these disorders and improve our understanding of the different brain regions involved in these pathologic processes. METHODS We included ET and PD patients scheduled to undergo DBS surgery in this observational study. Patients underwent 3T brain MRI while under general anesthesia as part of their procedure. Cortical thicknesses and subcortical volumes were quantified from T1-weighted images using automated multi-atlas segmentation. We used logistic regression analysis to identify brain regions associated with diagnosis of ET or PD. RESULTS 149 ET and 265 PD patients were included. Smaller volumes in the pallidum and thalamus and reduced thickness in the anterior orbital gyrus, lateral orbital gyrus, and medial precentral gyrus were associated with greater odds of ET diagnosis. Conversely, reduced volumes in the caudate, amygdala, putamen, and basal forebrain, and reduced thickness in the orbital part of the inferior frontal gyrus, supramarginal gyrus, and posterior cingulate were associated with greater odds of PD diagnosis. CONCLUSIONS These findings identify structural brain differences between PD and ET patients. These results expand our understanding of the different brain regions involved in these disorders and suggest that structural MRI may help to differentiate patients with these two disorders.
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Affiliation(s)
- Giulia Franco
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Paula Trujillo
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Alexander M Lopez
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Megan A Aumann
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA.
| | - Allison Hainline
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37203, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37203, USA.
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, 33 Medical Center Drive, Morgantown, WV 26505, USA.
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, PMB 351662, Nashville, TN 37235-1662, USA.
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Sarah K Bick
- Department of Neurosurgery, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA; Department of Psychiatry, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
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Nayak R, Lee J, Sotoudehnia S, Chang SY, Fatemi M, Alizad A. Mapping Pharmacologically Evoked Neurovascular Activation and Its Suppression in a Rat Model of Tremor Using Functional Ultrasound: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6902. [PMID: 37571686 PMCID: PMC10422538 DOI: 10.3390/s23156902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
Functional ultrasound (fUS), an emerging hemodynamic-based functional neuroimaging technique, is especially suited to probe brain activity and primarily used in animal models. Increasing use of pharmacological models for essential tremor extends new research to the utilization of fUS imaging in such models. Harmaline-induced tremor is an easily provoked model for the development of new therapies for essential tremor (ET). Furthermore, harmaline-induced tremor can be suppressed by the same classic medications used for essential tremor, which leads to the utilization of this model for preclinical testing. However, changes in local cerebral activities under the effect of tremorgenic doses of harmaline have not been completely investigated. In this study, we explored the feasibility of fUS imaging for visualization of cerebral activation and deactivation associated with harmaline-induced tremor and tremor-suppressing effects of propranolol. The spatial resolution of fUS using a high frame rate imaging enabled us to visualize time-locked and site-specific changes in cerebral blood flow associated with harmaline-evoked tremor. Intraperitoneal administration of harmaline generated significant neural activity changes in the primary motor cortex and ventrolateral thalamus (VL Thal) regions during tremor and then gradually returned to baseline level as tremor subsided with time. To the best of our knowledge, this is the first functional ultrasound study to show the neurovascular activation of harmaline-induced tremor and the therapeutic suppression in a rat model. Thus, fUS can be considered a noninvasive imaging method for studying neuronal activities involved in the ET model and its treatment.
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Affiliation(s)
- Rohit Nayak
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Jeyeon Lee
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Setayesh Sotoudehnia
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Su-Youne Chang
- Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
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10
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The Perturbational Map of Low Frequency Repetitive Transcranial Magnetic Stimulation of Primary Motor Cortex in Movement Disorders. BRAIN DISORDERS 2023. [DOI: 10.1016/j.dscb.2023.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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11
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Huang YH, Lee MT, Hsueh HY, Knutson DE, Cook J, Mihovilovic MD, Sieghart W, Chiou LC. Cerebellar α6GABA A Receptors as a Therapeutic Target for Essential Tremor: Proof-of-Concept Study with Ethanol and Pyrazoloquinolinones. Neurotherapeutics 2023; 20:399-418. [PMID: 36696034 PMCID: PMC10121996 DOI: 10.1007/s13311-023-01342-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
Ethanol has been shown to suppress essential tremor (ET) in patients at low-to-moderate doses, but its mechanism(s) of action remain unknown. One of the ET hypotheses attributes the ET tremorgenesis to the over-activated firing of inferior olivary neurons, causing synchronic rhythmic firings of cerebellar Purkinje cells. Purkinje cells, however, also receive excitatory inputs from granule cells where the α6 subunit-containing GABAA receptors (α6GABAARs) are abundantly expressed. Since ethanol is a positive allosteric modulator (PAM) of α6GABAARs, such action may mediate its anti-tremor effect. Employing the harmaline-induced ET model in male ICR mice, we evaluated the possible anti-tremor effects of ethanol and α6GABAAR-selective pyrazoloquinolinone PAMs. The burrowing activity, an indicator of well-being in rodents, was measured concurrently. Ethanol significantly and dose-dependently attenuated action tremor at non-sedative doses (0.4-2.4 g/kg, i.p.). Propranolol and α6GABAAR-selective pyrazoloquinolinones also significantly suppressed tremor activity. Neither ethanol nor propranolol, but only pyrazoloquinolinones, restored burrowing activity in harmaline-treated mice. Importantly, intra-cerebellar micro-injection of furosemide (an α6GABAAR antagonist) had a trend of blocking the effect of pyrazoloquinolinone Compound 6 or ethanol on harmaline-induced tremor. In addition, the anti-tremor effects of Compound 6 and ethanol were synergistic. These results suggest that low doses of ethanol and α6GABAAR-selective PAMs can attenuate action tremor, at least partially by modulating cerebellar α6GABAARs. Thus, α6GABAARs are potential therapeutic targets for ET, and α6GABAAR-selective PAMs may be a potential mono- or add-on therapy.
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Affiliation(s)
- Ya-Hsien Huang
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Section 1, Taipei, 10051, Taiwan
| | - Ming Tatt Lee
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Section 1, Taipei, 10051, Taiwan
- Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, 56000, Malaysia
| | - Han-Yun Hsueh
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Section 1, Taipei, 10051, Taiwan
| | - Daniel E Knutson
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | - James Cook
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | | | - Werner Sieghart
- Center for Brain Research, Department of Molecular Neurosciences, Medical University Vienna, Vienna, 1090, Austria
| | - Lih-Chu Chiou
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Section 1, Taipei, 10051, Taiwan.
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan.
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12
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Dardiotis E, Skouras P, Varvarelis OP, Aloizou AM, Hernández AF, Liampas I, Rikos D, Dastamani M, Golokhvast KS, Bogdanos DP, Tsatsakis A, Siokas V, Mitsias PD, Hadjigeorgiou GM. Pesticides and tremor: An overview of association, mechanisms and confounders. ENVIRONMENTAL RESEARCH 2023; 229:115442. [PMID: 36758916 DOI: 10.1016/j.envres.2023.115442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 05/06/2023]
Abstract
Pesticides are a heterogeneous class of chemicals mainly used for the protection of crops from pests. Because of their very widespread use, acute or/and chronic exposure to these chemicals can lead to a plethora of sequelae inflicting diseases, many of which involve the nervous system. Tremor has been associated with pesticide exposure in human and animal studies. This review is aimed at assessing the studies currently available on the association between the various types of pesticides/insecticides and tremor, while also accounting for potential confounding factors. To our knowledge, this is the first coherent review on the subject. After appraising the available evidence, we call for more intensive research on this topic, as well as intonate the need of implementing future preventive measures to protect the exposed populations and to reduce potential disabilities and social drawbacks.
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Affiliation(s)
- Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Panagiotis Skouras
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Orfeas-Petros Varvarelis
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Antonio F Hernández
- Department of Legal Medicine and Toxicology, University of Granada School of Medicine, Granada, Spain; Health Research Institute of Granada (ibs.GRANADA), Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Rikos
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Metaxia Dastamani
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Kirill S Golokhvast
- Siberian Federal Scientific Center of Agrobiotechnology RAS, Krasnoobsk, Russia, 630501
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Aristidis Tsatsakis
- Center of Toxicology Science & Research, Medical School, University of Crete, 71003, Heraklion, Crete, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Panayiotis D Mitsias
- Department of Neurology, School of Medicine, University of Crete, 71003, Heraklion, Greece; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Georgios M Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa Greece, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
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13
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Kosmowska B, Paleczna M, Biała D, Kadłuczka J, Wardas J, Witkin JM, Cook JM, Sharmin D, Marcinkowska M, Kuter KZ. GABA-A Alpha 2/3 but Not Alpha 1 Receptor Subunit Ligand Inhibits Harmaline and Pimozide-Induced Tremor in Rats. Biomolecules 2023; 13:biom13020197. [PMID: 36830567 PMCID: PMC9953228 DOI: 10.3390/biom13020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Abstract
Treatment of tremors, such as in essential tremor (ET) and Parkinson's disease (PD) is mostly ineffective. Exact tremor pathomechanisms are unknown and relevant animal models are missing. GABA-A receptor is a target for tremorolytic medications, but current non-selective drugs produce side effects and have safety liabilities. The aim of this study was a search for GABA-A subunit-specific tremorolytics using different tremor-generating mechanisms. Two selective positive allosteric modulators (PAMs) were tested. Zolpidem, targeting GABA-A α1, was not effective in models of harmaline-induced ET, pimozide- or tetrabenazine-induced tremulous jaw movements (TJMs), while the novel GABA-A α2/3 selective MP-III-024 significantly reduced both the harmaline-induced ET tremor and pimozide-induced TJMs. While zolpidem decreased the locomotor activity of the rats, MP-III-024 produced small increases. These results provide important new clues into tremor suppression mechanisms initiated by the enhancement of GABA-driven inhibition in pathways controlled by α2/3 but not α1 containing GABA-A receptors. Tremor suppression by MP-III-024 provides a compelling reason to consider selective PAMs targeting α2/3-containing GABA-A receptors as novel therapeutic drug targets for ET and PD-associated tremor. The possibility of the improved tolerability and safety of this mechanism over non-selective GABA potentiation provides an additional rationale to further pursue the selective α2/3 hypothesis.
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Affiliation(s)
- Barbara Kosmowska
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Martyna Paleczna
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Dominika Biała
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Justyna Kadłuczka
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Jadwiga Wardas
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Jeffrey M. Witkin
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
- RespireRx Pharmaceuticals Inc., Glen Rock, NJ 07452, USA
| | - James M. Cook
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
- RespireRx Pharmaceuticals Inc., Glen Rock, NJ 07452, USA
| | - Dishary Sharmin
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Monika Marcinkowska
- Department of Pharmaceutical Chemistry, Jagiellonian University, Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Katarzyna Z. Kuter
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
- Correspondence: ; Tel.: +48-12-662-32-26
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14
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Cheng F, Duan Y, Jiang H, Zeng Y, Chen X, Qin L, Zhao L, Yi F, Tang Y, Liu C. Identifying and distinguishing of essential tremor and Parkinson's disease with grouped stability analysis based on searchlight-based MVPA. Biomed Eng Online 2022; 21:81. [PMID: 36443843 PMCID: PMC9703788 DOI: 10.1186/s12938-022-01050-2] [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: 03/09/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since both essential tremor (ET) and Parkinson's disease (PD) are movement disorders and share similar clinical symptoms, it is very difficult to recognize the differences in the presentation, course, and treatment of ET and PD, which leads to misdiagnosed commonly. PURPOSE Although neuroimaging biomarker of ET and PD has been investigated based on statistical analysis, it is unable to assist the clinical diagnosis of ET and PD and ensure the efficiency of these biomarkers. The aim of the study was to identify the neuroimaging biomarkers of ET and PD based on structural magnetic resonance imaging (MRI). Moreover, the study also distinguished ET from PD via these biomarkers to validate their classification performance. METHODS This study has developed and implemented a three-level machine learning framework to identify and distinguish ET and PD. First of all, at the model-level assessment, the searchlight-based machine learning method has been used to identify the group differences of patients (ET/PD) with normal controls (NCs). And then, at the feature-level assessment, the stability of group differences has been tested based on structural brain atlas separately using the permutation test to identify the robust neuroimaging biomarkers. Furthermore, the identified biomarkers of ET and PD have been applied to classify ET from PD based on machine learning techniques. Finally, the identified biomarkers have been compared with the previous findings of the biology-level assessment. RESULTS According to the biomarkers identified by machine learning, this study has found widespread alterations of gray matter (GM) for ET and large overlap between ET and PD and achieved superior classification performance (PCA + SVM, accuracy = 100%). CONCLUSIONS This study has demonstrated the significance of a machine learning framework to identify and distinguish ET and PD. Future studies using a large data set are needed to confirm the potential clinical application of machine learning techniques to discern between PD and ET.
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Affiliation(s)
- FuChao Cheng
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - YuMei Duan
- Department of Computer and Software, Chengdu Jincheng College, Chengdu, China
| | - Hong Jiang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zeng
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - XiaoDan Chen
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - Ling Qin
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - LiQin Zhao
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - FaSheng Yi
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China ,Key Laboratory of Pattern Recognition and Intelligent Information Processing, Institutions of Higher Education of Sichuan Province, Chengdu, China
| | - YiQian Tang
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - Chang Liu
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
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15
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Lee J, Kim J, Cortez J, Chang SY. Thalamo-cortical network is associated with harmaline-induced tremor in rodent model. Exp Neurol 2022; 358:114210. [PMID: 36007599 DOI: 10.1016/j.expneurol.2022.114210] [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: 07/31/2022] [Accepted: 08/19/2022] [Indexed: 11/04/2022]
Abstract
Essential tremor (ET) is the most frequent form of pathologic tremor and one of the most common adult-onset neurologic impairments. However, underlying mechanisms by which structural alterations within the tremor circuit generate the pathological state and how rhythmic neuronal activities propagate and drive tremor remains unclear. Harmaline (HA)-induced tremor model has been most frequently utilized animal model for ET studies, however, there is still a dearth of knowledge over the degree to whether HA-induced tremor mimics the actual underlying pathophysiology of ET, particularly the involvement of thalamo-cortical region. In this study, we investigated the electrophysiological response of the motor circuit including the ventrolateral thalamus (vlTh) and the primary motor cortex (M1), and the modulatory effect of thalamic deep brain stimulation (DBS) using a rat HA-induced tremor model. We found that the theta and high-frequency oscillation (HFO) band power significantly increased after HA administration in both vlTh and M1, and the activity was modulated by the tremor suppression drug (propranolol) and the thalamic DBS. The theta band phase synchronization between the vlTh and M1 was significantly enhanced during the HA-induced tremor, and the transition of cross-frequency coupling in vlTh was found to be associated with the state of HA-induced tremor. Our findings support that the HA tremor could be useful as a valid preclinical model of ET in the context of thalamo-cortical neural network interaction.
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Affiliation(s)
- Jeyeon Lee
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jiwon Kim
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joshua Cortez
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Su-Youne Chang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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16
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Sharifi S, Luft F, de Boer L, Buijink AWG, Mugge W, Schouten AC, Heida T, Bour LJ, van Rootselaar AF. Closing the loop: Novel quantitative fMRI approach for manipulation of the sensorimotor loop in tremor. Neuroimage 2022; 262:119554. [PMID: 35963505 DOI: 10.1016/j.neuroimage.2022.119554] [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: 10/24/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 10/31/2022] Open
Abstract
Tremor is thought to be an effect of oscillatory activity within the sensorimotor network. To date, the underlying pathological brain networks are not fully understood. Disentangling tremor activity from voluntary motor output and sensorimotor feedback systems is challenging. To better understand the intrinsic sensorimotor fingerprint underlying tremor, we aimed to disentangle the sensorimotor system into driving (motor) and feedback/compensatory (sensory) neuronal involvement, and aimed to pinpoint tremor activity in essential tremor (ET) and tremor-dominant Parkinson's disease (PD) with a novel closed-loop approach. Eighteen ET patients, 14 tremor-dominant PD patients, and 18 healthy controls were included. An MR-compatible wrist manipulator was employed during functional MRI (fMRI) while muscle activity during (in)voluntary movements was concurrently recorded using electromyography (EMG). Tremor was quantified based on EMG and correlated to brain activity. Participants performed three tasks: an active wrist motor task, a passive wrist movement task, and rest (no wrist movement). The results in healthy controls proved that our experimental paradigm activated the expected motor and sensory networks separately using the active (motor) and passive (sensory) task. ET patients showed similar patterns of activation within the motor and sensory networks. PD patients had less activity during the active motor task in the cerebellum and basal ganglia compared to ET and healthy controls. EMG showed that in ET, tremor fluctuations correlated positively with activity in the inferior olive region, and that in PD tremor fluctuations correlated positively with cerebellar activity. Our novel approach with an MR-compatible wrist manipulator, allowed to investigate the involvement of the motor and sensory networks separately, and as such to better understand tremor pathophysiology. In ET sensorimotor network function did not differ from healthy controls. PD showed less motor-related activity. Focusing on tremor, our results indicate involvement of the inferior olive in ET tremor modulation, and cerebellar involvement in PD tremor modulation.
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Affiliation(s)
- S Sharifi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands.
| | - F Luft
- Department of Biomedical Signals and Systems, TechMed Centre, University of Twente, Enschede, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
| | - L de Boer
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands
| | - A W G Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
| | - W Mugge
- Faculty of Mechanical, Maritime and Materials Engineering, Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - A C Schouten
- Faculty of Mechanical, Maritime and Materials Engineering, Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - T Heida
- Department of Biomedical Signals and Systems, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - L J Bour
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands
| | - A F van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
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17
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Morphometric features of drug-resistant essential tremor and recovery after stereotactic radiosurgical thalamotomy. Netw Neurosci 2022; 6:850-869. [PMID: 36605417 PMCID: PMC9810368 DOI: 10.1162/netn_a_00253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 01/09/2023] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its neural underpinnings remain unclear. Here, we quantified structural covariance between cortical thickness (CT), surface area (SA), and mean curvature (MC) estimates in patients with ET before and 1 year after ventro-intermediate nucleus stereotactic radiosurgical thalamotomy, and contrasted the observed patterns with those from matched healthy controls. For SA, complex rearrangements within a network of motion-related brain areas characterized patients with ET. This was complemented by MC alterations revolving around the left middle temporal cortex and the disappearance of positive-valued covariance across both modalities in the right fusiform gyrus. Recovery following thalamotomy involved MC readjustments in frontal brain centers, the amygdala, and the insula, capturing nonmotor characteristics of the disease. The appearance of negative-valued CT covariance between the left parahippocampal gyrus and hippocampus was another recovery mechanism involving high-level visual areas. This was complemented by the appearance of negative-valued CT/MC covariance, and positive-valued SA/MC covariance, in the right inferior temporal cortex and bilateral fusiform gyrus. Our results demonstrate that different morphometric properties provide complementary information to understand ET, and that their statistical cross-dependences are also valuable. They pinpoint several anatomical features of the disease and highlight routes of recovery following thalamotomy.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,* Corresponding Author:
| | - Dimitri Van De Ville
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland,Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland,Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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18
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Graph Theoretical Analysis of Structural Covariance Reveals the Relevance of Visuospatial and Attentional Areas in Essential Tremor Recovery After Stereotactic Radiosurgical Thalamotomy. Front Aging Neurosci 2022; 14:873605. [PMID: 35677202 PMCID: PMC9168220 DOI: 10.3389/fnagi.2022.873605] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its pathophysiology is only partially understood. Here, we leveraged graph theoretical analysis on structural covariance patterns quantified from morphometric estimates for cortical thickness, surface area, and mean curvature in patients with ET before and one year after (to account for delayed clinical effect) ventro-intermediate nucleus (Vim) stereotactic radiosurgical thalamotomy. We further contrasted the observed patterns with those from matched healthy controls (HCs). Significant group differences at the level of individual morphometric properties were specific to mean curvature and the post-/pre-thalamotomy contrast, evidencing brain plasticity at the level of the targeted left thalamus, and of low-level visual, high-level visuospatial and attentional areas implicated in the dorsal visual stream. The introduction of cross-correlational analysis across pairs of morphometric properties strengthened the presence of dorsal visual stream readjustments following thalamotomy, as cortical thickness in the right lingual gyrus, bilateral rostral middle frontal gyrus, and left pre-central gyrus was interrelated with mean curvature in the rest of the brain. Overall, our results position mean curvature as the most relevant morphometric feature to understand brain plasticity in drug-resistant ET patients following Vim thalamotomy. They also highlight the importance of examining not only individual features, but also their interactions, to gain insight into the routes of recovery following intervention.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Dimitri Van De Ville
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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19
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Cho HJ. Is essential tremor a degenerative or an electrical disorder? Electrical disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:103-128. [PMID: 35750360 DOI: 10.1016/bs.irn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Essential tremor (ET) is one of the most common movement disorders, yet we do not have a complete understanding of its pathophysiology. From a phenomenology standpoint, ET is an isolated tremor syndrome of bilateral upper limb action tremor with or without tremor in other body locations. ET is a pathological tremor that arises from excessive oscillation in the central motor network. The tremor network comprises of multiple brain regions including the inferior olive, cerebellum, thalamus, and motor cortex, and there is evidence that a dynamic oscillatory disturbance within this network leads to tremor. ET is a chronic disorder, and the natural history shows a slow progression of tremor intensity with age. There are reported data suggesting that ET follows the disease model of a neurodegenerative disorder, however whether ET is a degenerative or electrical disorder has been a subject of debate. In this chapter, we will review cumulative evidence that ET as a syndrome is a fundamentally electric disorder. The etiology is likely heterogenous and may not be primarily neurodegenerative.
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Affiliation(s)
- Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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20
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Liao C, Castonguay CE, Heilbron K, Vuokila V, Medeiros M, Houle G, Akçimen F, Ross JP, Catoire H, Diez-Fairen M, Kang J, Mueller SH, Girard SL, Hopfner F, Lorenz D, Clark LN, Soto-Beasley AI, Klebe S, Hallett M, Wszolek ZK, Pendziwiat M, Lorenzo-Betancor O, Seppi K, Berg D, Vilariño-Güell C, Postuma RB, Bernard G, Dupré N, Jankovic J, Testa CM, Ross OA, Arzberger T, Chouinard S, Louis ED, Mandich P, Vitale C, Barone P, García-Martín E, Alonso-Navarro H, Agúndez JAG, Jiménez-Jiménez FJ, Pastor P, Rajput A, Deuschl G, Kuhlenbaümer G, Meijer IA, Dion PA, Rouleau GA. Association of Essential Tremor With Novel Risk Loci: A Genome-Wide Association Study and Meta-analysis. JAMA Neurol 2022; 79:185-193. [PMID: 34982113 PMCID: PMC8728658 DOI: 10.1001/jamaneurol.2021.4781] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Question Can common genetic variants associated with essential tremor (ET) be identified? Findings In this genome-wide association study and meta-analysis including genetic data on 483 054 individuals, 5 genome-wide significant loci were associated with risk of ET and common variants were associated with approximately 18% of ET heritability. Meaning Findings of this study may help identify new genes and inform ET biology. Importance Essential tremor (ET) is one of the most common movement disorders, affecting 5% of the general population older than 65 years. Common variants are thought to contribute toward susceptibility to ET, but no variants have been robustly identified. Objective To identify common genetic factors associated with risk of ET. Design, Setting, and Participants Case-control genome-wide association study. Inverse-variance meta-analysis was used to combine cohorts. Multicenter samples collected from European populations were collected from January 2010 to September 2019 as part of an ongoing study. Included patients were clinically diagnosed with or reported having ET. Control individuals were not diagnosed with or reported to have ET. Of 485 250 individuals, data for 483 054 passed data quality control and were used. Main Outcomes and Measures Genotypes of common variants associated with risk of ET. Results Of the 483 054 individuals included, there were 7177 with ET (3693 [51.46%] female; mean [SD] age, 62.66 [15.12] years), and 475 877 control individuals (253 785 [53.33%] female; mean [SD] age, 56.40 [17.6] years). Five independent genome-wide significant loci and were identified and were associated with approximately 18% of ET heritability. Functional analyses found significant enrichment in the cerebellar hemisphere, cerebellum, and axonogenesis pathways. Genetic correlation (r), which measures the degree of genetic overlap, revealed significant common variant overlap with Parkinson disease (r, 0.28; P = 2.38 × 10−8) and depression (r, 0.12; P = 9.78 × 10−4). A separate fine-mapping of transcriptome-wide association hits identified genes such as BACE2, LRRN2, DHRS13, and LINC00323 in disease-relevant brain regions, such as the cerebellum. Conclusions and Relevance The results of this genome-wide association study suggest that a portion of ET heritability can be explained by common genetic variation and can help identify new common genetic risk factors for ET.
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Affiliation(s)
- Calwing Liao
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Charles-Etienne Castonguay
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - Veikko Vuokila
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Miranda Medeiros
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Houle
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Fulya Akçimen
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jay P Ross
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Helene Catoire
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Monica Diez-Fairen
- Fundació Docència i Recerca Mútua Terrassa, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain.,Movement Disorders Unit, Department of Neurology, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Jooeun Kang
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stefanie H Mueller
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Simon L Girard
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, Quebec, Canada.,Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - Delia Lorenz
- University Children's Hospital, University of Würzburg, Wurzburg, Germany
| | - Lorraine N Clark
- Department of Pathology and Cell Biology, Taub Institute, Columbia University, New York, New York
| | | | - Stephan Klebe
- Department of Neurology, University Hospital Würzburg, Wurzburg, Germany.,Department of Neurology, University Hospital Essen, Essen, Germany
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | | | - Manuela Pendziwiat
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany.,Department of Neuropediatrics, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Oswaldo Lorenzo-Betancor
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Neurology, University of Washington School of Medicine, Seattle
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Carles Vilariño-Güell
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald B Postuma
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Geneviève Bernard
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Division of Pediatric Neurology, Departments of Pediatrics, Neurology and Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada.,Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Medical Genetics, Department of Specialized Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicolas Dupré
- Faculté de Médecine, Université Laval, Centre Hospitalier Universitaire de Québec (l'Enfant-Jésus), Quebec, Canada
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Claudia M Testa
- Parkinson's and Movement Disorders Center, Department of Neurology, Virginia Commonwealth University, Richmond
| | - Owen A Ross
- Departments of Neuroscience and Clinical Genomics, Mayo Clinic Florida, Jacksonville
| | - Thomas Arzberger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Elan D Louis
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genova, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico Policlinico, San Martino, Genova, Italy
| | - Carmine Vitale
- Department of Motor Sciences and Wellness, University Parthenope, Naples, Italy
| | - Paolo Barone
- Center for Neurodegenerative Disease (CEMAND), Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, UNEx, ARADyAL Instituto de Salud Carlos III, Caceres, Spain
| | | | - José A G Agúndez
- University Institute of Molecular Pathology Biomarkers, UNEx, ARADyAL Instituto de Salud Carlos III, Caceres, Spain
| | | | - Pau Pastor
- Fundació Docència i Recerca Mútua Terrassa, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Alex Rajput
- University of Saskatchewan, Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada
| | - Günther Deuschl
- Department of Neurology, University Medical Center Schleswig Holstein, University of Kiel, Kiel, Germany
| | - Gregor Kuhlenbaümer
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Inge A Meijer
- Department of Neuroscience and Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Patrick A Dion
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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21
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Sieghart W, Chiou LC, Ernst M, Fabjan J, M Savić M, Lee MT. α6-Containing GABA A Receptors: Functional Roles and Therapeutic Potentials. Pharmacol Rev 2022; 74:238-270. [PMID: 35017178 DOI: 10.1124/pharmrev.121.000293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/08/2021] [Indexed: 12/11/2022] Open
Abstract
GABAA receptors containing the α6 subunit are highly expressed in cerebellar granule cells and less abundantly in many other neuronal and peripheral tissues. Here, we for the first time summarize their importance for the functions of the cerebellum and the nervous system. The cerebellum is not only involved in motor control but also in cognitive, emotional, and social behaviors. α6βγ2 GABAA receptors located at cerebellar Golgi cell/granule cell synapses enhance the precision of inputs required for cerebellar timing of motor activity and are thus involved in cognitive processing and adequate responses to our environment. Extrasynaptic α6βδ GABAA receptors regulate the amount of information entering the cerebellum by their tonic inhibition of granule cells, and their optimal functioning enhances input filtering or contrast. The complex roles of the cerebellum in multiple brain functions can be compromised by genetic or neurodevelopmental causes that lead to a hypofunction of cerebellar α6-containing GABAA receptors. Animal models mimicking neuropsychiatric phenotypes suggest that compounds selectively activating or positively modulating cerebellar α6-containing GABAA receptors can alleviate essential tremor and motor disturbances in Angelman and Down syndrome as well as impaired prepulse inhibition in neuropsychiatric disorders and reduce migraine and trigeminal-related pain via α6-containing GABAA receptors in trigeminal ganglia. Genetic studies in humans suggest an association of the human GABAA receptor α6 subunit gene with stress-associated disorders. Animal studies support this conclusion. Neuroimaging and post-mortem studies in humans further support an involvement of α6-containing GABAA receptors in various neuropsychiatric disorders, pointing to a broad therapeutic potential of drugs modulating α6-containing GABAA receptors. SIGNIFICANCE STATEMENT: α6-Containing GABAA receptors are abundantly expressed in cerebellar granule cells, but their pathophysiological roles are widely unknown, and they are thus out of the mainstream of GABAA receptor research. Anatomical and electrophysiological evidence indicates that these receptors have a crucial function in neuronal circuits of the cerebellum and the nervous system, and experimental, genetic, post-mortem, and pharmacological studies indicate that selective modulation of these receptors offers therapeutic prospects for a variety of neuropsychiatric disorders and for stress and its consequences.
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Affiliation(s)
- Werner Sieghart
- Center for Brain Research, Department of Molecular Neurosciences (W.S.), and Center for Brain Research, Department of Pathobiology of the Nervous System (M.E., J.F.), Medical University Vienna, Vienna, Austria; Graduate Institute of Pharmacology (L.-C.C., M.T.L.), and Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan (L.-C.C., M.T.L.); Faculty of Pharmacy, Department of Pharmacology, University of Belgrade, Belgrade, Serbia (M.M.S.); Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia (M.T.L.); and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan (L.-C.C.)
| | - Lih-Chu Chiou
- Center for Brain Research, Department of Molecular Neurosciences (W.S.), and Center for Brain Research, Department of Pathobiology of the Nervous System (M.E., J.F.), Medical University Vienna, Vienna, Austria; Graduate Institute of Pharmacology (L.-C.C., M.T.L.), and Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan (L.-C.C., M.T.L.); Faculty of Pharmacy, Department of Pharmacology, University of Belgrade, Belgrade, Serbia (M.M.S.); Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia (M.T.L.); and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan (L.-C.C.)
| | - Margot Ernst
- Center for Brain Research, Department of Molecular Neurosciences (W.S.), and Center for Brain Research, Department of Pathobiology of the Nervous System (M.E., J.F.), Medical University Vienna, Vienna, Austria; Graduate Institute of Pharmacology (L.-C.C., M.T.L.), and Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan (L.-C.C., M.T.L.); Faculty of Pharmacy, Department of Pharmacology, University of Belgrade, Belgrade, Serbia (M.M.S.); Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia (M.T.L.); and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan (L.-C.C.)
| | - Jure Fabjan
- Center for Brain Research, Department of Molecular Neurosciences (W.S.), and Center for Brain Research, Department of Pathobiology of the Nervous System (M.E., J.F.), Medical University Vienna, Vienna, Austria; Graduate Institute of Pharmacology (L.-C.C., M.T.L.), and Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan (L.-C.C., M.T.L.); Faculty of Pharmacy, Department of Pharmacology, University of Belgrade, Belgrade, Serbia (M.M.S.); Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia (M.T.L.); and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan (L.-C.C.)
| | - Miroslav M Savić
- Center for Brain Research, Department of Molecular Neurosciences (W.S.), and Center for Brain Research, Department of Pathobiology of the Nervous System (M.E., J.F.), Medical University Vienna, Vienna, Austria; Graduate Institute of Pharmacology (L.-C.C., M.T.L.), and Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan (L.-C.C., M.T.L.); Faculty of Pharmacy, Department of Pharmacology, University of Belgrade, Belgrade, Serbia (M.M.S.); Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia (M.T.L.); and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan (L.-C.C.)
| | - Ming Tatt Lee
- Center for Brain Research, Department of Molecular Neurosciences (W.S.), and Center for Brain Research, Department of Pathobiology of the Nervous System (M.E., J.F.), Medical University Vienna, Vienna, Austria; Graduate Institute of Pharmacology (L.-C.C., M.T.L.), and Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan (L.-C.C., M.T.L.); Faculty of Pharmacy, Department of Pharmacology, University of Belgrade, Belgrade, Serbia (M.M.S.); Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia (M.T.L.); and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan (L.-C.C.)
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22
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Mavroudis I, Kazis D, Petridis F, Chatzikonstantinou S, Karantali E, Njau S, Costa V, Ciobica A, Trus C, Balmus I, Baloyannis S. Morphological and morphometric changes in the Purkinje cells of patients with essential tremor. Exp Ther Med 2021; 23:167. [PMID: 35069848 PMCID: PMC8753961 DOI: 10.3892/etm.2021.11090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022] Open
Abstract
Essential tremor (ET) is a progressive neurological syndrome characterised by involuntary tremors of the hands or arms, head, jaw and voice. The pathophysiology of ET is not clearly understood yet. However, previous studies have reported several changes in the brain of patients with ET. One of the brain areas extensively investigated is the cerebellum. In the present study, a morphometric analysis of Purkinje cells in patients with ET and ET-plus was performed, and subsequently compared with normal controls using the Golgi silver staining method and 3D neuronal reconstruction. Substantial morphological changes were uncovered in the Purkinje cells of patients with ET compared with normal controls, including a decreased dendritic length and field density, an overall loss of terminal branches and a decreased density of dendritic spines.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neurology, Leeds Teaching Hospitals, NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | | | - Eleni Karantali
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Samuel Njau
- Department of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Vasiliki Costa
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, Iasi 700506, Romania
| | - Constantin Trus
- Department of Morphological and Functional Sciences, Faculty of Medicine, Dunarea de Jos University, Galati 800008, Romania
| | - Ioana Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, Alexandru Ioan Cuza University of Iași, Iași 700057, Romania
| | - Stavros Baloyannis
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
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23
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Kosmowska B, Wardas J. The Pathophysiology and Treatment of Essential Tremor: The Role of Adenosine and Dopamine Receptors in Animal Models. Biomolecules 2021; 11:1813. [PMID: 34944457 PMCID: PMC8698799 DOI: 10.3390/biom11121813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022] Open
Abstract
Essential tremor (ET) is one of the most common neurological disorders that often affects people in the prime of their lives, leading to a significant reduction in their quality of life, gradually making them unable to independently perform the simplest activities. Here we show that current ET pharmacotherapy often does not sufficiently alleviate disease symptoms and is completely ineffective in more than 30% of patients. At present, deep brain stimulation of the motor thalamus is the most effective ET treatment. However, like any brain surgery, it can cause many undesirable side effects; thus, it is only performed in patients with an advanced disease who are not responsive to drugs. Therefore, it seems extremely important to look for new strategies for treating ET. The purpose of this review is to summarize the current knowledge on the pathomechanism of ET based on studies in animal models of the disease, as well as to present and discuss the results of research available to date on various substances affecting dopamine (mainly D3) or adenosine A1 receptors, which, due to their ability to modulate harmaline-induced tremor, may provide the basis for the development of new potential therapies for ET in the future.
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Affiliation(s)
| | - Jadwiga Wardas
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology Polish Academy of Sciences, 31-343 Kraków, Poland;
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24
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Wu P, Lin W, Li KH, Lai HC, Lee MT, Tsai KWK, Chiu PY, Chang WC, Wei CY, Taira T. Focused Ultrasound Thalamotomy for the Treatment of Essential Tremor: A 2-Year Outcome Study of Chinese People. Front Aging Neurosci 2021; 13:697029. [PMID: 34335232 PMCID: PMC8317688 DOI: 10.3389/fnagi.2021.697029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Essential tremor (ET) is a common movement disorder among elderly individuals worldwide and is occasionally associated with a high risk for mild cognitive impairment and dementia. This retrospective study aimed to determine the clinical outcome of unilateral magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy in Chinese patients with ET. Methods: In total, 31 male and 17 female patients with drug-refractory ET were enrolled in this research study from January 2017 to September 2019. The severity of tremor and disability were assessed using the Clinical Rating Scale for Tremor (CRST) within a 2-year follow-up period. Results: The mean age of the participants was 59.14 ± 13.5 years. The mean skull density ratio (SDR) was 0.5 ± 0.1. The mean highest temperature was 57.0 ± 2.4°C. The mean number of sonications was 10.0 ± 2.6. The average maximum energy was 19,710.5 ± 8,624.9 J. The total CRST scores and sub-scores after MRgFUS thalamotomy significantly reduced during each follow-up (p < 0.001). All but four (8.3%) of the patients had reversible adverse events (AEs) after the procedure. Conclusions: MRgFUS had sustained clinical efficacy 2 years after treatment for intractable ET. Only few patients presented with thalamotomy-related AEs including numbness, weakness, and ataxia for an extended period. Most Chinese patients were treated safely and effectively despite their low SDR.
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Affiliation(s)
- Peihan Wu
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Wei Lin
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Kun Hong Li
- MR-Guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Hui-Chin Lai
- MR-Guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Ming-Tsung Lee
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan
| | | | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Wei-Chieh Chang
- Department of Neurosurgery, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan.,Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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25
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Becktepe JS, Busse J, Jensen-Kondering U, Toedt I, Wolff S, Zeuner KE, Berg D, Granert O, Deuschl G. White Matter Hyperintensities Are Associated With Severity of Essential Tremor in the Elderly. Front Neurol 2021; 12:694286. [PMID: 34262526 PMCID: PMC8273287 DOI: 10.3389/fneur.2021.694286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Essential tremor (ET) occurs with steeply increasing prevalence in the elderly, and apart from disease duration, age is independently associated with an increase of tremor amplitude and a decrease of frequency. White matter hyperintensities (WMHs) are a common finding in the elderly, and their role in the pathophysiology of ET is unknown. The aims of this study were to examine whether ET patients differ in their total or region-specific WMH volumes from healthy controls and to determine the impact of WMH on tremor characteristics. Methods: A total of 47 elderly ET patients with a mean age of 72 years and 39 age-matched healthy controls underwent a thorough clinical assessment and 3T MRI. Total WMH volumes were derived from T2-weighted fluid-attenuated inversion recovery (FLAIR) MR images. Additionally, region of interest-based WMH volumes for the Johns Hopkins University (JHU) white matter tracts and labels were calculated, and WMHs were assessed semiquantitatively using the Fazekas scale. Results: Essential tremor patients and healthy controls did not differ in their total or tract-specific WMH volumes or Fazekas scores. However, WMH volume was significantly positively correlated with tremor severity on the TETRAS scale, and there was a significant negative correlation with the mean accelerometric tremor frequency. In a multiple linear regression model including disease duration, age, and age-adjusted total WMH volume, only the WMH volume significantly predicted tremor severity, while age and disease duration were not significant. Conclusion: We found evidence for a direct association between WMH volume and tremor severity. If confirmed by larger studies, our findings could explain the well-known relation between age and tremor severity.
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Affiliation(s)
- Jos S Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Johannes Busse
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Ulf Jensen-Kondering
- Department of Neuroradiology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Inken Toedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Stephan Wolff
- Department of Neuroradiology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
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Lopez-de-Ipina K, Solé-Casals J, Sánchez-Méndez JI, Romero-Garcia R, Fernandez E, Requejo C, Poologaindran A, Faúndez-Zanuy M, Martí-Massó JF, Bergareche A, Suckling J. Analysis of Fine Motor Skills in Essential Tremor: Combining Neuroimaging and Handwriting Biomarkers for Early Management. Front Hum Neurosci 2021; 15:648573. [PMID: 34168544 PMCID: PMC8219239 DOI: 10.3389/fnhum.2021.648573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
Essential tremor (ET) is a highly prevalent neurological disorder characterized by action-induced tremors involving the hand, voice, head, and/or face. Importantly, hand tremor is present in nearly all forms of ET, resulting in impaired fine motor skills and diminished quality of life. To advance early diagnostic approaches for ET, automated handwriting tasks and magnetic resonance imaging (MRI) offer an opportunity to develop early essential clinical biomarkers. In this study, we present a novel approach for the early clinical diagnosis and monitoring of ET based on integrating handwriting and neuroimaging analysis. We demonstrate how the analysis of fine motor skills, as measured by an automated Archimedes' spiral task, is correlated with neuroimaging biomarkers for ET. Together, we present a novel modeling approach that can serve as a complementary and promising support tool for the clinical diagnosis of ET and a large range of tremors.
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Affiliation(s)
- Karmele Lopez-de-Ipina
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- EleKin Research Group, Department of System Engineering and Automation, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Jordi Solé-Casals
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Data and Signal Processing Research Group, University of Vic-Central University of Catalonia, Barcelona, Spain
| | - José Ignacio Sánchez-Méndez
- EleKin Research Group, Department of System Engineering and Automation, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | | | - Elsa Fernandez
- EleKin Research Group, Department of System Engineering and Automation, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Catalina Requejo
- Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Anujan Poologaindran
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- The Alan Turing Institute, British Library, London, United Kingdom
| | | | - José Félix Martí-Massó
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
- Movement Disorders Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
- Biomedical Research Networking Centre Consortium for the Area of Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alberto Bergareche
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
- Movement Disorders Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
- Biomedical Research Networking Centre Consortium for the Area of Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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27
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Sleep disturbances in essential tremor: an investigation of associated brain microstructural changes using diffusion tensor imaging. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Lan H, Suo X, Li W, Li N, Li J, Peng J, Lei D, Sweeney JA, Kemp GJ, Peng R, Gong Q. Abnormalities of intrinsic brain activity in essential tremor: A meta-analysis of resting-state functional imaging. Hum Brain Mapp 2021; 42:3156-3167. [PMID: 33769638 PMCID: PMC8193520 DOI: 10.1002/hbm.25425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 02/05/2023] Open
Abstract
Neuroimaging studies using a variety of techniques have demonstrated abnormal patterns of spontaneous brain activity in patients with essential tremor (ET). However, the findings are variable and inconsistent, hindering understanding of underlying neuropathology. We conducted a meta‐analysis of whole‐brain resting‐state functional neuroimaging studies in ET compared to healthy controls (HC), using anisotropic effect‐size seed‐based d mapping, to identify the most consistent brain activity alterations and their relation to clinical features. After systematic literature search, we included 13 studies reporting 14 comparisons, describing 286 ET patients and 254 HC. Subgroup analyses were conducted considering medication status, head tremor status, and methodological factors. Brain activity in ET is altered not only in the cerebellum and cerebral motor cortex, but also in nonmotor cortical regions including prefrontal cortex and insula. Most of the results remained unchanged in subgroup analyses of patients with head tremor, medication‐naive patients, studies with statistical threshold correction, and the large subgroup of studies using functional magnetic resonance imaging. These findings not only show consistent and robust abnormalities in specific brain regions but also provide new information on the biology of patient heterogeneity, and thus help to elucidate the pathophysiology of ET.
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Affiliation(s)
- Huan Lan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Nannan Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junying Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiaxin Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rong Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
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29
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Hett K, Lyu I, Trujillo P, Lopez AM, Aumann M, Larson KE, Hedera P, Dawant B, Landman BA, Claassen DO, Oguz I. Anatomical texture patterns identify cerebellar distinctions between essential tremor and Parkinson's disease. Hum Brain Mapp 2021; 42:2322-2331. [PMID: 33755270 PMCID: PMC8090778 DOI: 10.1002/hbm.25331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 01/15/2023] Open
Abstract
Voxel-based morphometry is an established technique to study focal structural brain differences in neurologic disease. More recently, texture-based analysis methods have enabled a pattern-based assessment of group differences, at the patch level rather than at the voxel level, allowing a more sensitive localization of structural differences between patient populations. In this study, we propose a texture-based approach to identify structural differences between the cerebellum of patients with Parkinson's disease (n = 280) and essential tremor (n = 109). We analyzed anatomical differences of the cerebellum among patients using two features: T1-weighted MRI intensity, and a texture-based similarity feature. Our results show anatomical differences between groups that are localized to the inferior part of the cerebellar cortex. Both the T1-weighted intensity and texture showed differences in lobules VIII and IX, vermis VIII and IX, and middle peduncle, but the texture analysis revealed additional differences in the dentate nucleus, lobules VI and VII, vermis VI and VII. This comparison emphasizes how T1-weighted intensity and texture-based methods can provide a complementary anatomical structure analysis. While texture-based similarity shows high sensitivity for gray matter differences, T1-weighted intensity shows sensitivity for the detection of white matter differences.
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Affiliation(s)
- Kilian Hett
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Ilwoo Lyu
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Paula Trujillo
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Alexander M. Lopez
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Megan Aumann
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kathleen E. Larson
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Peter Hedera
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA,Department of NeurologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Benoit Dawant
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Bennett A. Landman
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Daniel O. Claassen
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ipek Oguz
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
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30
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Li JY, Lu ZJ, Suo XL, Li NN, Lei D, Wang L, Peng JX, Duan LR, Xi J, Jiang Y, Gong QY, Peng R. Patterns of intrinsic brain activity in essential tremor with resting tremor and tremor-dominant Parkinson's disease. Brain Imaging Behav 2021; 14:2606-2617. [PMID: 31989422 DOI: 10.1007/s11682-019-00214-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The clinical pictures of essential tremor (ET) with resting tremor (rET) and tremor-dominant Parkinson's disease (tPD) are often quite mimic at the early stage, current approaches to the diagnosis and treatment therefore remain challenging. The regional homogeneity (ReHo) method under resting-state functional magnetic resonance imaging (rs-fMRI) would help exhibit the patterns in neural activity, which further contribute to differentiate these disorders and explore the relationship between symptoms and regional functional abnormalities. Sixty-eight Chinese participants were recruited, including 19 rET patients, 24 tPD patients and 25 age- and gender-matched healthy controls (HCs). All participants underwent clinical assessment and rs-fMRI with a ReHo method to investigate the alterations of neural activity, and the correlation between them. Differences were compared by two-sample t-test (corrected with AlphaSim, p < 0.05). Compared with HCs, patients' groups both displayed decreased ReHo in the default mode network (DMN), bilateral putamen and bilateral cerebellum. While tPD patients specifically exihibited decreased ReHo in the bilateral supplementary motor area (SMA) and precentral gyrus (M1). The correlation analysis revealed that ReHo in the bilateral putamen, right SMA and left cerebellum_crus I were negatively correlated with the UPDRS-III score, respectively, in tPD group. Our results indicated the rET patients may share part of the pathophysiological mechanism of tPD patients. In addition, we found disorder-specific involvement of the SMA and M1 in tPD. Such a distinction may lend itself to use as a potential biomarker for differentiating between these two diseases.
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Affiliation(s)
- Jun-Ying Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Zhong-Jiao Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xue-Ling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Nan-Nan Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ling Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jia-Xin Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Li-Ren Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jing Xi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Qi-Yong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Rong Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Pietracupa S, Bologna M, Tommasin S, Elifani F, Vasselli F, Paparella G, Petsas N, Berardelli A, Pantano P. No evidence of iron deposition in essential tremor: a susceptibility-weighted imaging study. Neurol Sci 2021; 42:4667-4672. [PMID: 33721138 DOI: 10.1007/s10072-021-05173-7] [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: 06/08/2020] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the role of iron deposition in subcortical nuclei of patients with essential tremor (ET). METHODS Twenty-three patients with ET underwent a standardized 3T-MRI protocol. We specifically assessed iron deposition using susceptibility-weighted angiography (SWAN) images in seven specific regions of interest (ROIs): the thalamus, putamen, globus pallidus, caudate nucleus, substantia nigra, red nucleus, and dentate nucleus. Tremor in ET patients was clinically assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). ET patient data were compared with data obtained from 23 Parkinson's disease (PD) patients and 14 healthy subjects (HS). RESULTS No differences in iron deposition in the seven ROIs were found between ET patients and HS. Conversely, PD patients showed increased iron deposition in the substantia nigra in comparison with both ET patients and HS. CONCLUSIONS Our results indicate the absence of iron deposition in subcortical nuclei of ET patients, which is generally considered a marker of neurodegeneration.
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Affiliation(s)
- Sara Pietracupa
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.
| | - Matteo Bologna
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Elifani
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Federica Vasselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Paparella
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Nikolaos Petsas
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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32
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Riskin-Jones HH, Kashanian A, Sparks H, Tsolaki E, Pouratian N. Increased structural connectivity of thalamic stimulation sites to motor cortex relates to tremor suppression. NEUROIMAGE-CLINICAL 2021; 30:102628. [PMID: 33773164 PMCID: PMC8024765 DOI: 10.1016/j.nicl.2021.102628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
Clinically weighted tractography reveals key patterns of therapeutic brain stimulation. Thalamic stimulation for tremor preferentially connects to precentral gyrus and cerebellum. Thalamic DBS of areas most connected to motor cortex results in superior outcomes. Acute and chronic therapeutic outcomes demonstrate converging connectivity patterns.
Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM-DBS) is a highly successful treatment for medication-refractory essential tremor (ET). Clinical outcomes are dependent on accurate targeting. Here, we aim to develop a framework for connectivity-guided DBS targeting by evaluating probabilistic tractography and clinical response at both initial programming (IP) and clinical follow-up (CF). Magnetic resonance imaging and clinical outcomes were evaluated in 23 ET patients who were treated by VIM-DBS at the University of California Los Angeles (20 at IP, 18 at CF, 14 at both). Lead-DBS was used to model the volume of tissue activated tissue (VTA) based on programming configurations at both IP and CF. Probabilistic tractography, calculated in FSL, was used to evaluate 1) clinically weighted whole brain connectivity of VTA; 2) connectivity between VTA and freesurfer-derived target regions of interest (ROI) including primary motor, premotor, and prefrontal cortices, and cerebellum; and 3) volume of intersection between VTA and probabilistic tractography-based segmentation of the thalamus. At IP, individual contacts were scored as high or low efficacy based on acute tremor improvement. At CF, clinical response was measured by percent of change of the Clinical Rating Scale for Tremor (CRST) compared to preoperative scores. Contributions from each target ROI to clinical response was measured using logistic regression for IP and linear regression for CF. The clinically weighted map of whole brain connectivity of VTA shows preferential connectivity to precentral gyrus and brainstem/cerebellum. The volume of intersection between VTA and thalamic segmentation map based on probabilistic connectivity to primary motor cortex was a significant predictor of contact efficacy at IP (OR = 2.26 per 100 mm3 of overlap, p = .04) and percent change in CRST at CF (β = 14.67 per 100 mm3 of overlap, p = .003). Targeting DBS to the area of thalamus most connected to primary motor cortex based on probabilistic tractography is associated with superior outcomes, providing a potential guide not only for lead targeting but also therapeutic programming.
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Affiliation(s)
- Hannah H Riskin-Jones
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Alon Kashanian
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Hiro Sparks
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Evangelia Tsolaki
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States.
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Sood A, Shukla J, Shree R, Vatsa R, Modi M, Mittal BR. Comparative Performance of 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT Imaging in Patients With Parkinson's Disease, Parkinson-Plus Syndrome, and Essential Tremor. Clin Nucl Med 2021; 46:95-102. [PMID: 33234920 DOI: 10.1097/rlu.0000000000003409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the utility of presynaptic dopaminergic imaging using 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT and compare their performance in Parkinson's disease (PD), Parkinson-plus syndrome (PPS), and essential tremor (ET). PATIENTS AND METHODS A total of 103 patients (PD = 48, PPS = 19, and ET = 36) were enrolled prospectively. Hoehn and Yahr (H&Y) staging and MDS-UPDRS (Movement Disorder Society-Sponsored Revision of Unified Parkinson's Disease Rating Scale) were done for PD and PPS cases. All the patients underwent 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT brain scan. The scans were analyzed visually and semiquantitatively. Average pixel count and SUVmean of the striatum were calculated in SPECT and PET images, respectively, to calculate the specific uptake ratio of striatum (SUR). Comparison of scan findings and SURs among different groups and correlation with clinical characteristics was done. RESULTS Symmetrical comma-shaped uptake was seen in bilateral striatum in ET cases with mean SURs significantly higher than in cases of early PD (H&Y stage I and II, n = 37), PD and PPS both on SPECT and PET images (P ≤ 0.001). The mean SURs between PD and PPS showed no significant difference (SPECT, P = 0.17; PET, P = 0.61). Substantial agreement (weighted κ = 0.659) was found between 99mTc-TRODAT-1 and 18F-FDOPA for the detection of presynaptic dopaminergic dysfunction. Specific uptake ratio of striatum correlation between SPECT and PET was statistically significant (r = 0.67; P < 0.01). A negative but nonsignificant correlation was found between the SURs and H&Y staging/MDS-UPDRS. CONCLUSIONS Both 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT showed substantial agreement and proved to be potential imaging biomarker for the detection of dopaminergic dysfunction, thus assisting in differentiating early PD/PD and PPS from ET cases.
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Affiliation(s)
| | | | - Ritu Shree
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manish Modi
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Red nucleus structure and function: from anatomy to clinical neurosciences. Brain Struct Funct 2020; 226:69-91. [PMID: 33180142 PMCID: PMC7817566 DOI: 10.1007/s00429-020-02171-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022]
Abstract
The red nucleus (RN) is a large subcortical structure located in the ventral midbrain. Although it originated as a primitive relay between the cerebellum and the spinal cord, during its phylogenesis the RN shows a progressive segregation between a magnocellular part, involved in the rubrospinal system, and a parvocellular part, involved in the olivocerebellar system. Despite exhibiting distinct evolutionary trajectories, these two regions are strictly tied together and play a prominent role in motor and non-motor behavior in different animal species. However, little is known about their function in the human brain. This lack of knowledge may have been conditioned both by the notable differences between human and non-human RN and by inherent difficulties in studying this structure directly in the human brain, leading to a general decrease of interest in the last decades. In the present review, we identify the crucial issues in the current knowledge and summarize the results of several decades of research about the RN, ranging from animal models to human diseases. Connecting the dots between morphology, experimental physiology and neuroimaging, we try to draw a comprehensive overview on RN functional anatomy and bridge the gap between basic and translational research.
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35
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Filip P, Vojtíšek L, Baláž M, Mangia S, Michaeli S, Šumec R, Bareš M. Differential diagnosis of tremor syndromes using MRI relaxometry. Parkinsonism Relat Disord 2020; 81:190-193. [PMID: 33186797 DOI: 10.1016/j.parkreldis.2020.10.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023]
Abstract
Differential diagnosis of the most common tremor syndromes - essential tremor (ET) and Parkinson's disease (PD) is burdened with high error rate. However, diagnostic MRI biomarkers applicable in this clinically highly relevant scenario remain an unfulfilled objective. The presented study was designed in search for possible candidate MRI protocols relevant for differential diagnostic process in tremor syndromes.10 non-advanced tremor-dominant PD patients meeting diagnostic criteria for clinically established PD, 12 isolated ET patients and 16 healthy controls were enrolled into this study. The study focused on relaxation MRI protocols - T1, T2, adiabatic T1ρ and adiabatic T2ρ due to their relatively low post-processing requirements enabling implementation into routine clinical practice. Compared to ET, PD patients had significantly longer T2 relaxation times in striata with dominant findings in the putamen contralateral to the clinically more affected body side. This difference was driven by alterations in the PD group as confirmed in the complementary comparison with healthy controls. According to the receiver operating characteristic analysis, this region provided a reasonable sensitivity of 0.91 and specificity of 0.89 in the differential diagnosis of PD and ET. In PD patients, we further found prolonged T1ρ in the substantia nigra compared to ET and healthy controls, and shorter T2 and T2ρ in the cerebellum compared to healthy controls. T2 relaxation time in the putamen contralateral to the clinically more affected body side is a plausible candidate diagnostic marker for the differentiation of PD and ET.
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Affiliation(s)
- Pavel Filip
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic; International Clinical Research Center (ICRC), University Hospital of St. Anne, Brno, Czech Republic; Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA.
| | - Lubomír Vojtíšek
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
| | - Marek Baláž
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic
| | - Silvia Mangia
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
| | - Shalom Michaeli
- Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic
| | - Rastislav Šumec
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic; International Clinical Research Center (ICRC), University Hospital of St. Anne, Brno, Czech Republic; Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic; Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
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Meng Y, Hynynen K, Lipsman N. Applications of focused ultrasound in the brain: from thermoablation to drug delivery. Nat Rev Neurol 2020; 17:7-22. [PMID: 33106619 DOI: 10.1038/s41582-020-00418-z] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
Focused ultrasound (FUS) is a disruptive medical technology, and its implementation in the clinic represents the culmination of decades of research. Lying at the convergence of physics, engineering, imaging, biology and neuroscience, FUS offers the ability to non-invasively and precisely intervene in key circuits that drive common and challenging brain conditions. The actions of FUS in the brain take many forms, ranging from transient blood-brain barrier opening and neuromodulation to permanent thermoablation. Over the past 5 years, we have seen a dramatic expansion of indications for and experience with FUS in humans, with a resultant exponential increase in academic and public interest in the technology. Applications now span the clinical spectrum in neurological and psychiatric diseases, with insights still emerging from preclinical models and human trials. In this Review, we provide a comprehensive overview of therapeutic ultrasound and its current and emerging indications in the brain. We examine the potential impact of FUS on the landscape of brain therapies as well as the challenges facing further advancement and broader adoption of this promising minimally invasive therapeutic alternative.
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Affiliation(s)
- Ying Meng
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Harquail Centre for Neuromodulation, Toronto, ON, Canada.,Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medical Biophysics and Institute of Biomaterials & Biomedical Engineering (IBBME), University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Harquail Centre for Neuromodulation, Toronto, ON, Canada. .,Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Zhou M, Melin MD, Xu W, Südhof TC. Dysfunction of parvalbumin neurons in the cerebellar nuclei produces an action tremor. J Clin Invest 2020; 130:5142-5156. [PMID: 32634124 PMCID: PMC7524475 DOI: 10.1172/jci135802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
Essential tremor is a common brain disorder affecting millions of people, yet the neuronal mechanisms underlying this prevalent disease remain elusive. Here, we showed that conditional deletion of synaptotagmin-2, the fastest Ca2+ sensor for synaptic neurotransmitter release, from parvalbumin neurons in mice caused an action tremor syndrome resembling the core symptom of essential tremor patients. Combining brain region-specific and cell type-specific genetic manipulation methods, we found that deletion of synaptotagmin-2 from excitatory parvalbumin-positive neurons in cerebellar nuclei was sufficient to generate an action tremor. The synaptotagmin-2 deletion converted synchronous into asynchronous neurotransmitter release in projections from cerebellar nuclei neurons onto gigantocellular reticular nucleus neurons, which might produce an action tremor by causing signal oscillations during movement. The tremor was rescued by completely blocking synaptic transmission with tetanus toxin in cerebellar nuclei, which also reversed the tremor phenotype in the traditional harmaline-induced essential tremor model. Using a promising animal model for action tremor, our results thus characterized a synaptic circuit mechanism that may underlie the prevalent essential tremor disorder.
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Affiliation(s)
- Mu Zhou
- Department of Molecular and Cellular Physiology and
| | | | - Wei Xu
- Department of Molecular and Cellular Physiology and
| | - Thomas C. Südhof
- Department of Molecular and Cellular Physiology and
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, California, USA
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Boscolo Galazzo I, Magrinelli F, Pizzini FB, Storti SF, Agosta F, Filippi M, Marotta A, Mansueto G, Menegaz G, Tinazzi M. Voxel-based morphometry and task functional magnetic resonance imaging in essential tremor: evidence for a disrupted brain network. Sci Rep 2020; 10:15061. [PMID: 32934259 PMCID: PMC7493988 DOI: 10.1038/s41598-020-69514-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022] Open
Abstract
The pathophysiology of essential tremor (ET) is controversial and might be further elucidated by advanced neuroimaging. Focusing on homogenous ET patients diagnosed according to the 2018 consensus criteria, this study aimed to: (1) investigate whether task functional MRI (fMRI) can identify networks of activated and deactivated brain areas, (2) characterize morphometric and functional modulations, relative to healthy controls (HC). Ten ET patients and ten HC underwent fMRI while performing two motor tasks with their upper limb: (1) maintaining a posture (both groups); (2) simulating tremor (HC only). Activations/deactivations were obtained from General Linear Model and compared across groups/tasks. Voxel-based morphometry and linear regressions between clinical and fMRI data were also performed. Few cerebellar clusters of gray matter loss were found in ET. Conversely, widespread fMRI alterations were shown. Tremor in ET (task 1) was associated with extensive deactivations mainly involving the cerebellum, sensory-motor cortex, and basal ganglia compared to both tasks in HC, and was negatively correlated with clinical tremor scales. Homogeneous ET patients demonstrated deactivation patterns during tasks triggering tremor, encompassing a network of cortical and subcortical regions. Our results point towards a marked cerebellar involvement in ET pathophysiology and the presence of an impaired cerebello-thalamo-cortical tremor network.
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Affiliation(s)
- Ilaria Boscolo Galazzo
- Department of Computer Science, University of Verona, Strada Le Grazie 15, Ca' Vignal 2, 37134, Verona, Italy.
| | - Francesca Magrinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Section, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | | | - Silvia Francesca Storti
- Department of Computer Science, University of Verona, Strada Le Grazie 15, Ca' Vignal 2, 37134, Verona, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Angela Marotta
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Section, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Giancarlo Mansueto
- Department of Diagnostics and Pathology, University of Verona, Verona, Italy
| | - Gloria Menegaz
- Department of Computer Science, University of Verona, Strada Le Grazie 15, Ca' Vignal 2, 37134, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Section, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Chiu SY, Nozile-Firth K, Klassen BT, Adams A, Lee K, Van Gompel JJ, Hassan A. Ataxia and tolerance after thalamic deep brain stimulation for essential tremor. Parkinsonism Relat Disord 2020; 80:47-53. [PMID: 32950784 DOI: 10.1016/j.parkreldis.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) thalamus is highly effective to treat medication-refractory essential tremor (ET). Complications of stimulation-induced ataxia and tolerance have been reported in limited series, ranging from 5 to 40%. OBJECTIVE We analyzed a large single-center cohort of ET patients treated with thalamic DBS to assess rates of ataxia and tolerance. METHODS Retrospective study of all ET patients that underwent VIM DBS at Mayo Clinic from 2010 to 2014. Demographic, clinical and DBS data were extracted. Risk factors, complications and time to onset of tolerance and ataxia were examined. RESULTS One hundred and thirteen ET patients (51% male) of mean age 68 ± 10 years and mean ET duration 27 ± 18 years underwent DBS during the study period. Of these, 98 (87%) had follow-up of ≥6 months (mean 4.0 ± 1.5 years) and were included for analysis. Complications of isolated ataxia (26%), isolated tolerance (4%), both tolerance and ataxia (9%), or neither (61%) were identified. Development of ataxia was about 3 times more common than tolerance (35% vs. 13%). The mean time to ataxia was 5.5 ± 0.3 years postoperatively. Risk factors for ataxia were baseline ataxic features, older age, and shorter ET disease duration. Small sample size limited calculation of risk factors and onset time for tolerance. CONCLUSIONS Stimulation-related ataxia occurred in one-third of ET patients, while tolerance was less common. Presence of baseline ataxia, age, and disease duration may aid counseling of stimulation-related ataxia risk. Larger studies are warranted to confirm these findings and further assess risk factors for tolerance.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, University of Florida, Gainesville, FL, USA.
| | | | | | - Andrea Adams
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kendall Lee
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Louis ED, Faust PL. Essential tremor: the most common form of cerebellar degeneration? CEREBELLUM & ATAXIAS 2020; 7:12. [PMID: 32922824 PMCID: PMC7427947 DOI: 10.1186/s40673-020-00121-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023]
Abstract
Background The degenerative cerebellar ataxias comprise a large and heterogeneous group of neurological diseases whose hallmark clinical feature is ataxia, and which are accompanied, to variable degrees, by other features that are attributable to cerebellar dysfunction. Essential tremor (ET) is an exceptionally common neurological disease whose primary motor feature is action tremor, although patients often manifest intention tremor, mild gait ataxia and several other features of cerebellar dysfunction. Main Body In this paper, we review the abundant evidence derived from clinical, neuroimaging and postmortem studies, linking ET to cerebellar dysfunction. Furthermore, we review the combination of clinical, natural history and postmortem features suggesting that ET is neurodegenerative. We then compare the prevalence of ET (400 – 900 cases per 100,000) to that of the other cerebellar degenerations (ranging from <0.5 – 9 cases per 100,000, and in composite likely to be on the order of 20 cases per 100,000) and conclude that ET is 20 to 45 times more prevalent than all other forms of cerebellar degeneration combined. Conclusion Given the data we present, it is logical to conclude that ET is, by far, the most common form of cerebellar degeneration.
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Affiliation(s)
- Elan D Louis
- Department of Neurology and Therapeutics, University of Texas Southwestern, Dallas, TX USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY USA
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Sengul Y, Temur HO, Corakcı Z, Sengul HS, Dowd H, Ustun I, Alkan A, Louis ED. Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study. Int J Neurosci 2020; 132:154-164. [PMID: 32730718 DOI: 10.1080/00207454.2020.1803859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. OBJECTIVE To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. METHOD Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. RESULTS Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. CONCLUSION These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.
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Affiliation(s)
- Y Sengul
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey.,Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - H O Temur
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Z Corakcı
- Department of Occupational Therapy, Bezmialem Foundation University School of Medical Sciences, Istanbul, Turkey
| | - H S Sengul
- Laboratory of Neuropsychology, Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey
| | - H Dowd
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - I Ustun
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - A Alkan
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - E D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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42
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Altered spontaneous brain activity in essential tremor with and without resting tremor: a resting-state fMRI study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:201-212. [PMID: 32661843 DOI: 10.1007/s10334-020-00865-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/02/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Essential tremor with resting tremor (rET) often exhibits severer clinical features and more extensive functional impairment than essential tremor without resting tremor (ETwr). However, the pathophysiology of rET is still unclear. This study aims to use resting-state functional magnetic resonance imaging (rs-fMRI) to explore the alterations of brain activity between the drug-naïve patients of rET and ETwr. METHODS We recruited 19 patients with rET, 31 patients with ETwr and 25 healthy controls (HCs) to undergo a 3.0-T rs-fMRI examination. The differences of regional brain spontaneous activity between the rET, ETwr and HCs, as well as between total ET (rET + ETwr) and HCs were measured by amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF). The relationships between the altered brain measurements and the clinical scores were analyzed. RESULTS Compared with HCs, both ET subgroups showed significantly decreased ALFF or fALFF values in the basal ganglia, inferior orbitofrontal gyrus and insula. The rET group specifically showed decreased ALFF values in the hippocampus and motor cortices, while the ETwr group specifically evidenced increased ALFF and fALFF values in the cerebellum. DISCUSSION Regional spontaneous activity in rET and ETwr share common changes and have differences, which may suggest that the functional activities in the limbic system and cerebellum are different between the two subtypes. Improved insights into rET and ETwr subtypes and the different brain spontaneous activity will be valuable for improving our understanding of the pathophysiology of the disease.
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Tapper S, Göransson N, Lundberg P, Tisell A, Zsigmond P. A pilot study of essential tremor: cerebellar GABA+/Glx ratio is correlated with tremor severity. CEREBELLUM & ATAXIAS 2020; 7:8. [PMID: 32607248 PMCID: PMC7318770 DOI: 10.1186/s40673-020-00116-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022]
Abstract
Objective Essential tremor is a common movement disorder with an unclear origin. Emerging evidence suggests the role of the cerebellum and the thalamus in tremor pathophysiology. We examined the two main neurotransmitters acting inhibitory (GABA+) and excitatory (Glx) respectively, in the thalamus and cerebellum, in patients diagnosed with severe essential tremor. Furthermore, we also investigated the relationship between determined neurotransmitter concentrations and tremor severity in the essential tremor patients. Methods Ten essential tremor patients (prior to deep brain stimulation surgery) and six healthy controls, were scanned using a 3 T MR system. GABA+ and Glx concentrations were measured using magnetic resonance spectroscopy (MRS) performed using single voxel MEGA-PRESS. For the purpose of assessing the tremor severity, the essential tremor rating scale (ETRS) was used in accordance with Fahn, Tolosa, and Marin. Results We demonstrated that the cerebellar GABA+/Glx ratio was positively correlated to the ETRS (r = 0.70, p = 0.03) in essential tremor. Cerebellar and thalamic GABA+ and Glx concentrations did not show any significant difference when comparing essential tremor patients with healthy controls, at the group level. Conclusion We demonstrated a positive correlation between increasing tremor disability and the ratio of GABA+/ Glx in the cerebellum of essential tremor patients. This highlights the impact of an altered balance of the excitatory and inhibitory neurotransmitters in tremor severity. Rather than a change in GABA+, which was constant, we attribute this finding to an overall decrease of Glx.
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Affiliation(s)
- Sofie Tapper
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nathanael Göransson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Tisell
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Al-Fatly B, Ewert S, Kübler D, Kroneberg D, Horn A, Kühn AA. Connectivity profile of thalamic deep brain stimulation to effectively treat essential tremor. Brain 2020; 142:3086-3098. [PMID: 31377766 DOI: 10.1093/brain/awz236] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/19/2023] Open
Abstract
Essential tremor is the most prevalent movement disorder and is often refractory to medical treatment. Deep brain stimulation offers a therapeutic approach that can efficiently control tremor symptoms. Several deep brain stimulation targets (ventral intermediate nucleus, zona incerta, posterior subthalamic area) have been discussed for tremor treatment. Effective deep brain stimulation therapy for tremor critically involves optimal targeting to modulate the tremor network. This could potentially become more robust and precise by using state-of-the-art brain connectivity measurements. In the current study, we used two normative brain connectomes (structural and functional) to show the pattern of effective deep brain stimulation electrode connectivity in 36 patients with essential tremor. Our structural and functional connectivity models were significantly predictive of postoperative tremor improvement in out-of-sample data (P < 0.001 for both structural and functional leave-one-out cross-validation). Additionally, we segregated the somatotopic brain network based on head and hand tremor scores. These resulted in segregations that mapped onto the well-known somatotopic maps of both motor cortex and cerebellum. Crucially, this shows that slightly distinct networks need to be modulated to ameliorate head versus hand tremor and that those networks could be identified based on somatotopic zones in motor cortex and cerebellum. Finally, we propose a multi-modal connectomic deep brain stimulation sweet spot that may serve as a reference to enhance clinical care, in the future. This spot resided in the posterior subthalamic area, encroaching on the inferior borders of ventral intermediate nucleus and sensory thalamus. Our results underscore the importance of integrating brain connectivity in optimizing deep brain stimulation targeting for essential tremor.
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Affiliation(s)
- Bassam Al-Fatly
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Siobhan Ewert
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dorothee Kübler
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Kroneberg
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Horn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Exzellenzcluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lopez AM, Trujillo P, Hernandez AB, Lin YC, Kang H, Landman BA, Englot DJ, Dawant BM, Konrad PE, Claassen DO. Structural Correlates of the Sensorimotor Cerebellum in Parkinson's Disease and Essential Tremor. Mov Disord 2020; 35:1181-1188. [PMID: 32343870 DOI: 10.1002/mds.28044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/15/2019] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) and essential tremor (ET) are commonly encountered movement disorders. Pathophysiologic processes that localize to the cerebellum are described in both. There are limited studies investigating cerebellar structural changes in these conditions, largely because of inherent challenges in the efficiency of segmentation. METHODS We applied a novel multiatlas cerebellar segmentation method to T1-weighted images in 282 PD and 111 essential tremor patients to define 26 cerebellar lobule volumes. The severity of postural and resting tremor in both populations and gait and postural instability in PD patients were defined using subscores of the UPDRS and Washington Heights-Inwood Genetic Study motor scales. These clinical measurements were related to lobule volume size. Multiple comparisons were controlled using a false discovery rate method. RESULTS Group differences were identified between ET and PD patients, with reductions in deep cerebellar nucleus volume in ET versus reduced lobule VI volume in PD. In ET patients, lobule VIII was negatively correlated with the severity of postural tremor. In PD patients, lobule IV was positively correlated with resting tremor and total tremor severity. We observed differences in cerebellar structure that localized to sensorimotor lobules of the cerebellum. Lobule volumes appeared to differentially relate to clinical symptoms, suggesting important clinicopathologic distinctions between these conditions. These results emphasize the role of the cerebellum in tremor symptoms and should foster future clinical and pathologic investigations of the sensorimotor lobules of the cerebellum. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alexander M Lopez
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paula Trujillo
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adreanna B Hernandez
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ya-Chen Lin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bennett A Landman
- Department of Radiology/Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benoit M Dawant
- Department of Radiology/Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Luft F, Sharifi S, Mugge W, Schouten AC, Bour LJ, van Rootselaar AF, Veltink PH, Heida T. Distinct cortical activity patterns in Parkinson's disease and essential tremor during a bimanual tapping task. J Neuroeng Rehabil 2020; 17:45. [PMID: 32183867 PMCID: PMC7079392 DOI: 10.1186/s12984-020-00670-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background Parkinson’s disease (PD) and essential tremor (ET) are neurodegenerative diseases characterized by movement deficits. Especially in PD, maintaining cyclic movement can be significantly disturbed due to pathological changes in the basal ganglia and the cerebellum. Providing external cues improves timing of these movements in PD and also affects ET. The aim of this study is to determine differences in cortical activation patterns in PD and ET patients during externally and internally cued movements. Methods Eleven PD patients, twelve ET patients, OFF tremor suppressing medication, and nineteen age-matched healthy controls (HC) were included and asked to perform a bimanual tapping task at two predefined cue frequencies. The auditory cue, a metronome sound presented at 2 or 4 Hz, was alternately switched on and off every 30 s. Tapping at two different frequencies were used since it is expected that different brain networks are involved at different frequencies as has been shown in previous studies. Cortical activity was recorded using a 64-channel EEG cap. To establish the cortical activation pattern in each group, the task related power (TRP) was calculated for each subject. For inter-groups analysis, EEG electrodes for divided into 5 different areas. Results Inter-group analysis revealed significant differences in areas responsible for motor planning, organization and regulation and involved in initiation, maintenance, coordination and planning of complex sequences of movements. Within the area of the primary motor cortex the ET group showed a significantly lower TRP than the HC group. In the area responsible for combining somatosensory, auditory and visual information both patient groups had a higher TRP than the HC group. Conclusions Different neurological networks are involved during cued and non-cued movements in ET, PD and HC. Distinct cortical activation patterns were revealed using task related power calculations. Different activation patterns were revealed during the 2 and 4 Hz tapping task indicating different strategies to execute movements at these rates. The results suggest that a including a cued/non-cued tapping task during clinical decision making could be a valuable tool in an objective diagnostic protocol.
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Affiliation(s)
- Frauke Luft
- Department of Biomedical Signals and Systems, Faculty EEMCS, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands.
| | - Sarvi Sharifi
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Winfred Mugge
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands
| | - Alfred C Schouten
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Lo J Bour
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anne Fleur van Rootselaar
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, Faculty EEMCS, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands
| | - Tijtske Heida
- Department of Biomedical Signals and Systems, Faculty EEMCS, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands
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Essential tremor pathology: neurodegeneration and reorganization of neuronal connections. Nat Rev Neurol 2020; 16:69-83. [PMID: 31959938 DOI: 10.1038/s41582-019-0302-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 01/26/2023]
Abstract
Essential tremor (ET) is the most common tremor disorder globally and is characterized by kinetic tremor of the upper limbs, although other clinical features can also occur. Postmortem studies are a particularly important avenue for advancing our understanding of the pathogenesis of ET; however, until recently, the number of such studies has been limited. Several recent postmortem studies have made important contributions to our understanding of the pathological changes that take place in ET. These studies identified abnormalities in the cerebellum, which primarily affected Purkinje cells (PCs), basket cells and climbing fibres, in individuals with ET. We suggest that some of these pathological changes (for example, focal PC axonal swellings, swellings in and regression of the PC dendritic arbor and PC death) are likely to be primary and degenerative. By contrast, other changes, such as an increase in PC recurrent axonal collateral formation and hypertrophy of GABAergic basket cell axonal processes, could be compensatory responses to restore cerebellar GABAergic tone and cerebellar cortical inhibitory efficacy. Such compensatory responses are likely to be insufficient, enabling the disease to progress. Here, we review the results of recent postmortem studies of ET and attempt to place these findings into an anatomical-physiological disease model.
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48
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Awad A, Blomstedt P, Westling G, Eriksson J. Deep brain stimulation in the caudal zona incerta modulates the sensorimotor cerebello-cerebral circuit in essential tremor. Neuroimage 2019; 209:116511. [PMID: 31901420 DOI: 10.1016/j.neuroimage.2019.116511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/09/2019] [Accepted: 12/30/2019] [Indexed: 01/25/2023] Open
Abstract
Essential tremor is effectively treated with deep brain stimulation (DBS), but the neural mechanisms underlying the treatment effect are poorly understood. Essential tremor is driven by a dysfunctional cerebello-thalamo-cerebral circuit resulting in pathological tremor oscillations. DBS is hypothesised to interfere with these oscillations at the stimulated target level, but it is unknown whether the stimulation modulates the activity of the cerebello-thalamo-cerebral circuit during different task states (with and without tremor) in awake essential tremor patients. To address this issue, we used functional MRI in 16 essential tremor patients chronically implanted with DBS in the caudal zona incerta. During scanning, the patients performed unilateral tremor-inducing postural holding and pointing tasks as well as rest, with contralateral stimulation turned On and Off. We show that DBS exerts both task-dependent as well as task-independent modulation of the sensorimotor cerebello-cerebral regions (p ≤ 0.05, FWE cluster-corrected for multiple comparisons). Task-dependent modulation (DBS × task interaction) resulted in two patterns of stimulation effects. Firstly, activity decreases (blood oxygen level-dependent signal) during tremor-inducing postural holding in the primary sensorimotor cortex and cerebellar lobule VIII, and activity increases in the supplementary motor area and cerebellar lobule V during rest (p ≤ 0.05, post hoc two-tailed t-test). These effects represent differences at the effector level and may reflect DBS-induced tremor reduction since the primary sensorimotor cortex, cerebellum and supplementary motor area exhibit less motor task-activity as compared to the resting condition during On stimulation. Secondly, task-independent modulation (main effect of DBS) was observed as activity increase in the lateral premotor cortex during all motor tasks, and also during rest (p ≤ 0.05, post hoc two-tailed t-test). This task-independent effect may mediate the therapeutic effects of DBS through the facilitation of the premotor control over the sensorimotor circuit, making it less susceptible to tremor entrainment. Our findings support the notion that DBS in essential tremor is modulating the sensorimotor cerebello-cerebral circuit, distant to the stimulated target, and illustrate the complexity of stimulation mechanisms by demonstrating task-dependent as well as task-independent actions in cerebello-cerebral regions.
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Affiliation(s)
- Amar Awad
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Sweden; Department of Integrative Medical Biology, Physiology Section, Umeå University, Sweden.
| | - Patric Blomstedt
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Sweden
| | - Göran Westling
- Department of Integrative Medical Biology, Physiology Section, Umeå University, Sweden
| | - Johan Eriksson
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Sweden; Department of Integrative Medical Biology, Physiology Section, Umeå University, Sweden
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49
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Lenka A, Louis ED. Revisiting the Clinical Phenomenology of "Cerebellar Tremor": Beyond the Intention Tremor. THE CEREBELLUM 2019; 18:565-574. [PMID: 30565088 DOI: 10.1007/s12311-018-0994-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is a central feature of a range of diseases resulting from pathological changes in the cerebellum. Interestingly, in modern times, the terms "cerebellar tremor" and "intention tremor" are often used synonymously and interchangeably. However, "cerebellar tremor" (i.e., tremors of cerebellar origin) do not always present exclusively as intention tremor. In this article, we comprehensively revisit the clinical phenomenology of tremors observed in various diseases that are based in the cerebellum. By this, we mean diseases for which the cerebellum and its various connections are often seen as playing a central and defining role. These include spinocerebellar ataxias, essential tremor, orthostatic tremor, dystonia, acute cerebellitis, cerebellar tumors, paraneoplastic cerebellar degeneration, and cerebellar strokes. The theme of this article is to highlight, through published data available in the current literature, that the clinical phenomenology of tremor of cerebellar origin is heterogeneous, and it extends beyond that of intention tremor to include postural tremors, kinetic tremor, rest tremor, and orthostatic tremor. This heterogeneity is consistent with the seminal work of Gordon Holmes, in which he described a variety of tremors aside from intention tremor in the setting of cerebellar lesions. In the end, it would seem that the notion that intention tremor is the sole signature of cerebellar lesions is an over-simplification and is not correct. Future studies are warranted to identify and further characterize the heterogeneity of tremors arising from the various cerebellar etiologies.
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Affiliation(s)
- Abhishek Lenka
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Department of Neurology, Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA.
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50
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The cortico-rubral and cerebello-rubral pathways are topographically organized within the human red nucleus. Sci Rep 2019; 9:12117. [PMID: 31431648 PMCID: PMC6702172 DOI: 10.1038/s41598-019-48164-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/11/2019] [Indexed: 02/03/2023] Open
Abstract
The Red Nucleus (RN) is a large nucleus located in the ventral midbrain: it is subdivided into a small caudal magnocellular part (mRN) and a large rostral parvocellular part (pRN). These distinct structural regions are part of functionally different networks and show distinctive connectivity features: the mRN is connected to the interposed nucleus, whilst the pRN is mainly connected to dentate nucleus, cortex and inferior olivary complex. Despite functional neuroimaging studies suggest RN involvement in complex motor and higher order functions, the pRN and mRN cannot be distinguished using conventional MRI. Herein, we employ high-quality structural and diffusion MRI data of 100 individuals from the Human Connectome Project repository and constrained spherical deconvolution tractography to perform connectivity-based segmentation of the human RN. In particular, we tracked connections of RN with the inferior olivary complex, the interposed nucleus, the dentate nucleus and the cerebral cortex. We found that the RN can be subdivided according to its connectivity into two clusters: a large ventrolateral one, mainly connected with the cerebral cortex and the inferior olivary complex, and a smaller dorsomedial one, mainly connected with the interposed nucleus. This structural topography strongly reflects the connectivity patterns of pRN and mRN respectively. Structural connectivity-based segmentation could represent a useful tool for the identification of distinct subregions of the human red nucleus on 3T MRI thus allowing a better evaluation of this subcortical structure in healthy and pathological conditions.
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