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Rouiller EM. Adaptation of the layer V supraspinal motor corticofugal projections from the primary (M1) and premotor (PM) cortices after CNS motor disorders in non-human primates: A survey. Transl Neurosci 2024; 15:20220342. [PMID: 38860225 PMCID: PMC11163158 DOI: 10.1515/tnsci-2022-0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 06/12/2024] Open
Abstract
Motor commands are transmitted from the motor cortical areas to effectors mostly via the corticospinal (CS) projection. Several subcortical motor nuclei also play an important role in motor control, the subthalamic nucleus, the red nucleus, the reticular nucleus and the superior colliculus. These nuclei are influenced by motor cortical areas via respective corticofugal projections, which undergo complex adaptations after motor trauma (spinal cord/motor cortex injury) or motor disease (Parkinson), both in the absence or presence of putative treatments, as observed in adult macaque monkeys. A dominant effect was a nearly complete suppression of the corticorubral projection density and a strong downregulation of the corticoreticular projection density, with the noticeable exception in the latter case of a considerable increase of projection density following spinal cord injury, even enhanced when an anti-NogoA antibody treatment was administered. The effects were diverse and less prominent on the corticotectal and corticosubthalamic projections. The CS projection may still be the major efferent pathway through which motor adaptations can take place after motor trauma or disease. However, the parallel supraspinal motor corticofugal projections may also participate in connectional adaptations supporting the functional recovery of motor abilities, representing potential targets for future clinical strategies, such as selective electrical neurostimulations.
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Affiliation(s)
- Eric M. Rouiller
- Department of Neurosciences and Movement sciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, Ch. du Musée 5, CH-1700Fribourg, Switzerland
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2
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Qiu Y, Yin Z, Wang M, Duan A, Xie M, Wu J, Wang Z, Chen G. Motor function improvement and acceptability of non-invasive brain stimulation in patients with Parkinson's disease: a Bayesian network analysis. Front Neurosci 2023; 17:1212640. [PMID: 37564368 PMCID: PMC10410144 DOI: 10.3389/fnins.2023.1212640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disorder defined by progressive motor and non-motor symptoms. Currently, the pro-cognitive effects of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are well-supported in previous literatures. However, controversy surrounding the optimal therapeutic target for motor symptom improvement remains. Objective This network meta-analysis (NMA) was conducted to comprehensively evaluate the optimal strategy to use rTMS and tDCS to improve motor symptoms in PD. Methods We searched PubMed, Embase, and Cochrane electronic databases for eligible randomized controlled studies (RCTs). The primary outcome was the changes of Unified Parkinson's Disease Rating Scale (UPDRS) part III score, the secondary outcomes were Time Up and Go Test (TUGT) time, and Freezing of Gait Questionnaire (FOGQ) score. The safety outcome was indicated by device-related adverse events (AEs). Result We enrolled 28 studies that investigated various strategies, including high-frequency rTMS (HFrTMS), low-frequency rTMS (LFrTMS), anodal tDCS (AtDCS), AtDCS_ cathode tDCS (CtDCS), HFrTMS_LFrTMS, and Sham control groups. Both HFrTMS (short-term: mean difference (MD) -5.21, 95% credible interval (CrI) -9.26 to -1.23, long-term: MD -4.74, 95% CrI -6.45 to -3.05), and LFrTMS (long-term: MD -4.83, 95% CrI -6.42 to -3.26) were effective in improving UPDRS-III score compared with Sham stimulation. For TUGT time, HFrTMS (short-term: MD -2.04, 95% CrI -3.26 to -0.8, long-term: MD -2.66, 95% CrI -3.55 to -1.77), and AtDCS (short-term: MD -0.8, 95% CrI -1.26 to -0.34, long-term: MD -0.69, 95% CrI -1.31 to -0.08) produced a significant difference compared to Sham stimulation. However, no statistical difference was found in FOGQ score among the various groups. According to the surface under curve ranking area, HFrTMS ranked first in short-term UPDRS-III score (0.77), short-term (0.82), and long-term (0.84) TUGT time, and short-term FOGQ score (0.73). With respect to the safety outcomes, all strategies indicated few and self-limiting AEs. Conclusion HFrTMS may be the optimal non-invasive brain stimulation (NIBS) intervention to improve motor function in patients with PD while NIBS has generally been well tolerated. However, further studies focusing on the clinical outcomes resulting from the different combined schedules of tDCS and rTMS are required. Systematic review registration https://inplasy.com/inplasy-2023-4-0087/, identifier: 202340087.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziqian Yin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Menghan Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Coenen VA, Watakabe A, Skibbe H, Yamamori T, Döbrössy MD, Sajonz BEA, Reinacher PC, Reisert M. Tomographic tract tracing and data driven approaches to unravel complex 3D fiber anatomy of DBS relevant prefrontal projections to the diencephalic-mesencephalic junction in the marmoset. Brain Stimul 2023; 16:670-681. [PMID: 37028755 DOI: 10.1016/j.brs.2023.03.012] [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: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Understanding prefrontal cortex projections to diencephalic-mesencephalic junction (DMJ), especially to subthalamic nucleus (STN) and ventral mesencephalic tegmentum (VMT) helps our comprehension of Deep Brain Stimulation (DBS) in major depression (MD) and obsessive-compulsive disorder (OCD). Fiber routes are complex and tract tracing studies in non-human primate species (NHP) have yielded conflicting results. The superolateral medial forebrain bundle (slMFB) is a promising target for DBS in MD and OCD. It has become a focus of criticism owing to its name and its diffusion weighted-imaging based primary description. OBJECTIVE To investigate DMJ connectivity in NHP with a special focus on slMFB and the limbic hyperdirect pathway utilizing three-dimensional and data driven techniques. METHODS We performed left prefrontal adeno-associated virus - tracer based injections in the common marmoset monkey (n = 52). Histology and two-photon microscopy were integrated into a common space. Manual and data driven cluster analyses of DMJ, subthalamic nucleus and VMT together, followed by anterior tract tracing streamline (ATTS) tractography were deployed. RESULTS Typical pre- and supplementary motor hyperdirect connectivity was confirmed. The advanced tract tracing unraveled the complex connectivity to the DMJ. Limbic prefrontal territories directly projected to the VMT but not STN. DISCUSSION Intricate results of tract tracing studies warrant the application of advanced three-dimensional analyses to understand complex fiber-anatomical routes. The applied three-dimensional techniques can enhance anatomical understanding also in other regions with complex fiber anatomy. CONCLUSION Our work confirms slMFB anatomy and enfeebles previous misconceptions. The rigorous NHP approach strengthens the role of the slMFB as a target structure for DBS predominantly in psychiatric indications like MD and OCD.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany; Medical Faculty of the University of Freiburg, Breisacher Str. 153, 79110, Freiburg Im Breisgau, Germany; Center for Deep Brain Stimulation, Medical Center of the University of Freiburg, Germany; AG Stereotaxy and Interventional Neurosciences (SIN), Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany
| | - Akiya Watakabe
- Laboratory for Molecular Analysis of Higher Brain Function, RIKEN Center for Brain Science, Japan
| | - Henrik Skibbe
- Brain Image Analysis Unit, RIKEN Center for Brain Science, Japan
| | - Tetsuo Yamamori
- Laboratory for Molecular Analysis of Higher Brain Function, RIKEN Center for Brain Science, Japan
| | - Máté D Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany; AG Stereotaxy and Interventional Neurosciences (SIN), Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany; Medical Faculty of the University of Freiburg, Breisacher Str. 153, 79110, Freiburg Im Breisgau, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany; Medical Faculty of the University of Freiburg, Breisacher Str. 153, 79110, Freiburg Im Breisgau, Germany; Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany, Breisacher Straße 64, 79106, Freiburg Im Breisgau, Germany; Medical Faculty of the University of Freiburg, Breisacher Str. 153, 79110, Freiburg Im Breisgau, Germany; Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center - University of Freiburg, Killianstrasse 5a, 79106, Freiburg, Germany.
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Borgognon S, Rouiller EM. Loss of Motor Cortical Inputs to the Red Nucleus after CNS Disorders in Nonhuman Primates. J Neurosci 2023; 43:1682-1691. [PMID: 36693756 PMCID: PMC10010457 DOI: 10.1523/jneurosci.1942-22.2023] [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: 10/17/2022] [Revised: 12/14/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
The premotor (PM) and primary motor (M1) cortical areas broadcast voluntary motor commands through multiple neuronal pathways, including the corticorubral projection that reaches the red nucleus (RN). However, the respective contribution of M1 and PM to corticorubral projections as well as changes induced by motor disorders or injuries are not known in nonhuman primates. Here, we quantified the density and topography of axonal endings of the corticorubral pathway in RN in intact monkeys, as well as in monkeys subjected to either cervical spinal cord injury (SCI), Parkinson's disease (PD)-like symptoms or primary motor cortex injury (MCI). Twenty adult macaque monkeys of either sex were injected with the biotinylated dextran amine anterograde tracer either in PM or in M1. We developed a semiautomated algorithm to reliably detect and count axonal boutons within the magnocellular and parvocellular (pRN) subdivisions of RN. In intact monkeys, PM and M1 preferentially target the medial part of the ipsilateral pRN, reflecting its somatotopic organization. Projection of PM to the ipsilateral pRN is denser than that of M1, matching previous observations for the corticotectal, corticoreticular, and corticosubthalamic projections (Fregosi et al., 2018, 2019; Borgognon et al., 2020). In all three types of motor disorders, there was a uniform and strong decrease (near loss) of the corticorubral projections from PM and M1. The RN may contribute to functional recovery after SCI, PD, and MCI, by reducing direct cortical influence. This reduction possibly privileges direct access to the final output motor system, via emphasis on the direct corticospinal projection.SIGNIFICANCE STATEMENT We measured the corticorubral projection density arising from the PM or the M1 cortices in adult macaques. The premotor cortex sent denser corticorubral projections than the primary motor cortex, as previously observed for the corticotectal, corticoreticular, and corticosubthalamic projections. The premotor cortex may thus exert more influence than primary motor cortex onto subcortical structures. We next asked whether the corticorubral motor projections undergo lesion-dependent plasticity after either cervical spinal cord injury, Parkinson's disease-like symptoms, or primary motor cortex lesion. In all three types of pathology, there was a strong decrease of the corticorubral motor projection density, suggesting that the red nucleus may contribute to functional recovery after such motor system disorders based on a reduced direct cortical influence.
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Affiliation(s)
- Simon Borgognon
- Center for the Neural Basis of Cognition, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
- Department of Neurosciences and Movement Sciences, Section of Medicine, Faculty of Science and Medicine, University of Fribourg, CH-1700 Fribourg, Switzerland
- Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland
| | - Eric M Rouiller
- Department of Neurosciences and Movement Sciences, Section of Medicine, Faculty of Science and Medicine, University of Fribourg, CH-1700 Fribourg, Switzerland
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Bingham CS, Petersen MV, Parent M, McIntyre CC. Evolving characterization of the human hyperdirect pathway. Brain Struct Funct 2023; 228:353-365. [PMID: 36708394 PMCID: PMC10716731 DOI: 10.1007/s00429-023-02610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
The hyperdirect pathway (HDP) represents the main glutamatergic input to the subthalamic nucleus (STN), through which the motor and prefrontal cerebral cortex can modulate basal ganglia activity. Further, direct activation of the motor HDP is thought to be an important component of therapeutic deep brain stimulation (DBS), mediating the disruption of pathological oscillations. Alternatively, unintended recruitment of the prefrontal HDP may partly explain some cognitive side effects of DBS therapy. Previous work describing the HDP has focused on non-human primate (NHP) histological pathway tracings, diffusion-weighted MRI analysis of human white matter, and electrophysiology studies involving paired cortical recordings with DBS. However, none of these approaches alone yields a complete understanding of the complexities of the HDP. As such, we propose that generative modeling methods hold promise to bridge anatomy and physiology results, from both NHPs and humans, into a more detailed representation of the human HDP. Nonetheless, numerous features of the HDP remain to be experimentally described before model-based methods can simulate corticosubthalamic activity with a high degree of scientific detail. Therefore, the goals of this review are to examine the experimental evidence for HDP projections from across the primate neocortex and discuss new data which are required to improve the utility of anatomical and biophysical models of the human corticosubthalamic system.
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Affiliation(s)
- Clayton S Bingham
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Martin Parent
- Department of Psychiatry and Neuroscience, Laval University, Quebec, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Neurosurgery, Duke University, Durham, NC, USA.
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Trevarrow MP, Munoz MJ, Rivera YM, Arora R, Drane QH, Rosenow JM, Sani SB, Pal GD, Verhagen Metman L, Goelz LC, Corcos DM, David FJ. The Effects of Subthalamic Nucleus Deep Brain Stimulation and Retention Delay on Memory-Guided Reaching Performance in People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:917-935. [PMID: 37522216 PMCID: PMC10578280 DOI: 10.3233/jpd-225041] [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: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) improves intensive aspects of movement (velocity) in people with Parkinson's disease (PD) but impairs the more cognitively demanding coordinative aspects of movement (error). We extended these findings by evaluating STN-DBS induced changes in intensive and coordinative aspects of movement during a memory-guided reaching task with varying retention delays. OBJECTIVE We evaluated the effect of STN-DBS on motor control during a memory-guided reaching task with short and long retention delays in participants with PD and compared performance to healthy controls (HC). METHODS Eleven participants with PD completed the motor section of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS III) and performed a memory-guided reaching task under four different STN-DBS conditions (DBS-OFF, DBS-RIGHT, DBS-LEFT, and DBS-BOTH) and two retention delays (0.5 s and 5 s). An additional 13 HC completed the memory-guided reaching task. RESULTS Unilateral and bilateral STN-DBS improved the MDS-UPDRS III scores. In the memory-guided reaching task, both unilateral and bilateral STN-DBS increased the intensive aspects of movement (amplitude and velocity) in the direction toward HC but impaired coordinative aspects of movement (error) away from the HC. Furthermore, movement time was decreased but reaction time was unaffected by STN-DBS. Shorter retention delays increased amplitude and velocity, decreased movement times, and decreased error, but increased reaction times in the participants with PD. There were no interactions between STN-DBS condition and retention delay. CONCLUSION STN-DBS may affect cognitive-motor functioning by altering activity throughout cortico-basal ganglia networks and the oscillatory activity subserving them.
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Affiliation(s)
- Michael P. Trevarrow
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Miranda J. Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Yessenia M. Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Rishabh Arora
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Quentin H. Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sepehr B. Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Gian D. Pal
- Department of Neurology, Division of Movement Disorders, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Verhagen Metman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa C. Goelz
- Department of Kinesiology and Nutrition, UIC College of Applied Health Sciences, Chicago, IL, USA
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Fabian J. David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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Pujol S, Cabeen RP, Yelnik J, François C, Fernandez Vidal S, Karachi C, Bardinet E, Cosgrove GR, Kikinis R. Somatotopic Organization of Hyperdirect Pathway Projections From the Primary Motor Cortex in the Human Brain. Front Neurol 2022; 13:791092. [PMID: 35547388 PMCID: PMC9081715 DOI: 10.3389/fneur.2022.791092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The subthalamic nucleus (STN) is an effective neurosurgical target to improve motor symptoms in Parkinson's Disease (PD) patients. MR-guided Focused Ultrasound (MRgFUS) subthalamotomy is being explored as a therapeutic alternative to Deep Brain Stimulation (DBS) of the STN. The hyperdirect pathway provides a direct connection between the cortex and the STN and is likely to play a key role in the therapeutic effects of MRgFUS intervention in PD patients. Objective This study aims to investigate the topography and somatotopy of hyperdirect pathway projections from the primary motor cortex (M1). Methods We used advanced multi-fiber tractography and high-resolution diffusion MRI data acquired on five subjects of the Human Connectome Project (HCP) to reconstruct hyperdirect pathway projections from M1. Two neuroanatomy experts reviewed the anatomical accuracy of the tracts. We extracted the fascicles arising from the trunk, arm, hand, face and tongue area from the reconstructed pathways. We assessed the variability among subjects based on the fractional anisotropy (FA) and mean diffusivity (MD) of the fibers. We evaluated the spatial arrangement of the different fascicles using the Dice Similarity Coefficient (DSC) of spatial overlap and the centroids of the bundles. Results We successfully reconstructed hyperdirect pathway projections from M1 in all five subjects. The tracts were in agreement with the expected anatomy. We identified hyperdirect pathway fascicles projecting from the trunk, arm, hand, face and tongue area in all subjects. Tract-derived measurements showed low variability among subjects, and similar distributions of FA and MD values among the fascicles projecting from different M1 areas. We found an anterolateral somatotopic arrangement of the fascicles in the corona radiata, and an average overlap of 0.63 in the internal capsule and 0.65 in the zona incerta. Conclusion Multi-fiber tractography combined with high-resolution diffusion MRI data enables the identification of the somatotopic organization of the hyperdirect pathway. Our preliminary results suggest that the subdivisions of the hyperdirect pathway projecting from the trunk, arm, hand, face, and tongue motor area are intermixed at the level of the zona incerta and posterior limb of the internal capsule, with a predominantly overlapping topographical organization in both regions. Subject-specific knowledge of the hyperdirect pathway somatotopy could help optimize target definition in MRgFUS intervention.
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Affiliation(s)
- Sonia Pujol
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ryan P Cabeen
- Laboratory of Neuro Imaging, Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine of the USC, University of Southern California, Los Angeles, CA, United States
| | - Jérôme Yelnik
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Chantal François
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Sara Fernandez Vidal
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Carine Karachi
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France.,Department of Neurosurgery, APHP, Hôpitaux Universitaires Pitié-Salpêtriére/Charles Foix, Paris, France
| | - Eric Bardinet
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ron Kikinis
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Pani P, Giarrocco F, Bardella G, Brunamonti E, Ferraina S. Action-stopping models must consider the role of the dorsal premotor cortex. Cortex 2022; 152:160-163. [DOI: 10.1016/j.cortex.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
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9
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Coenen VA, Schlaepfer TE, Sajonz BEA, Reinacher PC, Döbrössy MD, Reisert M. “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as MAINTENANCE Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder. Brain Sci 2022; 12:brainsci12040438. [PMID: 35447971 PMCID: PMC9028695 DOI: 10.3390/brainsci12040438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive–compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB’s (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy.
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Affiliation(s)
- Volker A. Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Correspondence: ; Tel.: +49-761-270-50630; Fax: +49-761-270-50100
| | - Thomas E. Schlaepfer
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Department of Interventional Biological Psychiatry, Medical Center of University of Freiburg, 79106 Freiburg, Germany
| | - Bastian E. A. Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany
| | - Máté D. Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center of University of Freiburg, 79106 Freiburg, Germany
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10
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Bahners BH, Waterstraat G, Kannenberg S, Curio G, Schnitzler A, Nikulin V, Florin E. Electrophysiological characterization of the hyperdirect pathway and its functional relevance for subthalamic deep brain stimulation. Exp Neurol 2022; 352:114031. [PMID: 35247373 DOI: 10.1016/j.expneurol.2022.114031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
The subthalamic nucleus (STN) receives input from various cortical areas via hyperdirect pathway (HDP) which bypasses the basal-ganglia loop. Recently, the HDP has gained increasing interest, because of its relevance for STN deep brain stimulation (DBS). To understand the HDP's role cortical responses evoked by STN-DBS have been investigated. These responses have short (<2 ms), medium (2-15 ms), and long (20-70 ms) latencies. Medium-latency responses are supposed to represent antidromic cortical activations via HDP. Together with long-latency responses the medium responses can potentially be used as biomarker of DBS efficacy as well as side effects. We here propose that the activation sequence of the cortical evoked responses can be conceptualized as high frequency oscillations (HFO) for signal analysis. HFO might therefore serve as marker for antidromic activation. Using existing knowledge on HFO recordings, this approach allows data analyses and physiological modeling to advance the pathophysiological understanding of cortical DBS-evoked high-frequency activity.
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Affiliation(s)
- Bahne Hendrik Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gunnar Waterstraat
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurophysics Group, Department of Neurology, Berlin, Germany
| | - Silja Kannenberg
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gabriel Curio
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Neurophysics Group, Department of Neurology, Berlin, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Vadim Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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11
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Yaghoubi E, Shariat SV, Rashedi V, Ghanbari Jolfaei A. Repetitive Transcranial Magnetic Stimulation in Delirium: A Double-blind, Randomized, Sham-controlled, Pilot Study. Basic Clin Neurosci 2022; 13:237-246. [PMID: 36425946 PMCID: PMC9682314 DOI: 10.32598/bcn.2022.1830.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/20/2020] [Accepted: 11/14/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Delirium is a fatal but potentially reversible disorder of the central nervous system that imposes high costs on health systems. This study aims to evaluate the effect of intermittent theta-burst stimulation on the severity and course of delirium disorder. METHODS This is a double-blind, randomized, sham-controlled pilot study. The study participants were randomly allocated into the active (active intermittent theta-burst stimulation) and sham groups. The severity of delirium was assessed 15 minutes before the intervention and 15 minutes after that by the Neelon and Champagne (NEECHAM) confusion scale. RESULTS In the active group, total and subscale scores of NEECHAM significantly decreased after intervention (P<0.05). Although no statistical difference was found in the control group regarding the subscale scores of NEECHAM, the difference in the total scores before and after the sham intervention was statistically significant. CONCLUSION Carrying one session of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex can reduce the delirium severity in a short period, although it will not decrease the number of delirium cases three days after the intervention. HIGHLIGHTS Delirium is a CNS disorder;Delirium treatment is based on pharmacological and non-pharmacological;rTMS is quasi-modern treatment of neurocognitive disorders. PLAIN LANGUAGE SUMMARY Delirium is fatal but reversible disorder. regarding the restrictions of routine treatments of delirium and by considering the cognition disturbances as the core symptom of delirium, and the positive effect of rTMS on cognition functions. we hypothesized that rTMS could be effective in the treatment of delirium.
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Affiliation(s)
- Emad Yaghoubi
- Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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12
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Milardi D, Antonio Basile G, Faskowitz J, Bertino S, Quartarone A, Anastasi G, Bramanti A, Ciurleo R, Cacciola A. Effects of diffusion signal modeling and segmentation approaches on subthalamic nucleus parcellation. Neuroimage 2022; 250:118959. [PMID: 35122971 DOI: 10.1016/j.neuroimage.2022.118959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 11/24/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
The subthalamic nucleus (STN) is commonly used as a surgical target for deep brain stimulation in movement disorders such as Parkinson's Disease. Tractography-derived connectivity-based parcellation (CBP) has been recently proposed as a suitable tool for non-invasive in vivo identification and pre-operative targeting of specific functional territories within the human STN. However, a well-established, accurate and reproducible protocol for STN parcellation is still lacking. The present work aims at testing the effects of different tractography-based approaches for the reconstruction of STN functional territories. We reconstructed functional territories of the STN on the high-quality dataset of 100 unrelated healthy subjects and on the test-retest dataset of the Human Connectome Project (HCP) repository. Connectivity-based parcellation was performed with a hypothesis-driven approach according to cortico-subthalamic connectivity, after dividing cortical areas into three groups: associative, limbic and sensorimotor. Four parcellation pipelines were compared, combining different signal modeling techniques (single-fiber vs multi-fiber) and different parcellation approaches (winner takes all parcellation vs fiber density thresholding). We tested these procedures on STN regions of interest obtained from three different, commonly employed, subcortical atlases. We evaluated the pipelines both in terms of between-subject similarity, assessed on the cohort of 100 unrelated healthy subjects, and of within-subject similarity, using a second cohort of 44 subjects with available test-retest data. We found that each parcellation provides converging results in terms of location of the identified parcels, but with significative variations in size and shape. All pipelines obtained very high within-subject similarity, with tensor-based approaches outperforming multi-fiber pipelines. On the other hand, higher between-subject similarity was found with multi-fiber signal modeling techniques combined with fiber density thresholding. We suggest that a fine-tuning of tractography-based parcellation may lead to higher reproducibility and aid the development of an optimized surgical targeting protocol.
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Affiliation(s)
- Demetrio Milardi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Gianpaolo Antonio Basile
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Joshua Faskowitz
- Program in Neuroscience, Indiana University, Bloomington, IN, USA; Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th Street, Bloomington, IN, 47405, USA
| | - Salvatore Bertino
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Angelo Quartarone
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giuseppe Anastasi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry "Medical School of Salerno"- University of Salerno, Italy
| | | | - Alberto Cacciola
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
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13
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Toward personalized medicine in connectomic deep brain stimulation. Prog Neurobiol 2021; 210:102211. [PMID: 34958874 DOI: 10.1016/j.pneurobio.2021.102211] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
At the group-level, deep brain stimulation leads to significant therapeutic benefit in a multitude of neurological and neuropsychiatric disorders. At the single-patient level, however, symptoms may sometimes persist despite "optimal" electrode placement at established treatment coordinates. This may be partly explained by limitations of disease-centric strategies that are unable to account for heterogeneous phenotypes and comorbidities observed in clinical practice. Instead, tailoring electrode placement and programming to individual patients' symptom profiles may increase the fraction of top-responding patients. Here, we propose a three-step, circuit-based framework with the aim of developing patient-specific treatment targets that address the unique symptom constellation prevalent in each patient. First, we describe how a symptom network target library could be established by mapping beneficial or undesirable DBS effects to distinct circuits based on (retrospective) group-level data. Second, we suggest ways of matching the resulting symptom networks to circuits defined in the individual patient (template matching). Third, we introduce network blending as a strategy to calculate optimal stimulation targets and parameters by selecting and weighting a set of symptom-specific networks based on the symptom profile and subjective priorities of the individual patient. We integrate the approach with published literature and conclude by discussing limitations and future challenges.
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14
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Steinmüller JB, Bjarkam CR, Orlowski D, Sørensen JCH, Glud AN. Anterograde Tracing From the Göttingen Minipig Motor and Prefrontal Cortex Displays a Topographic Subthalamic and Striatal Axonal Termination Pattern Comparable to Previous Findings in Primates. Front Neural Circuits 2021; 15:716145. [PMID: 34899195 PMCID: PMC8661455 DOI: 10.3389/fncir.2021.716145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/02/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Deep brain stimulation (DBS) of the dorsal subthalamic nucleus (STN) is a validated neurosurgical treatment of Parkinson’s Disease (PD). To investigate the mechanism of action, including potential DBS induced neuroplasticity, we have previously used a minipig model of Parkinson’s Disease, although the basal ganglia circuitry was not elucidated in detail. Aim: To describe the cortical projections from the primary motor cortex (M1) to the basal ganglia and confirm the presence of a cortico-striatal pathway and a hyperdirect pathway to the subthalamic nucleus, respectively, which is known to exist in primates. Materials and Methods: Five female Göttingen minipigs were injected into the primary motor cortex (n = 4) and adjacent prefrontal cortex (n = 1) with the anterograde neuronal tracer, Biotinylated Dextran Amine (BDA). 4 weeks later the animals were sacrificed and the brains cryosectioned into 30 μm thick coronal sections for subsequent microscopic analysis. Results: The hyperdirect axonal connections from the primary motor cortex were seen to terminate in the dorsolateral STN, whereas the axonal projections from the prefrontal cortex terminated medially in the STN. Furthermore, striatal tracing from the motor cortex was especially prominent in the dorsolateral putamen and less so in the dorsolateral caudate nucleus. The prefrontal efferents were concentrated mainly in the caudate nucleus and to a smaller degree in the juxtacapsular dorsal putamen, but they were also found in the nucleus accumbens and ventral prefrontal cortex. Discussion: The organization of the Göttingen minipig basal ganglia circuitry is in accordance with previous descriptions in primates. The existence of a cortico-striatal and hyperdirect basal ganglia pathway in this non-primate, large animal model may accordingly permit further translational studies on STN-DBS induced neuroplasticity of major relevance for future DBS treatments.
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Affiliation(s)
- Johannes Bech Steinmüller
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Dariusz Orlowski
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Andreas Nørgaard Glud
- CENSE, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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15
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Muthuraman M, Palotai M, Jávor-Duray B, Kelemen A, Koirala N, Halász L, Erőss L, Fekete G, Bognár L, Deuschl G, Tamás G. Frequency-specific network activity predicts bradykinesia severity in Parkinson's disease. Neuroimage Clin 2021; 32:102857. [PMID: 34662779 PMCID: PMC8526781 DOI: 10.1016/j.nicl.2021.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/15/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Bradykinesia has been associated with beta and gamma band interactions in the basal ganglia-thalamo-cortical circuit in Parkinson's disease. In this present cross-sectional study, we aimed to search for neural networks with electroencephalography whose frequency-specific actions may predict bradykinesia. METHODS Twenty Parkinsonian patients treated with bilateral subthalamic stimulation were first prescreened while we selected four levels of contralateral stimulation (0: OFF, 1-3: decreasing symptoms to ON state) individually, based on kinematics. In the screening period, we performed 64-channel electroencephalography measurements simultaneously with electromyography and motion detection during a resting state, finger tapping, hand grasping tasks, and pronation-supination of the arm, with the four levels of contralateral stimulation. We analyzed spectral power at the low (13-20 Hz) and high (21-30 Hz) beta frequency bands and low (31-60 Hz) and high (61-100 Hz) gamma frequency bands using the dynamic imaging of coherent sources. Structural equation modelling estimated causal relationships between the slope of changes in network beta and gamma activities and the slope of changes in bradykinesia measures. RESULTS Activity in different subnetworks, including predominantly the primary motor and premotor cortex, the subthalamic nucleus predicted the slopes in amplitude and speed while switching between stimulation levels. These subnetwork dynamics on their preferred frequencies predicted distinct types and parameters of the movement only on the contralateral side. DISCUSSION Concurrent subnetworks affected in bradykinesia and their activity changes in the different frequency bands are specific to the type and parameters of the movement; and the primary motor and premotor cortex are common nodes.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders, Imaging and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marcell Palotai
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | - Andrea Kelemen
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Nabin Koirala
- Movement Disorders, Imaging and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Haskins Laboratories, New Haven, USA
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Gábor Fekete
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - László Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary.
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16
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Coenen VA, Döbrössy MD, Teo SJ, Wessolleck J, Sajonz BEA, Reinacher PC, Thierauf-Emberger A, Spittau B, Leupold J, von Elverfeldt D, Schlaepfer TE, Reisert M. Diverging prefrontal cortex fiber connection routes to the subthalamic nucleus and the mesencephalic ventral tegmentum investigated with long range (normative) and short range (ex-vivo high resolution) 7T DTI. Brain Struct Funct 2021; 227:23-47. [PMID: 34482443 PMCID: PMC8741702 DOI: 10.1007/s00429-021-02373-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
Uncertainties
concerning anatomy and function of cortico-subcortical projections have arisen during the recent years. A clear distinction between cortico-subthalamic (hyperdirect) and cortico-tegmental projections (superolateral medial forebrain bundle, slMFB) so far is elusive. Deep Brain Stimulation (DBS) of the slMFB (for major depression, MD and obsessive compulsive disorders, OCD) has on the one hand been interpreted as actually involving limbic (prefrontal) hyperdirect pathways. On the other hand slMFB’s stimulation region in the mesencephalic ventral tegmentum is said to impact on other structures too, going beyond the antidepressant (or anti OCD) efficacy of sole modulation of the cortico-tegmental reward-associated pathways. We have here used a normative diffusion MRT template (HCP, n = 80) for long-range tractography and augmented this dataset with ex-vivo high resolution data (n = 1) in a stochastic brain space. We compared this data with histological information and used the high resolution ex-vivo data set to scrutinize the mesencephalic tegmentum for small fiber pathways present. Our work resolves an existing ambiguity between slMFB and prefrontal hyperdirect pathways which—for the first time—are described as co-existent. DBS of the slMFB does not appear to modulate prefrontal hyperdirect cortico-subthalamic but rather cortico-tegmental projections. Smaller fiber structures in the target region—as far as they can be discerned—appear not to be involved in slMFB DBS. Our work enfeebles previous anatomical criticism and strengthens the position of the slMFB DBS target for its use in MD and OCD.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany. .,Medical Faculty of Freiburg University, Freiburg, Germany. .,Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany. .,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany.
| | - Máté D Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany
| | - Shi Jia Teo
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Johanna Wessolleck
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Annette Thierauf-Emberger
- Medical Faculty of Freiburg University, Freiburg, Germany.,Institute of Forensic Medicine, Medical Center of Freiburg University, Freiburg, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany.,Institute for Anatomy and Cell Biology, Department of Molecular Embryologie, Faculty of Medicine, Freiburg University, Freiburg, Germany
| | - Jochen Leupold
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominik von Elverfeldt
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas E Schlaepfer
- Medical Faculty of Freiburg University, Freiburg, Germany.,Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany.,Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical Center of Freiburg University, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
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17
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Alhourani A, Korzeniewska A, Wozny TA, Lipski WJ, Kondylis ED, Ghuman AS, Crone NE, Crammond DJ, Turner RS, Richardson RM. Subthalamic Nucleus Activity Influences Sensory and Motor Cortex during Force Transduction. Cereb Cortex 2021; 30:2615-2626. [PMID: 31989165 DOI: 10.1093/cercor/bhz264] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
The subthalamic nucleus (STN) is proposed to participate in pausing, or alternately, in dynamic scaling of behavioral responses, roles that have conflicting implications for understanding STN function in the context of deep brain stimulation (DBS) therapy. To examine the nature of event-related STN activity and subthalamic-cortical dynamics, we performed primary motor and somatosensory electrocorticography while subjects (n = 10) performed a grip force task during DBS implantation surgery. Phase-locking analyses demonstrated periods of STN-cortical coherence that bracketed force transduction, in both beta and gamma ranges. Event-related causality measures demonstrated that both STN beta and gamma activity predicted motor cortical beta and gamma activity not only during force generation but also prior to movement onset. These findings are consistent with the idea that the STN participates in motor planning, in addition to the modulation of ongoing movement. We also demonstrated bidirectional information flow between the STN and somatosensory cortex in both beta and gamma range frequencies, suggesting robust STN participation in somatosensory integration. In fact, interactions in beta activity between the STN and somatosensory cortex, and not between STN and motor cortex, predicted PD symptom severity. Thus, the STN contributes to multiple aspects of sensorimotor behavior dynamically across time.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40292, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Witold J Lipski
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Efstathios D Kondylis
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Avniel S Ghuman
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.,Brain Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Donald J Crammond
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Robert S Turner
- Brain Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
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18
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Borgognon S, Cottet J, Badoud S, Bloch J, Brunet JF, Rouiller EM. Cortical Projection From the Premotor or Primary Motor Cortex to the Subthalamic Nucleus in Intact and Parkinsonian Adult Macaque Monkeys: A Pilot Tracing Study. Front Neural Circuits 2020; 14:528993. [PMID: 33192334 PMCID: PMC7649525 DOI: 10.3389/fncir.2020.528993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022] Open
Abstract
Besides the main cortical inputs to the basal ganglia, via the corticostriatal projection, there is another input via the corticosubthalamic projection (CSTP), terminating in the subthalamic nucleus (STN). The present study investigated and compared the CSTPs originating from the premotor cortex (PM) or the primary motor cortex (M1) in two groups of adult macaque monkeys. The first group includes six intact monkeys, whereas the second group was made up of four monkeys subjected to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) intoxication producing Parkinson’s disease (PD)-like symptoms and subsequently treated with an autologous neural cell ecosystem (ANCE) therapy. The CSTPs were labeled with the anterograde tracer biotinylated dextran amine (BDA), injected either in PM or in M1. BDA-labeled axonal terminal boutons in STN were charted, counted, and then normalized based on the number of labeled corticospinal axons in each monkey. In intact monkeys, the CSTP from PM was denser than that originating from M1. In two PD monkeys, the CSTP originating from PM or M1 were substantially increased, as compared to intact monkeys. In one other PD monkey, there was no obvious change, whereas the last PD monkey showed a decrease of the CSTP originating from M1. Interestingly, the linear relationship between CSTP density and PD symptoms yielded a possible dependence of the CSTP re-organization with the severity of the MPTP lesion. The higher the PD symptoms, the larger the CSTP densities, irrespective of the origin (from both M1 or PM). Plasticity of the CSTP in PD monkeys may be related to PD itself and/or to the ANCE treatment.
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Affiliation(s)
- Simon Borgognon
- Department of Neurosciences and Movement Sciences, Faculty of Science and Medicine, Section of Medicine, Fribourg Cognition Center, Platform of Translational Neurosciences (PTN), Swiss Primate Competence Center for Research (SPCCR), University of Fribourg, Fribourg, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jérôme Cottet
- Department of Neurosciences and Movement Sciences, Faculty of Science and Medicine, Section of Medicine, Fribourg Cognition Center, Platform of Translational Neurosciences (PTN), Swiss Primate Competence Center for Research (SPCCR), University of Fribourg, Fribourg, Switzerland
| | - Simon Badoud
- Department of Neurosciences and Movement Sciences, Faculty of Science and Medicine, Section of Medicine, Fribourg Cognition Center, Platform of Translational Neurosciences (PTN), Swiss Primate Competence Center for Research (SPCCR), University of Fribourg, Fribourg, Switzerland
| | - Jocelyne Bloch
- Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean-François Brunet
- Cell Production Center (CPC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Eric M Rouiller
- Department of Neurosciences and Movement Sciences, Faculty of Science and Medicine, Section of Medicine, Fribourg Cognition Center, Platform of Translational Neurosciences (PTN), Swiss Primate Competence Center for Research (SPCCR), University of Fribourg, Fribourg, Switzerland
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19
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Chen W, de Hemptinne C, Miller AM, Leibbrand M, Little SJ, Lim DA, Larson PS, Starr PA. Prefrontal-Subthalamic Hyperdirect Pathway Modulates Movement Inhibition in Humans. Neuron 2020; 106:579-588.e3. [PMID: 32155442 PMCID: PMC7274135 DOI: 10.1016/j.neuron.2020.02.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/06/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
The ability to dynamically change motor outputs, such as stopping an initiated response, is an important aspect of human behavior. A hyperdirect pathway between the inferior frontal gyrus and subthalamic nucleus is hypothesized to mediate movement inhibition, but there is limited evidence for this in humans. We recorded high spatial and temporal resolution field potentials from both the inferior frontal gyrus and subthalamic nucleus in 21 subjects. Cortical potentials evoked by subthalamic stimulation revealed short latency events indicative of monosynaptic connectivity between the inferior frontal gyrus and ventral subthalamic nucleus. During a stop signal task, stopping-related potentials in the cortex preceded stopping-related activity in the subthalamic nucleus, and synchronization between these task-evoked potentials predicted the stop signal reaction time. Thus, we show that a prefrontal-subthalamic hyperdirect pathway is present in humans and mediates rapid stopping. These findings may inform therapies to treat disorders featuring perturbed movement inhibition.
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Affiliation(s)
- Witney Chen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Coralie de Hemptinne
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Miller
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | | | - Simon J Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Daniel A Lim
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.
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20
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Emmi A, Antonini A, Macchi V, Porzionato A, De Caro R. Anatomy and Connectivity of the Subthalamic Nucleus in Humans and Non-human Primates. Front Neuroanat 2020; 14:13. [PMID: 32390807 PMCID: PMC7189217 DOI: 10.3389/fnana.2020.00013] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/13/2020] [Indexed: 02/02/2023] Open
Abstract
The Subthalamic Nucleus (STh) is an oval-shaped diencephalic structure located ventrally to the thalamus, playing a fundamental role in the circuitry of the basal ganglia. In addition to being involved in the pathophysiology of several neurodegenerative disorders, such as Huntington’s and Parkinson’s disease, the STh is one of the target nuclei for deep brain stimulation. However, most of the anatomical evidence available derives from non-human primate studies. In this review, we will present the topographical and morphological organization of the nucleus and its connections to structurally and functionally related regions of the basal ganglia circuitry. We will also highlight the importance of additional research in humans focused on validating STh connectivity, cytoarchitectural organization, and its functional subdivision.
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Affiliation(s)
- Aron Emmi
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
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21
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Direct Activation of Primary Motor Cortex during Subthalamic But Not Pallidal Deep Brain Stimulation. J Neurosci 2020; 40:2166-2177. [PMID: 32019827 DOI: 10.1523/jneurosci.2480-19.2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an effective treatment for parkinsonian motor signs. Though its therapeutic mechanisms remain unclear, it has been suggested that antidromic activation of the primary motor cortex (M1) plays a significant role in mediating its therapeutic effects. This study tested the hypothesis that antidromic activation of M1 is a prominent feature underlying the therapeutic effect of STN and GPi DBS. Single-unit activity in M1 was recorded using high-density microelectrode arrays in two parkinsonian nonhuman primates each implanted with DBS leads targeting the STN and GPi. Stimulation in each DBS target had similar therapeutic effects, however, antidromic activation of M1 was only observed during STN DBS. Although both animals undergoing STN DBS had similar beneficial effects, the proportion of antidromic-classified cells in each differed, 30 versus 6%. Over 4 h of continuous STN DBS, antidromic activation became less robust, whereas therapeutic benefits were maintained. Although antidromic activation waned over time, synchronization of spontaneous spiking in M1 was significantly reduced throughout the 4 h. Although we cannot discount the potential therapeutic role of antidromic M1 activation at least in the acute phase of STN DBS, the difference in observed antidromic activation between animals, and target sites, raise questions about its hypothesized role as the primary mechanism underlying the therapeutic effect of DBS. These results lend further support that reductions in synchronization at the level of M1 are an important factor in the therapeutic effects of DBS.SIGNIFICANCE STATEMENT Recently there has been great interest and debate regarding the potential role of motor cortical activation in the therapeutic mechanisms of deep brain stimulation (DBS) for Parkinson's disease. In this study we used chronically implanted high density microelectrode arrays in primary motor cortex (M1) to record neuronal population responses in parkinsonian nonhuman primates during subthalamic nucleus (STN) DBS and globus pallidus internus (GPi) DBS. Our results suggest a contribution of antidromic activation of M1 during STN DBS in disrupting synchronization in cortical neuronal populations; however, diminishing antidromic activity over time, and differences in observed antidromic activation between animals and target sites with antidromic activation not observed during GPi DBS, raise questions about its role as the primary mechanism underlying the therapeutic effect of DBS.
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22
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Understanding Parkinson's disease and deep brain stimulation: Role of monkey models. Proc Natl Acad Sci U S A 2019; 116:26259-26265. [PMID: 31871164 DOI: 10.1073/pnas.1902300116] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative movement disorder affecting over 10 million people worldwide. In the 1930s and 1940s there was little understanding regarding what caused PD or how to treat it. In a desperate attempt to improve patients' lives different regions of the neuraxis were ablated. Morbidity and mortality were common, but some patients' motor signs improved with lesions involving the basal ganglia or thalamus. With the discovery of l-dopa the advent of medical therapy began and surgical approaches became less frequent. It soon became apparent, however, that medical therapy was associated with side effects in the form of drug-induced dyskinesia and motor fluctuations and surgical therapies reemerged. Fortunately, during this time studies in monkeys had begun to lay the groundwork to understand the functional organization of the basal ganglia, and with the discovery of the neurotoxin MPTP a monkey model of PD had been developed. Using this model scientists were characterizing the physiological changes that occurred in the basal ganglia in PD and models of basal ganglia function and dysfunction were proposed. This work provided the rationale for the return of pallidotomy, and subsequently deep brain stimulation procedures. In this paper we describe the evolution of these monkey studies, how they provided a greater understanding of the pathophysiology underlying the development of PD and provided the rationale for surgical procedures, the search to understand mechanisms of DBS, and how these studies have been instrumental in understanding PD and advancing the development of surgical therapies for its treatment.
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23
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The anatomo-functional organization of the hyperdirect cortical pathway to the subthalamic area using in vivo structural connectivity imaging in humans. Brain Struct Funct 2019; 225:551-565. [DOI: 10.1007/s00429-019-02012-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022]
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24
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Dimov AV, Gupta A, Kopell BH, Wang Y. High-resolution QSM for functional and structural depiction of subthalamic nuclei in DBS presurgical mapping. J Neurosurg 2019; 131:360-367. [PMID: 30095333 DOI: 10.3171/2018.3.jns172145] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Faithful depiction of the subthalamic nucleus (STN) is critical for planning deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD). Quantitative susceptibility mapping (QSM) has been shown to be superior to traditional T2-weighted spin echo imaging (T2w). The aim of the study was to describe submillimeter QSM for preoperative imaging of the STN in planning of DBS. METHODS Seven healthy volunteers were included in this study. T2w and QSM were obtained for all healthy volunteers, and images of different resolutions were reconstructed. Image quality and visibility of STN anatomical features were analyzed by a radiologist using a 5-point scale, and contrast properties of the STN and surrounding tissue were calculated. Additionally, data from 10 retrospectively and randomly selected PD patients who underwent 3-T MRI for DBS were analyzed for STN size and susceptibility gradient measurements. RESULTS Higher contrast-to-noise ratio (CNR) values were observed in both high-resolution and low-resolution QSM images. Inter-resolution comparison demonstrated improvement in CNR for QSM, but not for T2w images. QSM provided higher inter-quadrant contrast ratios (CR) within the STN, and depicted a gradient in the distribution of susceptibility sources not visible in T2w images. CONCLUSIONS For 3-T MRI, submillimeter QSM provides accurate delineation of the functional and anatomical STN features for DBS targeting.
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Affiliation(s)
- Alexey V Dimov
- 1Meinig School of Biomedical Engineering, Cornell University, Ithaca.,2Department of Radiology, Weill Medical College of Cornell University; and
| | - Ajay Gupta
- 2Department of Radiology, Weill Medical College of Cornell University; and
| | - Brian H Kopell
- 3Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - Yi Wang
- 1Meinig School of Biomedical Engineering, Cornell University, Ithaca.,2Department of Radiology, Weill Medical College of Cornell University; and
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25
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Ramirez Pasos UE, Steigerwald F, Reich MM, Matthies C, Volkmann J, Reese R. Levodopa Modulates Functional Connectivity in the Upper Beta Band Between Subthalamic Nucleus and Muscle Activity in Tonic and Phasic Motor Activity Patterns in Parkinson's Disease. Front Hum Neurosci 2019; 13:223. [PMID: 31312129 PMCID: PMC6614179 DOI: 10.3389/fnhum.2019.00223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Striatal dopamine depletion disrupts basal ganglia function and causes Parkinson's disease (PD). The pathophysiology of the dopamine-dependent relationship between basal ganglia signaling and motor control, however, is not fully understood. We obtained simultaneous recordings of local field potentials (LFPs) from the subthalamic nucleus (STN) and electromyograms (EMGs) in patients with PD to investigate the impact of dopaminergic state and movement on long-range beta functional connectivity between basal ganglia and lower motor neurons. Methods: Eight PD patients were investigated 3 months after implantation of a deep brain stimulation (DBS)-system capable of recording LFPs via chronically-implanted leads (Medtronic, ACTIVA PC+S®). We analyzed STN spectral power and its coherence with EMG in the context of two different movement paradigms (tonic wrist extension vs. alternating wrist extension and flexion) and the effect of levodopa (L-Dopa) intake using an unbiased data-driven approach to determine regions of interest (ROI). Results: Two ROIs capturing prominent coherence within a grand average coherogram were identified. A trend of a dopamine effect was observed for the first ROI (50-150 ms after movement start) with higher STN-EMG coherence in medicated patients. Concerning the second ROI (300-500 ms after movement start), an interaction effect of L-Dopa medication and movement task was observed with higher coherence in the isometric contraction task compared to alternating movements in the medication ON state, a pattern which was reversed in L-Dopa OFF. Discussion: L-Dopa medication may normalize functional connectivity between remote structures of the motor system with increased upper beta coherence reflecting a physiological restriction of the amount of information conveyed between remote structures. This may be necessary to maintain simple movements like isometric contraction. Our study adds dynamic properties to the complex interplay between STN spectral beta power and the nucleus' functional connectivity to remote structures of the motor system as a function of movement and dopaminergic state. This may help to identify markers of neuronal activity relevant for more individualized programming of DBS therapy.
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Affiliation(s)
| | - Frank Steigerwald
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin M Reich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - René Reese
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University of Rostock, Rostock, Germany
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26
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Scheil J, Kleinsorge T, Liefooghe B. Motor imagery entails task-set inhibition. PSYCHOLOGICAL RESEARCH 2019; 84:1729-1738. [PMID: 30949789 DOI: 10.1007/s00426-019-01183-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/29/2019] [Indexed: 11/29/2022]
Abstract
Motor imagery requires the covert execution of a movement without any overt motor output. Previous studies indicated that motor imagery results in the prolonged inhibition of motor commands. In the present study, we investigated whether motor imagery also leads to the inhibition of more abstract task representations. To do so, we investigated the effect of motor imagery on n - 2 repetition costs, which offer an index of the extent to which task representations are inhibited. Participants switched among three tasks and among two response modes: overt and covert responding (i.e., motor imagery). N - 2 repetition costs were present when the current trial required an overt response but absent when the current trial required a covert response. Furthermore, n - 2 repetition costs were more pronounced when trial n - 1 required a covert response rather than an overt response. This pattern of results suggests that motor imagery also leads to the inhibition of abstract task representations. We discuss our findings in view of current conceptualizations of motor imagery and argue that the inhibitory mechanism entailed by motor imagery targets more than motor commands alone. Finally, we also relate our findings to the mechanisms underlying the inhibition of task representations.
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Affiliation(s)
- Juliane Scheil
- Leibniz Research Centre for Working Environment and Human Factors, Ardeystraße 67, 44139, Dortmund, Germany.
| | - Thomas Kleinsorge
- Leibniz Research Centre for Working Environment and Human Factors, Ardeystraße 67, 44139, Dortmund, Germany
| | - Baptist Liefooghe
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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27
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Albayrak Y, Beyazyüz M, Abbak Ö, Altındağ E. A Report of Rabbit Syndrome Who Benefited from Sigma 1 Agonist Fluvoxamine. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2019; 17:134-138. [PMID: 30690950 PMCID: PMC6361034 DOI: 10.9758/cpn.2019.17.1.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/17/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022]
Abstract
Rabbit Syndrome is an uncommon side effect of antipsychotic treatment. Although it is usually associated with typical antipsychotics, it can also be related to atypical antipsychotics. Anticholinergics are the most accepted treatment approach in treating Rabbit Syndrome. Fluvoxamine is a member of selective serotonin reuptake inhibitors and it is a potent agonist of sigma 1 receptors. In this article, we report a Rabbit Syndrome case who has benefited from fluvoxamine, in terms of both depressive disorder and Rabbit Syndrome; and present the data on the effects of sigma 1 agonist fluvoxamine on numerous movement disorders.
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Affiliation(s)
- Yakup Albayrak
- Department of Psychiatry, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey
| | - Murat Beyazyüz
- Department of Psychiatry, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey
| | - Özlem Abbak
- Department of Psychiatry, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey
| | - Ece Altındağ
- Department of Psychiatry, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey
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28
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Senova S, Clair AH, Palfi S, Yelnik J, Domenech P, Mallet L. Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach. Front Psychiatry 2019; 10:905. [PMID: 31920754 PMCID: PMC6923766 DOI: 10.3389/fpsyt.2019.00905] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder featuring repetitive intrusive thoughts and behaviors associated with a significant handicap. Of patients, 20% are refractory to medication and cognitive behavioral therapy. Refractory OCD is associated with suicidal behavior and significant degradation of social and professional functioning, with high health costs. Deep brain stimulation (DBS) has been proposed as a reversible and controllable method to treat refractory patients, with meta-analyses showing 60% response rate following DBS, whatever the target: anterior limb of the internal capsule (ALIC), ventral capsule/ventral striatum (VC/VS), nucleus accumbens (NAcc), anteromedial subthalamic nucleus (amSTN), or inferior thalamic peduncle (ITP). But how do we choose the "best" target? Functional neuroimaging studies have shown that ALIC-DBS requires the modulation of the fiber tract within the ventral ALIC via the ventral striatum, bordering the bed nucleus of the stria terminalis and connecting the medial prefrontal cortex with the thalamus to be successful. VC/VS effective sites of stimulation were found within the VC and primarily connected to the medial orbitofrontal cortex (OFC) dorsomedial thalamus, amygdala, and the habenula. NAcc-DBS has been found to reduce OCD symptoms by decreasing excessive fronto-striatal connectivity between NAcc and the lateral and medial prefrontal cortex. The amSTN effective stimulation sites are located at the inferior medial border of the STN, primarily connected to lateral OFC, dorsal anterior cingulate, and dorsolateral prefrontal cortex. Finally, ITP-DBS recruits a bidirectional fiber pathway between the OFC and the thalamus. Thus, these functional connectivity studies show that the various DBS targets lie within the same diseased neural network. They share similar efficacy profiles on OCD symptoms as estimated on the Y-BOCS, the amSTN being the target supported by the strongest evidence in the literature. VC/VS-DBS, amSTN-DBS, and ALIC-DBS were also found to improve mood, behavioral adaptability and potentially both, respectively. Because OCD is such a heterogeneous disease with many different symptom dimensions, the ultimate aim should be to find the most appropriate DBS target for a given refractory patient. This quest will benefit from further investigation and understanding of the individual functional connectivity of OCD patients.
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Affiliation(s)
- Suhan Senova
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,IMRB UPEC/INSERM U 955 Team 14, Créteil, France
| | - Anne-Hélène Clair
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Stéphane Palfi
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,IMRB UPEC/INSERM U 955 Team 14, Créteil, France
| | - Jérôme Yelnik
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Philippe Domenech
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Luc Mallet
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
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29
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Single-axon tracing of the corticosubthalamic hyperdirect pathway in primates. Brain Struct Funct 2018; 223:3959-3973. [PMID: 30109491 DOI: 10.1007/s00429-018-1726-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Individual axons that form the hyperdirect pathway in Macaca fascicularis were visualized following microiontophoretic injections of biotinylated dextran amine in layer V of the primary motor cortex (M1). Twenty-eight singly labeled axons were reconstructed in 3D from serial sections. The M1 innervation of the subthalamic nucleus (STN) arises essentially from collaterals of long-ranged corticofugal axons en route to lower brainstem regions. Typically, after leaving M1, these large caliber axons (2-3 µm) enter the internal capsule and travel between caudate nucleus and putamen without providing any collateral to the striatum. More ventrally, they emit a thin collateral (0.5-1.5 µm) that runs lateromedially within the dorsal region of the STN, providing boutons en passant in the sensorimotor territory of the nucleus. In some cases, the medial tip of the collateral enters the lenticular fasciculus dorsally and yields a few beaded axonal branches in the zona incerta. In other cases, the collateral runs caudally and innervates the ventrolateral region of the red nucleus where large axon varicosities (up to 1.7 µm in diameter) are observed, many displaying perisomatic arrangements. Our ultrastructural analysis reveals a high synaptic incidence (141%) of cortical VGluT1-immunoreactive axon varicosities on distal dendrites of STN neurons, and on various afferent axons. Our single-axon reconstructions demonstrate that the so-called hyperdirect pathway derives essentially from collaterals of long-ranged corticofugal axons that are rarely exclusively devoted to the STN, as they also innervate the red nucleus and/or the zona incerta.
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30
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Isaacs BR, Forstmann BU, Temel Y, Keuken MC. The Connectivity Fingerprint of the Human Frontal Cortex, Subthalamic Nucleus, and Striatum. Front Neuroanat 2018; 12:60. [PMID: 30072875 PMCID: PMC6060372 DOI: 10.3389/fnana.2018.00060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/02/2018] [Indexed: 11/13/2022] Open
Abstract
Within the cortico basal ganglia (BG)-thalamic network, the direct and indirect pathways comprise of projections from the cortex to the striatum (STR), whereas the hyperdirect pathway(s) consist of cortical projections toward the subthalamic nucleus (STN). Each pathway possesses a functionally distinct role for action selection. The current study quantified and compared the structural connectivity between 17 distinct cortical areas with the STN and STR using 7 Tesla diffusion weighted magnetic resonance imaging (dMRI) and resting-state functional MRI (rs-fMRI) in healthy young subjects. The selection of these cortical areas was based on a literature search focusing on animal tracer studies. The results indicate that, relative to other cortical areas, both the STN and STR showed markedly weaker structural connections to areas assumed to be essential for action inhibition such as the inferior frontal cortex pars opercularis. Additionally, the cortical connectivity fingerprint of the STN and STR indicated relatively strong connections to areas related to voluntary motor initiation such as the cingulate motor area and supplementary motor area. Overall the results indicated that the cortical-STN connections were sparser compared to the STR. There were two notable exceptions, namely for the orbitofrontal cortex and ventral medial prefrontal cortex, where a higher tract strength was found for the STN. These two areas are thought to be involved in reward processing and action bias.
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Affiliation(s)
- Bethany R. Isaacs
- Integrative Model-Based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Birte U. Forstmann
- Integrative Model-Based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam, Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Max C. Keuken
- Integrative Model-Based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam, Netherlands
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31
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Subthalamic Nucleus Neurons Differentially Encode Early and Late Aspects of Speech Production. J Neurosci 2018; 38:5620-5631. [PMID: 29789378 DOI: 10.1523/jneurosci.3480-17.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/21/2022] Open
Abstract
Basal ganglia-thalamocortical loops mediate all motor behavior, yet little detail is known about the role of basal ganglia nuclei in speech production. Using intracranial recording during deep brain stimulation surgery in humans with Parkinson's disease, we tested the hypothesis that the firing rate of subthalamic nucleus neurons is modulated in sync with motor execution aspects of speech. Nearly half of 79 unit recordings exhibited firing-rate modulation during a syllable reading task across 12 subjects (male and female). Trial-to-trial timing of changes in subthalamic neuronal activity, relative to cue onset versus production onset, revealed that locking to cue presentation was associated more with units that decreased firing rate, whereas locking to speech onset was associated more with units that increased firing rate. These unique data indicate that subthalamic activity is dynamic during the production of speech, reflecting temporally-dependent inhibition and excitation of separate populations of subthalamic neurons.SIGNIFICANCE STATEMENT The basal ganglia are widely assumed to participate in speech production, yet no prior studies have reported detailed examination of speech-related activity in basal ganglia nuclei. Using microelectrode recordings from the subthalamic nucleus during a single-syllable reading task, in awake humans undergoing deep brain stimulation implantation surgery, we show that the firing rate of subthalamic nucleus neurons is modulated in response to motor execution aspects of speech. These results are the first to establish a role for subthalamic nucleus neurons in encoding of aspects of speech production, and they lay the groundwork for launching a modern subfield to explore basal ganglia function in human speech.
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Anderson RW, Farokhniaee A, Gunalan K, Howell B, McIntyre CC. Action potential initiation, propagation, and cortical invasion in the hyperdirect pathway during subthalamic deep brain stimulation. Brain Stimul 2018; 11:1140-1150. [PMID: 29779963 DOI: 10.1016/j.brs.2018.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/05/2018] [Accepted: 05/10/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND High frequency (∼130 Hz) deep brain stimulation (DBS) of the subthalamic region is an established clinical therapy for the treatment of late stage Parkinson's disease (PD). Direct modulation of the hyperdirect pathway, defined as cortical layer V pyramidal neurons that send an axon collateral to the subthalamic nucleus (STN), has emerged as a possible component of the therapeutic mechanisms. However, numerous questions remain to be addressed on the basic biophysics of hyperdirect pathway stimulation. OBJECTIVE Quantify action potential (AP) initiation, propagation, and cortical invasion in hyperdirect neurons during subthalamic stimulation. METHODS We developed an anatomically and electrically detailed computational model of hyperdirect neuron stimulation with explicit representation of the stimulating electric field, axonal response, AP propagation, and synaptic transmission. RESULTS We found robust AP propagation throughout the complex axonal arbor of the hyperdirect neuron. Even at therapeutic DBS frequencies, stimulation induced APs could reach all of the intracortical axon terminals with ∼100% fidelity. The functional result of this high frequency axonal driving of the thousands of synaptic connections made by each directly stimulated hyperdirect neuron is a profound synaptic suppression that would effectively disconnect the neuron from the cortical circuitry. CONCLUSIONS The synaptic suppression hypothesis integrates the fundamental biophysics of electrical stimulation, axonal transmission, and synaptic physiology to explain a generic mechanism of DBS.
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Affiliation(s)
- Ross W Anderson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - AmirAli Farokhniaee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Kabilar Gunalan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Bryan Howell
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA.
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Zhang S, Connolly AT, Madden LR, Vitek JL, Johnson MD. High-resolution local field potentials measured with deep brain stimulation arrays. J Neural Eng 2018; 15:046019. [PMID: 29651998 DOI: 10.1088/1741-2552/aabdf5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Local field potential (LFP) recordings along a deep brain stimulation (DBS) lead can provide useful feedback for titrating DBS therapy. However, conventional DBS leads with four cylindrical macroelectrodes likely undersample the spatial distribution of sinks and sources in a given brain region. In this study, we investigated the spectral power and spatial feature sizes of LFP activity in non-human primate subthalamic nucleus and globus pallidus using chronically implanted 32-channel directional DBS arrays. APPROACH Subthalamic nucleus and globus pallidus LFP signals were recorded from directional DBS arrays in the resting state and during a reach-and-retrieval task in two non-human primates in naïve and parkinsonian conditions. LFP recordings were compared amongst bipolar pairs of electrodes using individual and grouped electrode configurations, with the latter mimicking the cylindrical macroelectrode configurations used in current clinical LFP recordings. MAIN RESULTS Recordings from these DBS arrays showed that (1) beta oscillations have spatial 'fingerprints' in the subthalamic nucleus and globus pallidus, and (2) that these oscillations were muted when grouping electrode contacts together to create cylindrical macroelectrodes similar in relative dimension to those used clinically. Further, these maps depended on parkinsonian condition and whether the subject was resting or performing a motor task. SIGNIFICANCE Development of future closed-loop DBS therapies that rely on LFP feedback will benefit from implanting DBS arrays with electrode sizes and spacings that are more consistent with the dimensions of oscillatory sinks and sources within the brain.
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Affiliation(s)
- Simeng Zhang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
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David FJ, Goelz LC, Tangonan RZ, Metman LV, Corcos DM. Bilateral deep brain stimulation of the subthalamic nucleus increases pointing error during memory-guided sequential reaching. Exp Brain Res 2018; 236:1053-1065. [PMID: 29427240 PMCID: PMC5889310 DOI: 10.1007/s00221-018-5197-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (STN DBS) significantly improves clinical motor symptoms, as well as intensive aspects of movement like velocity and amplitude in patients with Parkinson's disease (PD). However, the effects of bilateral STN DBS on integrative and coordinative aspects of motor control are equivocal. The aim of this study was to investigate the effects of bilateral STN DBS on integrative and coordinative aspects of movement using a memory-guided sequential reaching task. The primary outcomes were eye and finger velocity and end-point error. We expected that bilateral STN DBS would increase reaching velocity. More importantly, we hypothesized that bilateral STN DBS would increase eye and finger end-point error and this would not simply be the result of a speed accuracy trade-off. Ten patients with PD and bilaterally implanted subthalamic stimulators performed a memory-guided sequential reaching task under four stimulator conditions (DBS-OFF, DBS-LEFT, DBS-RIGHT, and DBS-BILATERAL) over 4 days. DBS-BILATERAL significantly increased eye velocity compared to DBS-OFF, DBS-LEFT, and DBS-RIGHT. It also increased finger velocity compared to DBS-OFF and DBS-RIGHT. DBS-BILATERAL did not change eye end-point error. The novel finding was that DBS-BILATERAL increased finger end-point error compared to DBS-OFF, DBS-LEFT, and DBS-RIGHT even after adjusting for differences in velocity. We conclude that bilateral STN DBS may facilitate basal ganglia-cortical networks that underlie intensive aspects of movement like velocity, but it may disrupt selective basal ganglia-cortical networks that underlie certain integrative and coordinative aspects of movement such as spatial accuracy.
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Affiliation(s)
- Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 North Michigan Avenue, Suite 1100, Chicago, IL, 60611, USA.
| | - Lisa C Goelz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 North Michigan Avenue, Suite 1100, Chicago, IL, 60611, USA
- College of Medicine, University of Illinois, Chicago, IL, USA
| | - Ruth Z Tangonan
- College of Medicine, University of Illinois, Chicago, IL, USA
| | - Leonard Verhagen Metman
- Section of Parkinson Disease and Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 North Michigan Avenue, Suite 1100, Chicago, IL, 60611, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Optogenetic Tractography for anatomo-functional characterization of cortico-subcortical neural circuits in non-human primates. Sci Rep 2018; 8:3362. [PMID: 29463867 PMCID: PMC5820256 DOI: 10.1038/s41598-018-21486-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/29/2018] [Indexed: 11/08/2022] Open
Abstract
Dissecting neural circuitry in non-human primates (NHP) is crucial to identify potential neuromodulation anatomical targets for the treatment of pharmacoresistant neuropsychiatric diseases by electrical neuromodulation. How targets of deep brain stimulation (DBS) and cortical targets of transcranial magnetic stimulation (TMS) compare and might complement one another is an important question. Combining optogenetics and tractography may enable anatomo-functional characterization of large brain cortico-subcortical neural pathways. For the proof-of-concept this approach was used in the NHP brain to characterize the motor cortico-subthalamic pathway (m_CSP) which might be involved in DBS action mechanism in Parkinson’s disease (PD). Rabies-G-pseudotyped and Rabies-G-VSVg-pseudotyped EIAV lentiviral vectors encoding the opsin ChR2 gene were stereotaxically injected into the subthalamic nucleus (STN) and were retrogradely transported to the layer of the motor cortex projecting to STN. A precise anatomical mapping of this pathway was then performed using histology-guided high angular resolution MRI tractography guiding accurately cortical photostimulation of m_CSP origins. Photoexcitation of m_CSP axon terminals or m_CSP cortical origins modified the spikes distribution for photosensitive STN neurons firing rate in non-equivalent ways. Optogenetic tractography might help design preclinical neuromodulation studies in NHP models of neuropsychiatric disease choosing the most appropriate target for the tested hypothesis.
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Yang S, Wei X, Wang J, Deng B, Liu C, Yu H, Li H. Efficient hardware implementation of the subthalamic nucleus–external globus pallidus oscillation system and its dynamics investigation. Neural Netw 2017; 94:220-238. [DOI: 10.1016/j.neunet.2017.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/26/2017] [Accepted: 07/13/2017] [Indexed: 12/20/2022]
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Hamani C, Florence G, Heinsen H, Plantinga BR, Temel Y, Uludag K, Alho E, Teixeira MJ, Amaro E, Fonoff ET. Subthalamic Nucleus Deep Brain Stimulation: Basic Concepts and Novel Perspectives. eNeuro 2017; 4:ENEURO.0140-17.2017. [PMID: 28966978 PMCID: PMC5617209 DOI: 10.1523/eneuro.0140-17.2017] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 08/06/2017] [Indexed: 12/21/2022] Open
Abstract
Over the last decades, extensive basic and clinical knowledge has been acquired on the use of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD). It is now clear that mechanisms involved in the effects of this therapy are far more complex than previously anticipated. At frequencies commonly used in clinical practice, neural elements may be excited or inhibited and novel dynamic states of equilibrium are reached. Electrode contacts used for chronic DBS in PD are placed near the dorsal border of the nucleus, a highly cellular region. DBS may thus exert its effects by modulating these cells, hyperdirect projections from motor cortical areas, afferent and efferent fibers to the motor STN. Advancements in neuroimaging techniques may allow us to identify these structures optimizing surgical targeting. In this review, we provide an update on mechanisms and the neural elements modulated by STN DBS.
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Affiliation(s)
- Clement Hamani
- Division of Neurosurgery Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neuroimaging, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Gerson Florence
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Helmut Heinsen
- Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Clinic of Würzburg, Würzburg, Germany
| | - Birgit R. Plantinga
- Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kamil Uludag
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Eduardo Alho
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel J. Teixeira
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Amaro
- Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T. Fonoff
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
- Instituto de Ensino e Pesquisa Hospital Sírio-Libanês, São Paulo, Brazil
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On the Globality of Motor Suppression: Unexpected Events and Their Influence on Behavior and Cognition. Neuron 2017; 93:259-280. [PMID: 28103476 DOI: 10.1016/j.neuron.2016.12.013] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/08/2023]
Abstract
Unexpected events are part of everyday experience. They come in several varieties-action errors, unexpected action outcomes, and unexpected perceptual events-and they lead to motor slowing and cognitive distraction. While different varieties of unexpected events have been studied largely independently, and many different mechanisms are thought to explain their effects on action and cognition, we suggest a unifying theory. We propose that unexpected events recruit a fronto-basal-ganglia network for stopping. This network includes specific prefrontal cortical nodes and is posited to project to the subthalamic nucleus, with a putative global suppressive effect on basal-ganglia output. We argue that unexpected events interrupt action and impact cognition, partly at least, by recruiting this global suppressive network. This provides a common mechanistic basis for different types of unexpected events; links the literatures on motor inhibition, performance monitoring, attention, and working memory; and is relevant for understanding clinical symptoms of distractibility and mental inflexibility.
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Frontosubthalamic Circuits for Control of Action and Cognition. J Neurosci 2017; 36:11489-11495. [PMID: 27911752 DOI: 10.1523/jneurosci.2348-16.2016] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 12/20/2022] Open
Abstract
The subthalamic nucleus (STN) of the basal ganglia appears to have a potent role in action and cognition. Anatomical and imaging studies show that different frontal cortical areas directly project to the STN via so-called hyperdirect pathways. This review reports some of the latest findings about such circuits, including simultaneous recordings from cortex and the STN in humans, single-unit recordings in humans, high-resolution fMRI, and neurocomputational modeling. We argue that a major function of the STN is to broadly pause behavior and cognition when stop signals, conflict signals, or surprise signals occur, and that the fronto-STN circuits for doing this, at least for stopping and conflict, are dissociable anatomically and in terms of their spectral reactivity. We also highlight recent evidence for synchronization of oscillations between prefrontal cortex and the STN, which may provide a preferential "window in time" for single neuron communication via long-range connections.
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Akram H, Sotiropoulos SN, Jbabdi S, Georgiev D, Mahlknecht P, Hyam J, Foltynie T, Limousin P, De Vita E, Jahanshahi M, Hariz M, Ashburner J, Behrens T, Zrinzo L. Subthalamic deep brain stimulation sweet spots and hyperdirect cortical connectivity in Parkinson's disease. Neuroimage 2017; 158:332-345. [PMID: 28711737 DOI: 10.1016/j.neuroimage.2017.07.012] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/05/2017] [Accepted: 07/09/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Firstly, to identify subthalamic region stimulation clusters that predict maximum improvement in rigidity, bradykinesia and tremor, or emergence of side-effects; and secondly, to map-out the cortical fingerprint, mediated by the hyperdirect pathways which predict maximum efficacy. METHODS High angular resolution diffusion imaging in twenty patients with advanced Parkinson's disease was acquired prior to bilateral subthalamic nucleus deep brain stimulation. All contacts were screened one-year from surgery for efficacy and side-effects at different amplitudes. Voxel-based statistical analysis of volumes of tissue activated models was used to identify significant treatment clusters. Probabilistic tractography was employed to identify cortical connectivity patterns associated with treatment efficacy. RESULTS All patients responded well to treatment (46% mean improvement off medication UPDRS-III [p < 0.0001]) without significant adverse events. Cluster corresponding to maximum improvement in tremor was in the posterior, superior and lateral portion of the nucleus. Clusters corresponding to improvement in bradykinesia and rigidity were nearer the superior border in a further medial and posterior location. The rigidity cluster extended beyond the superior border to the area of the zona incerta and Forel-H2 field. When the clusters where averaged, the coordinates of the area with maximum overall efficacy was X = -10(-9.5), Y = -13(-1) and Z = -7(-3) in MNI(AC-PC) space. Cortical connectivity to primary motor area was predictive of higher improvement in tremor; whilst that to supplementary motor area was predictive of improvement in bradykinesia and rigidity; and connectivity to prefrontal cortex was predictive of improvement in rigidity. INTERPRETATION These findings support the presence of overlapping stimulation sites within the subthalamic nucleus and its superior border, with different cortical connectivity patterns, associated with maximum improvement in tremor, rigidity and bradykinesia.
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Affiliation(s)
- Harith Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - Stamatios N Sotiropoulos
- Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford, OX3 9DU, UK; Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, UK
| | - Saad Jbabdi
- Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Dejan Georgiev
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Philipp Mahlknecht
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan Hyam
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Enrico De Vita
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK; Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Tim Behrens
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK; Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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Cakmak YO, Apaydin H, Kiziltan G, Gündüz A, Ozsoy B, Olcer S, Urey H, Cakmak OO, Ozdemir YG, Ertan S. Rapid Alleviation of Parkinson's Disease Symptoms via Electrostimulation of Intrinsic Auricular Muscle Zones. Front Hum Neurosci 2017; 11:338. [PMID: 28701941 PMCID: PMC5487461 DOI: 10.3389/fnhum.2017.00338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) and the pedunculopontine nucleus (PPN) significantly improve cardinal motor symptoms and postural instability and gait difficulty, respectively, in Parkinson's disease (PD). Objective and Hypothesis: Intrinsic auricular muscle zones (IAMZs) allow the potential to simultaneously stimulate the C2 spinal nerve, the trigeminal nerve, the facial nerve, and sympathetic and parasympathetic nerves in addition to providing muscle feedback and control areas including the STN, the PPN and mesencephalic locomotor regions. Our aim was to observe the clinical responses to IAMZ stimulation in PD patients. Method: Unilateral stimulation of an IAMZ, which includes muscle fibers for proprioception, the facial nerve, and C2, trigeminal and autonomic nerve fibers, at 130 Hz was performed in a placebo- and sham-controlled, double-blinded, within design, two-armed study of 24 PD patients. Results: The results of the first arm (10 patients) of the present study demonstrated a substantial improvement in Unified Parkinson's Disease Ratings Scale (UPDRS) motor scores due to 10 min of IAMZ electrostimulation (p = 0.0003, power: 0.99) compared to the placebo control (p = 0.130). A moderate to large clinical difference in the improvement in UPDRS motor scores was observed in the IAMZ electrostimulation group. The results of the second arm (14 patients) demonstrated significant improvements with dry needling (p = 0.011) and electrostimulation of the IAMZ (p < 0.001) but not with sham electrostimulation (p = 0.748). In addition, there was a significantly greater improvement in UPDRS motor scores in the IAMZ electrostimulation group compared to the IAMZ dry needling group (p < 0.001) and the sham electrostimulation (p < 0.001) groups. The improvement in UPDRS motor scores of the IAMZ electrostimulation group (ΔUPDRS = 5.29) reached moderate to high clinical significance, which was not the case for the dry needling group (ΔUPDRS = 1.54). In addition, both arms of the study demonstrated bilateral improvements in motor symptoms in response to unilateral IAMZ electrostimulation. Conclusion: The present study is the first demonstration of a potential role of IAMZ electrical stimulation in improving the clinical motor symptoms of PD patients in the short term.
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Affiliation(s)
- Yusuf O Cakmak
- Department of Anatomy, School of Medical Sciences, Otago UniversityDunedin, New Zealand
| | - Hülya Apaydin
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
| | - Güneş Kiziltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
| | - Burak Ozsoy
- Global Dynamic Systems (GDS) ARGE, Teknopark IstanbulIstanbul, Turkey
| | - Selim Olcer
- Department of Electrical Engineering, College of Engineering, Koç UniversityIstanbul, Turkey
| | - Hakan Urey
- Department of Electrical Engineering, College of Engineering, Koç UniversityIstanbul, Turkey
| | - Ozgur O Cakmak
- Department of Neurology, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Yasemin G Ozdemir
- Department of Neurology, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Sibel Ertan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul UniversityIstanbul, Turkey
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Lipski WJ, Wozny TA, Alhourani A, Kondylis ED, Turner RS, Crammond DJ, Richardson RM. Dynamics of human subthalamic neuron phase-locking to motor and sensory cortical oscillations during movement. J Neurophysiol 2017; 118:1472-1487. [PMID: 28592690 DOI: 10.1152/jn.00964.2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 01/19/2023] Open
Abstract
Coupled oscillatory activity recorded between sensorimotor regions of the basal ganglia-thalamocortical loop is thought to reflect information transfer relevant to movement. A neuronal firing-rate model of basal ganglia-thalamocortical circuitry, however, has dominated thinking about basal ganglia function for the past three decades, without knowledge of the relationship between basal ganglia single neuron firing and cortical population activity during movement itself. We recorded activity from 34 subthalamic nucleus (STN) neurons, simultaneously with cortical local field potentials and motor output, in 11 subjects with Parkinson's disease (PD) undergoing awake deep brain stimulator lead placement. STN firing demonstrated phase synchronization to both low- and high-beta-frequency cortical oscillations, and to the amplitude envelope of gamma oscillations, in motor cortex. We found that during movement, the magnitude of this synchronization was dynamically modulated in a phase-frequency-specific manner. Importantly, we found that phase synchronization was not correlated with changes in neuronal firing rate. Furthermore, we found that these relationships were not exclusive to motor cortex, because STN firing also demonstrated phase synchronization to both premotor and sensory cortex. The data indicate that models of basal ganglia function ultimately will need to account for the activity of populations of STN neurons that are bound in distinct functional networks with both motor and sensory cortices and code for movement parameters independent of changes in firing rate.NEW & NOTEWORTHY Current models of basal ganglia-thalamocortical networks do not adequately explain simple motor functions, let alone dysfunction in movement disorders. Our findings provide data that inform models of human basal ganglia function by demonstrating how movement is encoded by networks of subthalamic nucleus (STN) neurons via dynamic phase synchronization with cortex. The data also demonstrate, for the first time in humans, a mechanism through which the premotor and sensory cortices are functionally connected to the STN.
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Affiliation(s)
- Witold J Lipski
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ahmad Alhourani
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Efstathios D Kondylis
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert S Turner
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; and.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania
| | - Donald J Crammond
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; .,Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; and.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania
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Horn A, Neumann WJ, Degen K, Schneider GH, Kühn AA. Toward an electrophysiological "sweet spot" for deep brain stimulation in the subthalamic nucleus. Hum Brain Mapp 2017; 38:3377-3390. [PMID: 28390148 DOI: 10.1002/hbm.23594] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022] Open
Abstract
Enhanced beta-band activity recorded in patients suffering from Parkinson's Disease (PD) has been described as a potential physiomarker for disease severity. Beta power is suppressed by Levodopa intake and STN deep brain stimulation (DBS) and correlates with disease severity across patients. The aim of the present study was to explore the promising signature of the physiomarker in the spatial domain. Based on local field potential data acquired from 54 patients undergoing STN-DBS, power values within alpha, beta, low beta, and high beta bands were calculated. Values were projected into common stereotactic space after DBS lead localization. Recorded beta power values were significantly higher at posterior and dorsal lead positions, as well as in active compared with inactive pairs. The peak of activity in the beta band was situated within the sensorimotor functional zone of the nucleus. In contrast, higher alpha activity was found in a more ventromedial region, potentially corresponding to associative or premotor functional zones of the STN. Beta- and alpha-power peaks were then used as seeds in a fiber tracking experiment. Here, the beta-site received more input from primary motor cortex whereas the alpha-site was more strongly connected to premotor and prefrontal areas. The results summarize predominant spatial locations of frequency signatures recorded in STN-DBS patients in a probabilistic fashion. The site of predominant beta-activity may serve as an electrophysiologically determined target for optimal outcome in STN-DBS for PD in the future. Hum Brain Mapp 38:3377-3390, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - University Medicine, Berlin, D-10117, Germany.,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - University Medicine, Berlin, D-10117, Germany
| | - Katharina Degen
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - University Medicine, Berlin, D-10117, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine, Berlin, D-10117, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - University Medicine, Berlin, D-10117, Germany.,NeuroCure - Cluster of Excellence, Berlin, D-10117, Germany.,Berlin School of Mind and Brain, Berlin, D-10117, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, D-10117, Germany
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Garcia-Garcia D, Guridi J, Toledo JB, Alegre M, Obeso JA, Rodríguez-Oroz MC. Stimulation sites in the subthalamic nucleus and clinical improvement in Parkinson's disease: a new approach for active contact localization. J Neurosurg 2016; 125:1068-1079. [DOI: 10.3171/2015.9.jns15868] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is widely used in patients with Parkinson's disease (PD). However, which target area of this region results in the highest antiparkinsonian efficacy is still a matter of debate. The aim of this study was to develop a more accurate methodology to locate the electrodes and the contacts used for chronic stimulation (active contacts) in the subthalamic region, and to determine the position at which stimulation conveys the greatest clinical benefit.
METHODS
The study group comprised 40 patients with PD in whom bilateral DBS electrodes had been implanted in the STN. Based on the Morel atlas, the authors created an adaptable 3D atlas that takes into account individual anatomical variability and divides the STN into functional territories. The locations of the electrodes and active contacts were obtained from an accurate volumetric assessment of the artifact using preoperative and postoperative MR images. Active contacts were positioned in the 3D atlas using stereotactic coordinates and a new volumetric method based on an ellipsoid representation created from all voxels that belong to a set of contacts. The antiparkinsonian benefit of the stimulation was evaluated by the reduction in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score and in the levodopa equivalent daily dose (LEDD) at 6 months. A homogeneous group classification for contact position and the respective clinical improvement was applied using a hierarchical clustering method.
RESULTS
Subthalamic stimulation induced a significant reduction of 58.0% ± 16.5% in the UPDRS-III score (p < 0.001) and 64.9% ± 21.0% in the LEDD (p < 0.001). The greatest reductions in the total and contralateral UPDRS-III scores (64% and 76%, respectively) and in the LEDD (73%) were obtained when the active contacts were placed approximately 12 mm lateral to the midline, with no influence of the position being observed in the anteroposterior and dorsoventral axes. In contrast, contacts located about 10 mm from the midline only reduced the global and contralateral UPDRS-III scores by 47% and 41%, respectively, and the LEDD by 33%. Using the ellipsoid method of location, active contacts with the highest benefit were positioned in the rostral and most lateral portion of the STN and at the interface between this subthalamic region, the zona incerta, and the thalamic fasciculus. Contacts placed in the most medial regions of the motor STN area provided the lowest clinical efficacy.
CONCLUSIONS
The authors report an accurate new methodology to assess the position of electrodes and contacts used for chronic subthalamic stimulation. Using this approach, the highest antiparkinsonian benefit is achieved when active contacts are located within the rostral and the most lateral parts of the motor region of the STN and at the interface of this region and adjacent areas (zona incerta and thalamic fasciculus).
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Affiliation(s)
- David Garcia-Garcia
- 1Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clínica Universidad de Navarra Medical School, Pamplona
- 2Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); and
| | - Jorge Guridi
- 1Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clínica Universidad de Navarra Medical School, Pamplona
- 2Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); and
| | - Jon B. Toledo
- 1Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clínica Universidad de Navarra Medical School, Pamplona
| | - Manuel Alegre
- 1Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clínica Universidad de Navarra Medical School, Pamplona
| | - José A. Obeso
- 1Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clínica Universidad de Navarra Medical School, Pamplona
- 2Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); and
| | - María C. Rodríguez-Oroz
- 1Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clínica Universidad de Navarra Medical School, Pamplona
- 2Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); and
- 3Neuroscience Unit, BioDonostia Research Institute, University Hospital Donostia, Basque Center on Cognition, Brain and Language (BCBL), San Sebastián; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
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Effect of subthalamic stimulation on distal and proximal upper limb movements in Parkinson's disease. Brain Res 2016; 1648:438-444. [PMID: 27543337 DOI: 10.1016/j.brainres.2016.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 07/17/2016] [Accepted: 08/15/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A different innervation pattern of proximal and distal muscles from the contra- and ipsilateral motor circuits raises the question as to whether bilateral, contra- and ipsilateral subthalamic stimulation may have different effects on the distal and proximal movements of the upper limb. To answer this question, we performed kinematic analyzes in patients with Parkinson's disease. METHODS Twenty-eight Parkinsonian patients treated by bilateral subthalamic stimulation were examined with an age-matched control group of 28 healthy subjects. They performed 14s of finger tapping, hand grasping and pronation-supination. The patient group performed these sessions in four conditions (BOTH ON, BOTH OFF, CONTRA ON, IPSI ON) after withdrawal of dopaminergic medication for 12h and a fifth condition after taking medication (BOTH ON-MED ON). A motion sensor with a three-dimensional gyroscope was worn on the index finger. Speed, amplitude, rhythm and decrement of movements were calculated and compared across these conditions. RESULTS Speed and amplitude of the more distal movements were improved similarly by contra- and bilateral stimulation. Bilateral stimulation was more effective than contralateral stimulation for the more proximal movements. Contra- and bilateral stimulation ameliorated the rhythm similarly in each movement task. Decrement of distal and proximal movements was not affected by the stimulation conditions. CONCLUSION This is the first study to show that the outcome of bi- and unilateral subthalamic stimulation on proximal and distal upper limb movements should be evaluated separately postulating the different somatotopic organization of subloops in the cortico-basal ganglia motor circuits.
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Leunissen I, Coxon JP, Swinnen SP. A proactive task set influences how response inhibition is implemented in the basal ganglia. Hum Brain Mapp 2016; 37:4706-4717. [PMID: 27489078 DOI: 10.1002/hbm.23338] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 06/25/2016] [Accepted: 07/26/2016] [Indexed: 01/02/2023] Open
Abstract
Increasing a participant's ability to prepare for response inhibition is known to result in longer Go response times and is thought to engage a "top-down fronto-striatal inhibitory task set." This premise is supported by the observation of anterior striatum activation in functional magnetic resonance imaging (fMRI) analyses that focus on uncertain versus certain Go trials. It is assumed that setting up a proactive inhibitory task set also influences how participants subsequently implement stopping. To assess this assumption, we aimed to manipulate the degree of proactive inhibition in a modified stop-signal task to see how this manipulation influences activation when reacting to the Stop cue. Specifically, we tested whether there is differential activity of basal ganglia nuclei, namely the subthalamic nucleus (STN) and anterior striatum, on Stop trials when stop-signal probability was relatively low (20%) or high (40%). Successful stopping was associated with increased STN activity when Stop trials were infrequent and increased caudate head activation when Stop trials were more likely, suggesting a different implementation of reactive response inhibition by the basal ganglia for differing degrees of proactive response control. Hum Brain Mapp 37:4706-4717, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Inge Leunissen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Leuven, Belgium
| | - James P Coxon
- Movement Neuroscience Laboratory, University of Auckland, New Zealand.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Stephan P Swinnen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Leuven, Belgium.,Leuven Research Institute for Neuroscience & Disease (LIND), Leuven, Belgium
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Petersen MV, Lund TE, Sunde N, Frandsen J, Rosendal F, Juul N, Østergaard K. Probabilistic versus deterministic tractography for delineation of the cortico-subthalamic hyperdirect pathway in patients with Parkinson disease selected for deep brain stimulation. J Neurosurg 2016; 126:1657-1668. [PMID: 27392264 DOI: 10.3171/2016.4.jns1624] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Diffusion-weighted MRI (DWI) and tractography allows noninvasive mapping of the structural connections of the brain, and may provide important information for neurosurgical planning. The hyperdirect pathway, connecting the subthalamic nucleus (STN) with the motor cortex, is assumed to play a key role in mediating the effects of deep brain stimulation (DBS), which is an effective but poorly understood treatment for Parkinson disease. This study aimed to apply recent methodological advances in DWI acquisition and analysis to the delineation of the hyperdirect pathway in patients with Parkinson disease selected for surgery. METHODS High spatial and angular resolution DWI data were acquired preoperatively from 5 patients with Parkinson disease undergoing DBS. The authors compared the delineated hyperdirect pathways and associated STN target maps generated by 2 different tractography methods: a tensor-based deterministic method, typically available in clinical settings, and an advanced probabilistic method based on constrained spherical deconvolution. In addition, 10 high-resolution data sets with the same scanning parameters were acquired from a healthy control participant to assess the robustness of the tractography results. RESULTS Both tractography approaches identified connections between the ipsilateral motor cortex and the STN. However, the 2 methods provided substantially different target regions in the STN, with the target center of gravity differing by > 1.4 mm on average. The probabilistic method (based on constrained spherical deconvolution) plausibly reconstructed a continuous set of connections from the motor cortex, terminating in the dorsolateral region of the STN. In contrast, the tensor-based method reconstructed a comparatively sparser and more variable subset of connections. Furthermore, across the control scans, the probabilistic method identified considerably more consistent targeting regions within the STN compared with the deterministic tensor-based method, which demonstrated a 1.9-2.4 times higher variation. CONCLUSIONS These data provide a strong impetus for the use of a robust probabilistic tractography framework based on constrained spherical deconvolution, or similar advanced DWI models, in clinical settings. The inherent limitations and demonstrated inaccuracy of the tensor-based method leave it questionable for use in high-precision stereotactic DBS surgery. The authors have also described a straightforward method for importing tractography-derived information into any clinical neuronavigation system, based on the generation of track-density images.
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Affiliation(s)
- Mikkel V Petersen
- Center of Functionally Integrative Neuroscience and.,Departments of 2 Neurosurgery
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Subthalamic nucleus deep brain stimulation induces impulsive action when patients with Parkinson's disease act under speed pressure. Exp Brain Res 2016; 234:1837-1848. [PMID: 26892884 PMCID: PMC4893074 DOI: 10.1007/s00221-016-4577-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/28/2016] [Indexed: 12/19/2022]
Abstract
The subthalamic nucleus (STN) is proposed to modulate response thresholds and speed–accuracy trade-offs. In situations of conflict, the STN is considered to raise response thresholds, allowing time for the accumulation of information to occur before a response is selected. Conversely, speed pressure is thought to reduce the activity of the STN and lower response thresholds, resulting in fast, errorful responses. In Parkinson’s disease (PD), subthalamic nucleus deep brain stimulation (STN-DBS) reduces the activity of the nucleus and improves motor symptoms. We predicted that the combined effects of STN stimulation and speed pressure would lower STN activity and lead to fast, errorful responses, hence resulting in impulsive action. We used the motion discrimination ‘moving-dots’ task to assess speed–accuracy trade-offs, under both speed and accuracy instructions. We assessed 12 patients with PD and bilateral STN-DBS and 12 age-matched healthy controls. Participants completed the task twice, and the patients completed it once with STN-DBS on and once with STN-DBS off, with order counterbalanced. We found that STN stimulation was associated with significantly faster reaction times but more errors under speed instructions. Application of the drift diffusion model showed that stimulation resulted in lower response thresholds when acting under speed pressure. These findings support the involvement of the STN in the modulation of speed–accuracy trade-offs and establish for the first time that speed pressure alone, even in the absence of conflict, can result in STN stimulation inducing impulsive action in PD.
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Ishida H, Inoue KI, Takada M, Hoshi E. Origins of multisynaptic projections from the basal ganglia to the forelimb region of the ventral premotor cortex in macaque monkeys. Eur J Neurosci 2015; 43:258-69. [PMID: 26547510 DOI: 10.1111/ejn.13127] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/01/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022]
Abstract
The ventral premotor cortex (PMv), occupying the ventral aspect of area 6 in the frontal lobe, has been implicated in action planning and execution based on visual signals. Although the PMv has been characterized by cortico-cortical connections with specific subregions of the parietal and prefrontal cortical areas, a topographical input/output organization between the PMv and the basal ganglia (BG) still remains elusive. In the present study, retrograde transneuronal labelling with the rabies virus was employed to identify the origins of multisynaptic projections from the BG to the PMv. The virus was injected into the forelimb region of the PMv, identified in the ventral aspect of the genu of the arcuate sulcus, in macaque monkeys. The survival time after the virus injection was set to allow either the second- or third-order neuron labelling across two or three synapses. The second-order neurons were observed in the ventral portion (primary motor territory) and the caudodorsal portion (higher-order motor territory) of the internal segment of the globus pallidus. Subsequently, the third-order neurons were distributed in the putamen caudal to the anterior commissure, including both the primary and the higher-order motor territories, and in the ventral striatum (limbic territory). In addition, they were found in the dorsolateral portion (motor territory) and ventromedial portion (limbic territory) of the subthalamic nucleus, and in the external segment of the globus pallidus including both the limbic and motor territories. These findings indicate that the PMv receives diverse signals from the primary motor, higher-order motor and limbic territories of the BG.
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Affiliation(s)
- Hiroaki Ishida
- Frontal Lobe Function Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, 156-8506, Japan
| | - Ken-ichi Inoue
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Aichi, 484-8506, Japan
| | - Masahiko Takada
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Aichi, 484-8506, Japan
| | - Eiji Hoshi
- Frontal Lobe Function Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, 156-8506, Japan
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Herrington TM, Cheng JJ, Eskandar EN. Mechanisms of deep brain stimulation. J Neurophysiol 2015; 115:19-38. [PMID: 26510756 DOI: 10.1152/jn.00281.2015] [Citation(s) in RCA: 273] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/22/2015] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) is widely used for the treatment of movement disorders including Parkinson's disease, essential tremor, and dystonia and, to a lesser extent, certain treatment-resistant neuropsychiatric disorders including obsessive-compulsive disorder. Rather than a single unifying mechanism, DBS likely acts via several, nonexclusive mechanisms including local and network-wide electrical and neurochemical effects of stimulation, modulation of oscillatory activity, synaptic plasticity, and, potentially, neuroprotection and neurogenesis. These different mechanisms vary in importance depending on the condition being treated and the target being stimulated. Here we review each of these in turn and illustrate how an understanding of these mechanisms is inspiring next-generation approaches to DBS.
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Affiliation(s)
- Todd M Herrington
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Jennifer J Cheng
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Emad N Eskandar
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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