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Rurak BK, Tan J, Rodrigues JP, Power BD, Drummond PD, Vallence AM. Cortico-cortical connectivity is influenced by levodopa in tremor-dominant Parkinson's disease. Neurobiol Dis 2024; 196:106518. [PMID: 38679112 DOI: 10.1016/j.nbd.2024.106518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/09/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
Resting tremor is the most common presenting motor symptom in Parkinson's disease (PD). The supplementary motor area (SMA) is a main target of the basal-ganglia-thalamo-cortical circuit and has direct, facilitatory connections with the primary motor cortex (M1), which is important for the execution of voluntary movement. Dopamine potentially modulates SMA and M1 activity, and both regions have been implicated in resting tremor. This study investigated SMA-M1 connectivity in individuals with PD ON and OFF dopamine medication, and whether SMA-M1 connectivity is implicated in resting tremor. Dual-site transcranial magnetic stimulation was used to measure SMA-M1 connectivity in PD participants ON and OFF levodopa. Resting tremor was measured using electromyography and accelerometry. Stimulating SMA inhibited M1 excitability OFF levodopa, and facilitated M1 excitability ON levodopa. ON medication, SMA-M1 facilitation was significantly associated with smaller tremor than SMA-M1 inhibition. The current findings contribute to our understanding of the neural networks involved in PD which are altered by levodopa medication and provide a neurophysiological basis for the development of interventions to treat resting tremor.
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Affiliation(s)
- B K Rurak
- Discipline of Psychology, College of Science, Health, Engineering and Education, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia
| | - J Tan
- Discipline of Psychology, College of Science, Health, Engineering and Education, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia
| | - J P Rodrigues
- Hollywood Private Hospital, Western Australia, Australia
| | - B D Power
- Hollywood Private Hospital, Western Australia, Australia; School of Medicine Fremantle, University of Notre Dame, Western Australia, Australia
| | - P D Drummond
- Discipline of Psychology, College of Science, Health, Engineering and Education, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia
| | - A M Vallence
- Discipline of Psychology, College of Science, Health, Engineering and Education, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Western Australia, Australia.
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2
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Sadeghi F, Pötter-Nerger M, Grimm K, Gerloff C, Schulz R, Zittel S. Smaller Cerebellar Lobule VIIb is Associated with Tremor Severity in Parkinson's Disease. CEREBELLUM (LONDON, ENGLAND) 2024; 23:355-362. [PMID: 36802020 PMCID: PMC10950956 DOI: 10.1007/s12311-023-01532-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Abstract
Alterations in the cerebellum's morphology in Parkinson's disease (PD) point to its pathophysiological involvement in this movement disorder. Such abnormalities have previously been attributed to different PD motor subtypes. The aim of the study was to relate volumes of specific cerebellar lobules to motor symptom severity, in particular tremor (TR), bradykinesia/rigidity (BR), and postural instability and gait disorders (PIGD) in PD. We performed a volumetric analysis based on T1-weighted MRI images of 55 participants with PD (22 females, median age 65 years, Hoehn and Yahr stage 2). Multiple regression models were fitted to investigate associations between volumes of cerebellar lobules with clinical symptom severity based on MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score and sub-scores for TR, BR, and PIGD; adjusted for age, sex, disease duration, and intercranial volume as cofactors. Smaller volume of lobule VIIb was associated with higher tremor severity (P = 0.004). No structure-function relationships were detected for other lobules or other motor symptoms. This distinct structural association denotes the involvement of the cerebellum in PD tremor. Characterizing morphological features of the cerebellum leads to a better understanding of its role in the spectrum of motor symptoms in PD and contributes further to identifying potential biological markers.
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Affiliation(s)
- Fatemeh Sadeghi
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Monika Pötter-Nerger
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kai Grimm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Robert Schulz
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Zittel
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany.
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Nakamura M, Isono O, Nasu T, Hinuma Y, Nakamura N. [Resting tremor of Parkinson's disease changing into Holmes' tremor by cerebellar hemorrhage: an examination of the pathophysiological mechanism of tremor]. Rinsho Shinkeigaku 2024; 64:185-189. [PMID: 38382934 DOI: 10.5692/clinicalneurol.cn-001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
A 71-year-old male who suffered from Hoehn and Yahr stage III Parkinson's disease with bradykinesia, rigidity and a 5-6-Hz tremor at rest in the right extremities was admitted to our hospital due to the sudden onset of vertigo. Right cerebellar hemorrhage was confirmed by CT. The patient's resting tremor in the right extremities disappeared immediately following the cerebellar hemorrhage. Six days later, MRI showed Wallerian degeneration in the cerebello-rubro-thalamic tract. Approximately 5 months later, a 2-3-Hz Holmes' tremor gradually appeared in the right upper extremity. This tremor was improved by increasing L-dopa doses. Case reports of the disappearance of Parkinson's resting tremor and subsequent emergence of Holmes' tremor due to cerebellar lesion are rare. Furthermore, the Wallerian degeneration of the cerebello-rubro-thalamic tract identified on MRI between tremors of the different frequencies is very rare. We hypothesize that the cause of the tremor frequency change was simultaneous damage to the nigro-striatal network and the cerebello-thalamo-cerebral network.
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Affiliation(s)
| | - Osamu Isono
- Department of Neurology, Kyoto Min-iren Asukai Hospital
| | - Tetsuya Nasu
- Department of Neurology, Kyoto Min-iren Asukai Hospital
| | - Yuji Hinuma
- Department of Neurology, Kyoto Min-iren Asukai Hospital
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Dumican M, Harper K, Stankiewicz J. The Effect of Oropharyngeal Resting Tremor on Swallowing Function in a Clinical Cohort of People with Parkinson's Disease. Dysphagia 2024:10.1007/s00455-024-10688-0. [PMID: 38512437 DOI: 10.1007/s00455-024-10688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
Parkinson's Disease (PD) is a progressive neurodegenerative disease, with hallmark symptomology typically consisting of tremor, bradykinesia, and rigidity. Though the classic "pill-rolling" rest tremor in the hand or upper limb are often the most salient, it can occur throughout the body including the lower limbs, jaw, face, or tongue. There have been investigations into other motor related phenomena potentially affecting swallow function in PwPD previously. However, there have been no investigations of how oropharyngeal resting tremor in structures such as the tongue or larynx explicitly affects swallowing physiology. A retrospective analysis of previously conducted VFSS on 34 patients diagnosed with idiopathic PD (IPD) was performed to examine how individuals that displayed resting tremor during VFSS (Tremor +) and those who did not (Tremor-) differ in swallowing function. Measures of swallowing function including timing intervals of key swallow events, post-swallow residue, and penetration-aspiration scale (PAS) scores were recorded, and key demographic information including time since diagnosis and medication status were extracted from the medical records available. Multivariate models were used to identify differences between tremor groups for timing intervals and post-swallow residue, and chi-squares were computed for differences in PAS score distribution by group and bolus. Sixty-eight percent (23/34) of this sample displayed oropharyngeal resting tremor in at least one structure during VFSS. There were no instances of other tremor types observed in this sample. All participants were taking medication to manage PD symptomology. Significant effects of tremor group were observed for swallow timing intervals related to airway closure (p < 0.001), post-swallow residue (p < 0.05), and swallow safety at the bolus level in the Tremor + group (p < 0.001). These results suggest that PwPD who present with resting tremor in oropharyngeal structures may manifest with different variations in swallowing physiology, including altered timings of swallow events, increased pharyngeal residue, and greater associations of airway invasion with thinner and larger volume boluses. This study highlights the need for substantially more research into how motor fluctuations and phenotypes of PwPD contribute to alterations in swallowing function.
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Affiliation(s)
- Matthew Dumican
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Services, Western Michigan University, 1200 Oakland Dr., Kalamazoo, MI, 49008, USA.
| | - Kaitlynn Harper
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Services, Western Michigan University, 1200 Oakland Dr., Kalamazoo, MI, 49008, USA
| | - Julia Stankiewicz
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Services, Western Michigan University, 1200 Oakland Dr., Kalamazoo, MI, 49008, USA
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Liu B, Xu J, Feng Z, Hui R, Zhang Y, Liu D, Chang Q, Yu X, Mao Z. One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson's disease. Front Aging Neurosci 2023; 15:1289183. [PMID: 38187361 PMCID: PMC10768017 DOI: 10.3389/fnagi.2023.1289183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Tremor-dominant Parkinson's disease (TD-PD) can be further separated into levodopa-responsive and levodopa-resistant types, the latter being considered to have a different pathogenesis. Previous studies indicated that deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus internus (GPi) individually was not sufficient for tremor control, especially for the levodopa-resistant TD-PD (LRTD-PD). The thalamic ventral intermediate nucleus (VIM) has been regarded as a potent DBS target for different kinds of tremors. Therefore, we focused on the LRTD-PD subgroup and performed one-pass combined DBSs of STN and VIM to treat refractory tremors, aiming to investigate the safety and effectiveness of this one-trajectory dual-target DBS scheme. Methods We retrospectively collected five LRTD-PD patients who underwent a one-pass combined DBS of STN and VIM via a trans-frontal approach. The targeting of VIM was achieved by probabilistic tractography. Changes in severity of symptoms (measured by the Unified Parkinson Disease Rating Scale part III, UPDRS-III), levodopa equivalent daily doses (LEDD), and disease-specific quality of life (measured by the 39-item Parkinson's Disease Questionnaire, PDQ-39) were evaluated. Results Three-dimensional reconstruction of electrodes illustrated that all leads were successfully implanted into predefined positions. The mean improvement rates (%) were 53 ± 6.2 (UPDRS-III), 82.6 ± 11.4 (tremor-related items of UPDRS), and 52.1 ± 11.4 (PDQ-39), respectively, with a mean follow-up of 11.4 months. Conclusion One-pass combined DBS of STN and VIM via the trans-frontal approach is an effective and safe strategy to alleviate symptoms for LRTD-PD patients.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhebin Feng
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rui Hui
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Chang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Angelini L, Terranova R, Lazzeri G, van den Berg KRE, Dirkx MF, Paparella G. The role of laboratory investigations in the classification of tremors. Neurol Sci 2023; 44:4183-4192. [PMID: 37814130 PMCID: PMC10641063 DOI: 10.1007/s10072-023-07108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Tremor is the most common movement disorder. Although clinical examination plays a significant role in evaluating patients with tremor, laboratory tests are useful to classify tremors according to the recent two-axis approach proposed by the International Parkinson and Movement Disorders Society. METHODS In the present review, we will discuss the usefulness and applicability of the various diagnostic methods in classifying and diagnosing tremors. We will evaluate a number of techniques, including laboratory and genetic tests, neurophysiology, and neuroimaging. The role of newly introduced innovative tremor assessment methods will also be discussed. RESULTS Neurophysiology plays a crucial role in tremor definition and classification, and it can be useful for the identification of specific tremor syndromes. Laboratory and genetic tests and neuroimaging may be of paramount importance in identifying specific etiologies. Highly promising innovative technologies are being developed for both clinical and research purposes. CONCLUSIONS Overall, laboratory investigations may support clinicians in the diagnostic process of tremor. Also, combining data from different techniques can help improve understanding of the pathophysiological bases underlying tremors and guide therapeutic management.
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Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
| | - Roberta Terranova
- Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giulia Lazzeri
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Kevin R E van den Berg
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michiel F Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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7
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Kerestes R, Laansma MA, Owens-Walton C, Perry A, van Heese EM, Al-Bachari S, Anderson TJ, Assogna F, Aventurato ÍK, van Balkom TD, Berendse HW, van den Berg KR, Mphys RB, Brioschi R, Carr J, Cendes F, Clark LR, Dalrymple-Alford JC, Dirkx MF, Druzgal J, Durrant H, Emsley HC, Garraux G, Haroon HA, Helmich RC, van den Heuvel OA, João RB, Johansson ME, Khachatryan S, Lochner C, McMillan CT, Melzer TR, Mosley P, Newman B, Opriessnig P, Parkes LM, Pellicano C, Piras F, Pitcher TL, Poston KL, Rango M, Roos A, Rummel C, Schmidt R, Schwingenschuh P, Silva LS, Smith V, Squarcina L, Stein DJ, Tavadyan Z, Tsai CC, Vecchio D, Vriend C, Wang JJ, Wiest R, Yasuda CL, Young CB, Jahanshad N, Thompson PM, van der Werf YD, Harding IH. Cerebellar Volume and Disease Staging in Parkinson's Disease: An ENIGMA-PD Study. Mov Disord 2023; 38:2269-2281. [PMID: 37964373 PMCID: PMC10754393 DOI: 10.1002/mds.29611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Increasing evidence points to a pathophysiological role for the cerebellum in Parkinson's disease (PD). However, regional cerebellar changes associated with motor and non-motor functioning remain to be elucidated. OBJECTIVE To quantify cross-sectional regional cerebellar lobule volumes using three dimensional T1-weighted anatomical brain magnetic resonance imaging from the global ENIGMA-PD working group. METHODS Cerebellar parcellation was performed using a deep learning-based approach from 2487 people with PD and 1212 age and sex-matched controls across 22 sites. Linear mixed effects models compared total and regional cerebellar volume in people with PD at each Hoehn and Yahr (HY) disease stage, to an age- and sex- matched control group. Associations with motor symptom severity and Montreal Cognitive Assessment scores were investigated. RESULTS Overall, people with PD had a regionally smaller posterior lobe (dmax = -0.15). HY stage-specific analyses revealed a larger anterior lobule V bilaterally (dmax = 0.28) in people with PD in HY stage 1 compared to controls. In contrast, smaller bilateral lobule VII volume in the posterior lobe was observed in HY stages 3, 4, and 5 (dmax = -0.76), which was incrementally lower with higher disease stage. Within PD, cognitively impaired individuals had lower total cerebellar volume compared to cognitively normal individuals (d = -0.17). CONCLUSIONS We provide evidence of a dissociation between anterior "motor" lobe and posterior "non-motor" lobe cerebellar regions in PD. Whereas less severe stages of the disease are associated with larger motor lobe regions, more severe stages of the disease are marked by smaller non-motor regions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Max A. Laansma
- Amsterdam UMC, Dept. Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Conor Owens-Walton
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Andrew Perry
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
| | - Eva M. van Heese
- Amsterdam UMC, Dept. Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Sarah Al-Bachari
- Faculty of Health and Medicine, The University of Lancaster, Lancaster, UK
| | - Tim J. Anderson
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Neurology Department, Te Wahtu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zew Zealand
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Ítalo K. Aventurato
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Tim D. van Balkom
- Amsterdam UMC, Dept. Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
- Amsterdam UMC, Dept. Psychiatry, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henk W. Berendse
- Amsterdam UMC, Dept. Neurology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kevin R.E. van den Berg
- Department of Neurology and Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Rebecca Betts Mphys
- School of Physics and Astronomy, Faculty of Science and Engineering, The University of Manchester, Manchester, UK
| | - Ricardo Brioschi
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
| | - Jonathan Carr
- Division of Neurology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Fernando Cendes
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Lyles R. Clark
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John C. Dalrymple-Alford
- New Zealand Brain Research Institute, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Michiel F. Dirkx
- Department of Neurology and Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, USA
| | - Helena Durrant
- School of Physics and Astronomy, Faculty of Science and Engineering, The University of Manchester, Manchester, UK
| | - Hedley C.A. Emsley
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gaëtan Garraux
- GIGA-CRC in vivo imaging, University of Liège, Belgium
- Department of Neurology, CHU Liège, Liège, Belgium
| | - Hamied A. Haroon
- Division of Psychology, Communication & Human Neuroscience, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rick C. Helmich
- Department of Neurology and Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Odile A. van den Heuvel
- Amsterdam UMC, Dept. Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
- Amsterdam UMC, Dept. Psychiatry, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rafael B. João
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Martin E. Johansson
- Department of Neurology and Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
- Centers for Sleep and Movement Disorders, Somnus Neurology Clinic, Yerevan, Armenia
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Corey T. McMillan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tracy R. Melzer
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Philip Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- The Australian eHealth Research Centre, CSIRO Health and Biosecurity, Brisbane, Queensland, Australia
| | - Benjamin Newman
- Department of Radiology and Medical Imaging, University of Virginia, USA
| | - Peter Opriessnig
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | - Laura M. Parkes
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Clelia Pellicano
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Toni L. Pitcher
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Kathleen L. Poston
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Mario Rango
- Excellence Center for Advanced MR Techniques and Parkinson’s Disease Center, Neurology unit, Fondazione IRCCS Cà Granda Maggiore Policlinico Hospital, University of Milan, Milan, Italy
- Dept of Neurosciences, Neurology Unit, Fondazione Ca’ Granda, IRCCS, Ospedale Policlinico, Univeristy of Milan, Milano, Italy
| | - Annerine Roos
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christian Rummel
- Support Center for Advanced Neuroimaging, (SCAN) University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Lucas S. Silva
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Viktorija Smith
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Letizia Squarcina
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Zaruhi Tavadyan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
- Centers for Sleep and Movement Disorders, Somnus Neurology Clinic, Yerevan, Armenia
| | - Chih-Chien Tsai
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Chris Vriend
- Amsterdam UMC, Dept. Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, Dept. Psychiatry, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, the Netherlands
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan City, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung Branch Keelung City, Taiwan
- Healthy Ageing Research Center, ChangGung University, Taiwan
- Department of Chemical Engineering, Ming-Chi University of Technology, New Taipei City, Taiwan
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, (SCAN) University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Clarissa L. Yasuda
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Christina B. Young
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Ysbrand D. van der Werf
- Amsterdam UMC, Dept. Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Ian H. Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
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8
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Li T, Le W, Jankovic J. Linking the cerebellum to Parkinson disease: an update. Nat Rev Neurol 2023; 19:645-654. [PMID: 37752351 DOI: 10.1038/s41582-023-00874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
Parkinson disease (PD) is characterized by heterogeneous motor and non-motor symptoms, resulting from neurodegeneration involving various parts of the central nervous system. Although PD pathology predominantly involves the nigral-striatal system, growing evidence suggests that pathological changes extend beyond the basal ganglia into other parts of the brain, including the cerebellum. In addition to a primary involvement in motor control, the cerebellum is now known to also have an important role in cognitive, sleep and affective processes. Over the past decade, an accumulating body of research has provided clinical, pathological, neurophysiological, structural and functional neuroimaging findings that clearly establish a link between the cerebellum and PD. This Review presents an overview and update on the involvement of the cerebellum in the clinical features and pathogenesis of PD, which could provide a novel framework for a better understanding the heterogeneity of the disease.
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Affiliation(s)
- Tianbai Li
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.
- Institute of Neurology, Sichuan Academy of Medical Sciences, Sichuan Provincial Hospital, Chengdu, China.
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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9
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Wirth T, Ferreira F, Vijiaratnam N, Girges C, Pakzad A, de Roquemaurel A, Sinani O, Hyam J, Hariz M, Zrinzo L, Akram H, Limousin P, Foltynie T. Parkinson's Disease Tremor Differentially Responds to Levodopa and Subthalamic Stimulation. Mov Disord Clin Pract 2023; 10:1639-1649. [PMID: 37982119 PMCID: PMC10654834 DOI: 10.1002/mdc3.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 11/21/2023] Open
Abstract
Background Tremor in Parkinson's disease (PD) has an inconsistent response to levodopa and subthalamic deep brain stimulation (STN-DBS). Objectives To identify predictive factors of PD tremor responsiveness to levodopa and STN-DBS. Material and Methods PD patients with upper limb tremor who underwent STN-DBS were included. The levodopa responsiveness of tremor (overall, postural, and rest sub-components), was assessed using the relevant Unified Parkinson's Disease Rating Scale-III items performed during the preoperative assessment. Post-surgical outcomes were similarly assessed ON and OFF stimulation. A score for the rest/postural tremor ratio was used to determine the influence of rest and postural tremor severity on STN-DBS outcome. Factors predictive of tremor responsiveness were determined using multiple linear regression modeling. Volume of tissue activated measurement coupled to voxel-based analysis was performed to identify anatomical clusters associated with motor symptoms improvement. Results One hundred and sixty five patients were included in this study. Male gender was negatively correlated with tremor responsiveness to levodopa, whereas the ratio of rest/postural tremor was positively correlated with both levodopa responsiveness and STN-DBS tremor outcome. Clusters corresponding to improvement of tremor were in the subthalamic nucleus, the zona incerta and the thalamus, whereas clusters corresponding to improvement for akinesia and rigidity were located within the subthalamic nucleus. Conclusion More severe postural tremor and less severe rest tremor were associated with both poorer levodopa and STN-DBS response. The different locations of clusters associated with best correction of tremor and other parkinsonian features suggest that STN-DBS effect on PD symptoms is underpinned by the modulation of different networks.
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Affiliation(s)
- Thomas Wirth
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Neurology DepartmentStrasbourg University HospitalStrasbourgFrance
- Institute of Genetics and Cellular and Molecular BiologyINSERM‐U964, CNRS‐UMR7104, University of StrasbourgStrasbourgFrance
- Strasbourg Translational Medicine FederationUniversity of StrasbourgStrasbourgFrance
| | - Francisca Ferreira
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Wellcome Centre for Human NeuroimagingLondonUnited Kingdom
| | - Nirosen Vijiaratnam
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Christine Girges
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Ashkan Pakzad
- EPSRC Centre for Doctoral Training i4healthUniversity College LondonLondonUnited Kingdom
| | - Alexis de Roquemaurel
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Olga Sinani
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Jonathan Hyam
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Marwan Hariz
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Department of Clinical Science, NeuroscienceUmeå UniversityUmeåSweden
| | - Ludvic Zrinzo
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Harith Akram
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
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10
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Pozzi NG, Bolzoni F, Biella GEM, Pezzoli G, Ip CW, Volkmann J, Cavallari P, Asan E, Isaias IU. Brain Noradrenergic Innervation Supports the Development of Parkinson's Tremor: A Study in a Reserpinized Rat Model. Cells 2023; 12:2529. [PMID: 37947607 PMCID: PMC10649099 DOI: 10.3390/cells12212529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
The pathophysiology of tremor in Parkinson's disease (PD) is evolving towards a complex alteration to monoaminergic innervation, and increasing evidence suggests a key role of the locus coeruleus noradrenergic system (LC-NA). However, the difficulties in imaging LC-NA in patients challenge its direct investigation. To this end, we studied the development of tremor in a reserpinized rat model of PD, with or without a selective lesioning of LC-NA innervation with the neurotoxin DSP-4. Eight male rats (Sprague Dawley) received DSP-4 (50 mg/kg) two weeks prior to reserpine injection (10 mg/kg) (DR-group), while seven male animals received only reserpine treatment (R-group). Tremor, rigidity, hypokinesia, postural flexion and postural immobility were scored before and after 20, 40, 60, 80, 120 and 180 min of reserpine injection. Tremor was assessed visually and with accelerometers. The injection of DSP-4 induced a severe reduction in LC-NA terminal axons (DR-group: 0.024 ± 0.01 vs. R-group: 0.27 ± 0.04 axons/um2, p < 0.001) and was associated with significantly less tremor, as compared to the R-group (peak tremor score, DR-group: 0.5 ± 0.8 vs. R-group: 1.6 ± 0.5; p < 0.01). Kinematic measurement confirmed the clinical data (tremor consistency (% of tremor during 180 s recording), DR-group: 37.9 ± 35.8 vs. R-group: 69.3 ± 29.6; p < 0.05). Akinetic-rigid symptoms did not differ between the DR- and R-groups. Our results provide preliminary causal evidence for a critical role of LC-NA innervation in the development of PD tremor and foster the development of targeted therapies for PD patients.
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Affiliation(s)
- Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
| | - Francesco Bolzoni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy;
| | | | - Gianni Pezzoli
- Centro Parkinson e Parkinsonismi, ASST G. Pini-CTO, 20072 Milano, Italy;
| | - Chi Wang Ip
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
| | - Paolo Cavallari
- Department of Pathophysiology and Transplantation, Human Physiology Section, Università degli Studi di Milano, via Mangiagalli 32, 20133 Milano, Italy;
| | - Esther Asan
- Institute of Anatomy and Cell Biology, Julius-Maximilians-Universität Würzburg, Koellikerstr 6, 97070 Würzburg, Germany;
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; (N.G.P.); (C.W.I.); (J.V.)
- Centro Parkinson e Parkinsonismi, ASST G. Pini-CTO, 20072 Milano, Italy;
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11
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Wu Y, Xu XJ, Sun X, Zhai H, Wang T, Cao XB, Xu Y. Integrated PET/MRI With 11C-CFT and 18F-FDG for levodopa response difference in Parkinson's disease. Behav Brain Res 2023; 454:114609. [PMID: 37532003 DOI: 10.1016/j.bbr.2023.114609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
AIM Parkinson's disease is one of the most common neurodegenerative diseases. Excellent levodopa responsiveness has been proposed as a characteristic supporting feature in substantiating the PD diagnosis. However, a small portion of clinically established PD patients shows poor levodopa response. This study aims to investigate brain function alterations of PD patients with poor levodopa responsiveness by PET/MRI. METHOD A total of 46 PD patients were recruited. They all completed 11C-CFT PET/MRI scans and the acute levodopa challenge test. Among these 46 PD patients, 42 participants further underwent 18F-FDG PET/MRI scans. Clinical variables regarding demographic data, disease features and cognition scales were also collected. Based on the improvement rate of UPDRS-III, PD patients were divided into non-responders (improvement rate < 33 %) and responders (improvement rate ≥ 33 %). Statistical parametric zapping was performed to analyze molecular imaging. Dopaminergic uptake and metabolism of 70 brain regions were converted to quantitative values and expressed as standard uptake value (SUV). SUV was further normalized by the cerebellum. The resulting SUV ratios and clinical variables were then compared by SPSS. RESULTS The difference between levodopa non-responders (n = 17) and responders (n = 29) in the UPDRS III baseline was statistically significant and the former had a lower UPDRS III baseline (19 (10, 32), p<0.05). In contrast, no statistical difference between these two groups was found in age, gender, disease duration, cognition, motor subtype and Hoehn-Yahr stage. Dopaminergic uptake differences between levodopa non-responders (n = 17) and responders (n = 29) were shown in the left inferior frontal cortex (1.00 ± 0.09 vs 1.07 ± 0.08, p < 0.05 and FDR < 0.2), the right posterior cingulum (1.10 ± 0.10 vs 1.20 ± 0.13, p < 0.05 and FDR < 0.2) and the right insula (1.21 ± 0.12 vs 1.30 ± 0.10, p < 0.05 and FDR < 0.2). The metabolic alterations between levodopa non-responders (n = 16) and responders (n = 26) were shown in the right supplementary motor area (1.30 (1.18, 1.39) vs 1.41 (1.31, 1.53), p < 0.05 and FDR < 0.2), right precuneus (1.37 ± 0.10 vs 1.47 ± 0.18, p < 0.05 and FDR < 0.2), right parietal cortex (1.14 ± 0.15 vs 1.27 ± 0.21, p < 0.05 and FDR < 0.2), right supramarginal gyrus (1.16 (1.12, 1.26) vs 1.25 (1.14, 1.46), p < 0.05 and FDR < 0.2), right postcentral gyrus (1.15 (1.08, 1.32) vs 1.24 (1.17, 1.39), p < 0.05 and FDR < 0.2), medulla (0.75 ± 0.07 vs 0.80 ± 0.07, p < 0.05 and FDR < 0.2), right rolandic operculum (1.25 (1.18, 1.32) vs 1.33 (1.25, 1.50), p < 0.05 and FDR < 0.2), right olfactory (0.95 (0.91, 1.01) vs 1.01 (0.95, 1.15), p < 0.05 and FDR < 0.2), the right insula (1.15 (1.06, 1.22) vs 1.21 (1.12, 1.35), p < 0.05 and FDR < 0.2) and the left cerebellum crus (0.96 (0.91, 1.01) vs 0.92 (0.86, 0.96), p < 0.05 and FDR < 0.2). CONCLUSIONS PD patients with poor response to levodopa showed less severe impairment of baseline motor symptoms, more severe dopaminergic deficits in the left inferior frontal, right posterior cingulate cortex and the right insula, and lower metabolism in the right supplementary motor area, right precuneus, right parietal cortex, right supramarginal gyrus, right postcentral gyrus, medulla, right rolandic operculum, right olfactory, the right insula and higher metabolism in the left cerebellum crus.
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Affiliation(s)
- Yi Wu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Jun Xu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xun Sun
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Zhai
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xue-Bing Cao
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yan Xu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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12
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Cao Z, Wu C, Hong H, Huang P, Zhou C, Guan X, Wu H, Duanmu X, Xu X, Zhang M. Predictability of inter-regional cerebral perfusion similarity on dopamine responsiveness and the moderation role of cognition in PD patients. Neuroimage 2023; 279:120305. [PMID: 37562719 DOI: 10.1016/j.neuroimage.2023.120305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Large heterogeneity can be found in dopamine responsiveness of patients with Parkinson's disease (PD). Instantly and objectively understanding dopamine responsiveness of patients may help clinical practice. PURPOSE This PD study explored the predictability of off-state inter-regional cerebral blood flow (CBF) perfusion similarity on patient's dopamine responsiveness and tested whether the predictive power could be moderated by patient's cognitive status. MATERIALS AND METHOD The PD cohort with 192 patients (containing off state and on state (PD-off and PD-on)) and the normal control (NC) cohort with 92 subjects were included. The intra-individual CBF relative variation networks were constructed and compared between PD-off and PD-on, PD-off and NC to identify the alterations caused by dopamine depletion. Based on that, regression analysis of off-state inter-regional CBF perfusion similarity on patient's dopamine responsiveness was performed. Finally, moderation analysis was conducted to test the moderation role of cognition on the regression model. RESULTS In the PD-off cohort, a total of 82 edges in the network were identified that affected by dopamine depletion. Off-state inter-regional CBF perfusion similarity was found that had a significant influence on patient's dopamine responsiveness. Cognitive status was validated that positively moderated the relationship between off-state inter-regional CBF perfusion similarity and dopamine responsiveness. CONCLUSION Dopamine responsiveness of PD patient could be predicted by off-state inter-regional CBF perfusion similarity. Patient's cognitive status might have a positive moderation effect on his/her dopamine responsiveness.
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Affiliation(s)
- Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Hui Hong
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Xiaojie Duanmu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
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Zhong Y, Liu H, Liu G, Liang Y, Dai C, Zhao L, Lai H, Mo L, Tan C, Deng F, Liu X, Chen L. Cerebellar and cerebral white matter changes in Parkinson's disease with resting tremor. Neuroradiology 2023; 65:1497-1506. [PMID: 37548715 DOI: 10.1007/s00234-023-03206-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Cerebellum modulates the amplitude of resting tremor in Parkinson's disease (PD) via cerebello-thalamo-cortical (CTC) circuit. Tremor-related white matter alterations have been identified in PD patients by pathological studies, but in vivo evidence is limited; the influence of such cerebellar white matter alterations on tremor-related brain network, including CTC circuit, is also unclear. In this study, we investigated the cerebral and cerebellar white matter alterations in PD patients with resting tremor using diffusion tensor imaging (DTI). METHODS In this study, 30 PD patients with resting tremor (PDWR), 26 PD patients without resting tremor (PDNR), and 30 healthy controls (HCs) from the Parkinson's Progression Markers Initiative (PPMI) cohort were included. Tract-based spatial statistics (TBSS) and region of interest-based analyses were conducted to determine white matter difference. Correlation analysis between DTI measures and clinical characteristics was also performed. RESULTS In the whole brain, TBSS and region of interest-based analyses identified higher fractional anisotropy (FA) value, lower mean diffusivity (MD) value, and lower radial diffusivity (RD) in multiple fibers. In the cerebellum, TBSS analysis revealed significantly higher FA value, decreased RD value as well as MD value in multiple cerebellar tracts including the inferior cerebellar peduncle (ICP) and middle cerebellar peduncle (MCP) when comparing the PDWR with HC, and higher FA value in the MCP when compared with PDNR. CONCLUSION We identified better white matter integrity in the cerebrum and cerebellum in PDWR indicating a potential association between the cerebral and cerebellar white matter and resting tremor in PD.
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Affiliation(s)
- Yuke Zhong
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Hang Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Guohui Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yi Liang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Chengcheng Dai
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Lili Zhao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Hongyu Lai
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Lijuan Mo
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Changhong Tan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Fen Deng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xi Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
| | - Lifen Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
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Dirkx MF, Shine JM, Helmich RC. Integrative Brain States Facilitate the Expression of Parkinson's Tremor. Mov Disord 2023; 38:1615-1624. [PMID: 37363818 PMCID: PMC10947311 DOI: 10.1002/mds.29506] [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: 02/24/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) rest tremor emerges from pathological activity in the basal ganglia and cerebello-thalamo-cortical circuits. A well-known clinical feature is the waxing and waning of PD tremor amplitude, but the mechanisms that drive this variability are unclear. Previous work has shown that arousal amplifies PD tremor by increasing between-network connectivity. Furthermore, brain states in PD are biased toward integration rather than segregation, a pattern that is also associated with increased arousal. OBJECTIVE The aim was to test the hypothesis that fluctuations in integrative brain states and/or arousal drive spontaneous fluctuations in PD rest tremor. METHODS We compared the temporal relationship between cerebral integration, the ascending arousal system, and tremor, both during cognitive load and in the resting state. In 40 tremor-dominant PD patients, we performed functional magnetic resonance imaging using concurrent tremor recordings and proxy measures of the ascending arousal system (pupil diameter, heart rate). We calculated whole-brain dynamic functional connectivity and used graph theory to determine a scan-by-scan measure of cerebral integration, which we related to the onset of tremor episodes. RESULTS Fluctuations in cerebral integration were time locked to spontaneous changes in tremor amplitude: cerebral integration increased 13 seconds before tremor onset and predicted the amplitude of subsequent increases in tremor amplitude. During but not before tremor episodes, pupil diameter and heart rate increased and correlated with tremor amplitude. CONCLUSIONS Integrative brain states are an important cerebral environment in which tremor-related activity emerges, which is then amplified by the ascending arousal system. New treatments focused on attenuating enhanced cerebral integration in PD may reduce tremor. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michiel F. Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - James M. Shine
- Brain and Mind CenterThe University of SydneySydneyNew South WalesAustralia
| | - Rick C. Helmich
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
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15
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Costanzo M, Cutrona C, Leodori G, De Bartolo MI, Fabbrini A, Vivacqua G, Conte A, Fabbrini G, Berardelli A, Belvisi D. Distal Upper Limb Tremor during Walking in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1198-1202. [PMID: 37635779 PMCID: PMC10450241 DOI: 10.1002/mdc3.13814] [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: 01/23/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 08/29/2023] Open
Abstract
Background Distal upper limb tremor during walking (TW) is frequently observed in Parkinson's disease (PD) but its clinical features are unknown. Objective To characterize the occurrence and the clinical features of TW in comparison to the other types of tremors in PD. Methods Fifty-one PD patients with rest tremor were evaluated off- and on-treatment. Occurrence, body distribution, severity and latency of TW and of other tremor types were assessed. Results TW was present in 78% of the PD patients examined. TW body distribution and severity were similar to those of rest and re-emergent tremor but different from the postural tremor presented by the same patients. TW latency, observed in 85% of patients, was on average 5.8 s. Dopaminergic treatment significantly improved TW, rest, and re-emergent tremor severity but left TW latency unaffected. Conclusions TW is a frequent motor sign in PD and is likely a clinical variant of rest tremor.
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Affiliation(s)
| | | | - Giorgio Leodori
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | | | - Andrea Fabbrini
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Giorgio Vivacqua
- Department of Experimental Morphology and Microscopy – Integrated Research Center (PRAAB) – Campus Biomedico University of RomeRomeItaly
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics SciencesSapienza University of RomeRomeItaly
| | - Antonella Conte
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Giovanni Fabbrini
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Alfredo Berardelli
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Daniele Belvisi
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
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16
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Zhou C, Wang L, Cheng W, Lv J, Guan X, Guo T, Wu J, Zhang W, Gao T, Liu X, Bai X, Wu H, Cao Z, Gu L, Chen J, Wen J, Huang P, Xu X, Zhang B, Feng J, Zhang M. Two distinct trajectories of clinical and neurodegeneration events in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:111. [PMID: 37443179 PMCID: PMC10344958 DOI: 10.1038/s41531-023-00556-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Increasing evidence suggests that Parkinson's disease (PD) exhibits disparate spatial and temporal patterns of progression. Here we used a machine-learning technique-Subtype and Stage Inference (SuStaIn) - to uncover PD subtypes with distinct trajectories of clinical and neurodegeneration events. We enrolled 228 PD patients and 119 healthy controls with comprehensive assessments of olfactory, autonomic, cognitive, sleep, and emotional function. The integrity of substantia nigra (SN), locus coeruleus (LC), amygdala, hippocampus, entorhinal cortex, and basal forebrain were assessed using diffusion and neuromelanin-sensitive MRI. SuStaIn model with above clinical and neuroimaging variables as input was conducted to identify PD subtypes. An independent dataset consisting of 153 PD patients and 67 healthy controls was utilized to validate our findings. We identified two distinct PD subtypes: subtype 1 with rapid eye movement sleep behavior disorder (RBD), autonomic dysfunction, and degeneration of the SN and LC as early manifestations, and cognitive impairment and limbic degeneration as advanced manifestations, while subtype 2 with hyposmia, cognitive impairment, and limbic degeneration as early manifestations, followed later by RBD and degeneration of the LC in advanced disease. Similar subtypes were shown in the validation dataset. Moreover, we found that subtype 1 had weaker levodopa response, more GBA mutations, and poorer prognosis than subtype 2. These findings provide new insights into the underlying disease biology and might be useful for personalized treatment for patients based on their subtype.
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Affiliation(s)
- Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Linbo Wang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Zhangjiang Fudan International Innovation Center, Shanghai, China.
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - JinChao Lv
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Wei Zhang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Zhangjiang Fudan International Innovation Center, Shanghai, China.
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China.
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17
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Matar E, Bhatia K. Dystonia and Parkinson's disease: Do they have a shared biology? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:347-411. [PMID: 37482398 DOI: 10.1016/bs.irn.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Parkinsonism and dystonia co-occur across many movement disorders and are most encountered in the setting of Parkinson's disease. Here we aim to explore the shared neurobiological underpinnings of dystonia and parkinsonism through the clinical lens of the conditions in which these movement disorders can be seen together. Foregrounding the discussion, we briefly review the circuits of the motor system and the neuroanatomical and neurophysiological aspects of motor control and highlight their relevance to the proposed pathophysiology of parkinsonism and dystonia. Insight into shared biology is then sought from dystonia occurring in PD and other forms of parkinsonism including those disorders in which both can be co-expressed simultaneously. We organize these within a biological schema along with important questions to be addressed in this space.
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Affiliation(s)
- Elie Matar
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kailash Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom
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18
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Marapin RS, van der Horn HJ, van der Stouwe AMM, Dalenberg JR, de Jong BM, Tijssen MAJ. Altered brain connectivity in hyperkinetic movement disorders: A review of resting-state fMRI. Neuroimage Clin 2023; 37:103302. [PMID: 36669351 PMCID: PMC9868884 DOI: 10.1016/j.nicl.2022.103302] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperkinetic movement disorders (HMD) manifest as abnormal and uncontrollable movements. Despite reported involvement of several neural circuits, exact connectivity profiles remain elusive. OBJECTIVES Providing a comprehensive literature review of resting-state brain connectivity alterations using resting-state fMRI (rs-fMRI). We additionally discuss alterations from the perspective of brain networks, as well as correlations between connectivity and clinical measures. METHODS A systematic review was performed according to PRISMA guidelines and searching PubMed until October 2022. Rs-fMRI studies addressing ataxia, chorea, dystonia, myoclonus, tics, tremor, and functional movement disorders (FMD) were included. The standardized mean difference was used to summarize findings per region in the Automated Anatomical Labeling atlas for each phenotype. Furthermore, the activation likelihood estimation meta-analytic method was used to analyze convergence of significant between-group differences per phenotype. Finally, we conducted hierarchical cluster analysis to provide additional insights into commonalities and differences across HMD phenotypes. RESULTS Most articles concerned tremor (51), followed by dystonia (46), tics (19), chorea (12), myoclonus (11), FMD (11), and ataxia (8). Altered resting-state connectivity was found in several brain regions: in ataxia mainly cerebellar areas; for chorea, the caudate nucleus; for dystonia, sensorimotor and basal ganglia regions; for myoclonus, the thalamus and cingulate cortex; in tics, the basal ganglia, cerebellum, insula, and frontal cortex; for tremor, the cerebello-thalamo-cortical circuit; finally, in FMD, frontal, parietal, and cerebellar regions. Both decreased and increased connectivity were found for all HMD. Significant spatial convergence was found for dystonia, FMD, myoclonus, and tremor. Correlations between clinical measures and resting-state connectivity were frequently described. CONCLUSION Key brain regions contributing to functional connectivity changes across HMD often overlap. Possible increases and decreases of functional connections of a specific region emphasize that HMD should be viewed as a network disorder. Despite the complex interplay of physiological and methodological factors, this review serves to gain insight in brain connectivity profiles across HMD phenotypes.
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Affiliation(s)
- Ramesh S Marapin
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Harm J van der Horn
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - A M Madelein van der Stouwe
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jelle R Dalenberg
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Bauke M de Jong
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Marina A J Tijssen
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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19
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Bagarinao E, Kawabata K, Watanabe H, Hara K, Ohdake R, Ogura A, Masuda M, Kato T, Maesawa S, Katsuno M, Sobue G. Connectivity impairment of cerebellar and sensorimotor connector hubs in Parkinson’s disease. Brain Commun 2022; 4:fcac214. [PMID: 36072644 PMCID: PMC9438962 DOI: 10.1093/braincomms/fcac214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/25/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Cognitive and movement processes involved integration of several large-scale brain networks. Central to these integrative processes are connector hubs, brain regions characterized by strong connections with multiple networks. Growing evidence suggests that many neurodegenerative and psychiatric disorders are associated with connector hub dysfunctions. Using a network metric called functional connectivity overlap ratio, we investigated connector hub alterations in Parkinson’s disease. Resting-state functional MRI data from 99 patients (male/female = 44/55) and 99 age- and sex-matched healthy controls (male/female = 39/60) participating in our cross-sectional study were used in the analysis. We have identified two sets of connector hubs, mainly located in the sensorimotor cortex and cerebellum, with significant connectivity alterations with multiple resting-state networks. Sensorimotor connector hubs have impaired connections primarily with primary processing (sensorimotor, visual), visuospatial, and basal ganglia networks, whereas cerebellar connector hubs have impaired connections with basal ganglia and executive control networks. These connectivity alterations correlated with patients’ motor symptoms. Specifically, values of the functional connectivity overlap ratio of the cerebellar connector hubs were associated with tremor score, whereas that of the sensorimotor connector hubs with postural instability and gait disturbance score, suggesting potential association of each set of connector hubs with the disorder’s two predominant forms, the akinesia/rigidity and resting tremor subtypes. In addition, values of the functional connectivity overlap ratio of the sensorimotor connector hubs were highly predictive in classifying patients from controls with an accuracy of 75.76%. These findings suggest that, together with the basal ganglia, cerebellar and sensorimotor connector hubs are significantly involved in Parkinson’s disease with their connectivity dysfunction potentially driving the clinical manifestations typically observed in this disorder.
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Affiliation(s)
- Epifanio Bagarinao
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 461–8673 Japan
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
| | - Kazuya Kawabata
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Hirohisa Watanabe
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
- Department of Neurology, Fujita Health University School of Medicine , Toyoake, Aichi, 470-1192 Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Reiko Ohdake
- Department of Neurology, Fujita Health University School of Medicine , Toyoake, Aichi, 470-1192 Japan
| | - Aya Ogura
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Toshiyasu Kato
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Satoshi Maesawa
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Department of Neurosurgery, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine , Nagoya, Aichi, 466-8550 Japan
| | - Gen Sobue
- Brain & Mind Research Center, Nagoya University , Nagoya, Aichi, 466–8550 Japan
- Aichi Medical University , Nagakute, Aichi, 480-1195 Japan
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20
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Chen R, Berardelli A, Bhattacharya A, Bologna M, Chen KHS, Fasano A, Helmich RC, Hutchison WD, Kamble N, Kühn AA, Macerollo A, Neumann WJ, Pal PK, Paparella G, Suppa A, Udupa K. Clinical neurophysiology of Parkinson's disease and parkinsonism. Clin Neurophysiol Pract 2022; 7:201-227. [PMID: 35899019 PMCID: PMC9309229 DOI: 10.1016/j.cnp.2022.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
This review is part of the series on the clinical neurophysiology of movement disorders and focuses on Parkinson’s disease and parkinsonism. The pathophysiology of cardinal parkinsonian motor symptoms and myoclonus are reviewed. The recordings from microelectrode and deep brain stimulation electrodes are reported in detail.
This review is part of the series on the clinical neurophysiology of movement disorders. It focuses on Parkinson’s disease and parkinsonism. The topics covered include the pathophysiology of tremor, rigidity and bradykinesia, balance and gait disturbance and myoclonus in Parkinson’s disease. The use of electroencephalography, electromyography, long latency reflexes, cutaneous silent period, studies of cortical excitability with single and paired transcranial magnetic stimulation, studies of plasticity, intraoperative microelectrode recordings and recording of local field potentials from deep brain stimulation, and electrocorticography are also reviewed. In addition to advancing knowledge of pathophysiology, neurophysiological studies can be useful in refining the diagnosis, localization of surgical targets, and help to develop novel therapies for Parkinson’s disease.
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Affiliation(s)
- Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Antonella Macerollo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.,The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kaviraja Udupa
- Department of Neurophysiology National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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21
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A review on pathology, mechanism, and therapy for cerebellum and tremor in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:82. [PMID: 35750692 PMCID: PMC9232614 DOI: 10.1038/s41531-022-00347-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/30/2022] [Indexed: 12/16/2022] Open
Abstract
Tremor is one of the core symptoms of Parkinson’s disease (PD), but its mechanism is poorly understood. The cerebellum is a growing focus in PD-related researches and is reported to play an important role in tremor in PD. The cerebellum may participate in the modulation of tremor amplitude via cerebello-thalamo-cortical circuits. The cerebellar excitatory projections to the ventral intermediate nucleus of the thalamus may be enhanced due to PD-related changes, including dopaminergic/non-dopaminergic system abnormality, white matter damage, and deep nuclei impairment, which may contribute to dysregulation and resistance to levodopa of tremor. This review summarized the pathological, structural, and functional changes of the cerebellum in PD and discussed the role of the cerebellum in PD-related tremor, aiming to provide an overview of the cerebellum-related mechanism of tremor in PD.
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22
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Hidding U, Schaper M, Gulberti A, Buhmann C, Gerloff C, Moll CKE, Hamel W, Choe CU, Pötter-Nerger M. Short pulse and directional thalamic deep brain stimulation have differential effects in parkinsonian and essential tremor. Sci Rep 2022; 12:7251. [PMID: 35508680 PMCID: PMC9068767 DOI: 10.1038/s41598-022-11291-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 04/05/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to assess the effects of novel stimulation algorithms of deep brain stimulation (short pulse and directional stimulation) in the ventrointermediate thalamus and posterior subthalamic area (VIM/PSA-DBS) on tremor in Parkinson’s disease (PD) and to compare the effects with those in essential tremor (ET). We recruited six PD patients (70.8 ± 10.4 years) and seven ET patients (64.4 ± 9.9 years) with implanted VIM/PSA-DBS in a stable treatment condition (> 3 months postoperatively). Tremor severity and ataxia were assessed in four different stimulation conditions in a randomized order: DBS switched off (STIM OFF), omnidirectional stimulation with 60 µs (oDBS60), omnidirectional stimulation with 30 µs (oDBS30), directional stimulation at the best segment with 60 µs (dDBS60). In both patient groups, all three DBS stimulation modes reduced the total tremor score compared to STIM OFF, whereas stimulation-induced ataxia was reduced by oDBS30 and partially by dDBS60 compared to oDBS60. Tremor reduction was more pronounced in PD than in ET due to a limited DBS effect on intention and action-specific drawing tremor in ET. In PD and ET tremor, short pulse or directional VIM/PSA-DBS is an effective and well tolerated therapeutic option. Trial registration: The study was registered in the DRKS (ID DRKS00025329, 18.05.2021, German Clinical Trials Register, DRKS—Deutsches Register Klinischer Studien).
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Affiliation(s)
- Ute Hidding
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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23
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Azghadi A, Rajagopal MM, Atkinson KA, Holloway KL. Utility of GPI+VIM dual-lead deep brain stimulation for Parkinson's disease patients with significant residual tremor on medication. J Neurosurg 2022; 136:1364-1370. [PMID: 34598140 DOI: 10.3171/2021.4.jns21502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Randomized controlled trials have demonstrated that deep brain stimulation (DBS) of both the globus pallidus internus (GPI) and subthalamic nucleus (STN) for Parkinson's disease (PD) is superior to the best medical therapy. Tremor is particularly responsive to DBS, with reports of 70%-80% improvement. However, a small number of patients do not obtain the expected response with both STN and GPI targets. Indeed, the authors' patient population had a similar 81.2% tremor reduction with a 9.6% failure rate. In an analysis of these failures, they identified patients with preoperative on-medication tremor who subsequently received a GPI lead as a subpopulation at higher risk for inadequate tremor control. Thereafter, STN DBS was recommended for patients with on-medication tremor. However, for the patients with symptoms and comorbidities that favored GPI as the target, dual GPI and ventral intermediate nucleus of the thalamus (VIM) leads were proposed. This report details outcomes for those patients. METHODS This is a retrospective review of patients with PD who met the criteria for and underwent simultaneous GPI+VIM DBS surgery from 2015 to 2020 and had available follow-up data. The preoperative Unified Parkinson's Disease Rating Scale scores were obtained with the study participants on and off their medication. Postoperatively, the GPI lead was kept on at baseline and scores were obtained with and without VIM stimulation. RESULTS Thirteen PD patients with significant residual preoperative tremor on medication underwent simultaneous GPI+VIM DBS surgery (11 unilateral, 2 bilateral). A mean 90.6% (SD 15.0%) reduction in tremor scores was achieved with dual GPI+VIM stimulation compared to a 21.8% (SD 71.9%) reduction with GPI stimulation alone and a 30.9% (SD 37.8%) reduction with medication. Although rigidity and bradykinesia reductions were accomplished with just GPI stimulation, 13 of the 15 hemispheres required VIM stimulation to achieve excellent tremor control. CONCLUSIONS GPI+VIM stimulation was required to adequately control tremor in all but 2 patients in this series, substantiating the authors' hypothesis that, in their population, medication-resistant tremor does not completely respond to GPI stimulation. Dual stimulation of the GPI and VIM proved to be an effective option for the patients who had symptoms and comorbidities that favored GPI as a target and had medication-resistant tremor.
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Affiliation(s)
- Adel Azghadi
- 1School of Medicine, Virginia Commonwealth University, Richmond
| | - Megan M Rajagopal
- 2Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and
| | - Kelsey A Atkinson
- 2Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and
| | - Kathryn L Holloway
- 2Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and
- 3Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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24
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Oldehinkel M, Llera A, Faber M, Huertas I, Buitelaar JK, Bloem BR, Marquand AF, Helmich R, Haak KV, Beckmann CF. Mapping dopaminergic projections in the human brain with resting-state fMRI. eLife 2022; 11:71846. [PMID: 35113016 PMCID: PMC8843090 DOI: 10.7554/elife.71846] [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: 07/01/2021] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
The striatum receives dense dopaminergic projections, making it a key region of the dopaminergic system. Its dysfunction has been implicated in various conditions including Parkinson’s disease (PD) and substance use disorder. However, the investigation of dopamine-specific functioning in humans is problematic as current MRI approaches are unable to differentiate between dopaminergic and other projections. Here, we demonstrate that ‘connectopic mapping’ – a novel approach for characterizing fine-grained, overlapping modes of functional connectivity – can be used to map dopaminergic projections in striatum. We applied connectopic mapping to resting-state functional MRI data of the Human Connectome Project (population cohort; N = 839) and selected the second-order striatal connectivity mode for further analyses. We first validated its specificity to dopaminergic projections by demonstrating a high spatial correlation (r = 0.884) with dopamine transporter availability – a marker of dopaminergic projections – derived from DaT SPECT scans of 209 healthy controls. Next, we obtained the subject-specific second-order modes from 20 controls and 39 PD patients scanned under placebo and under dopamine replacement therapy (L-DOPA), and show that our proposed dopaminergic marker tracks PD diagnosis, symptom severity, and sensitivity to L-DOPA. Finally, across 30 daily alcohol users and 38 daily smokers, we establish strong associations with self-reported alcohol and nicotine use. Our findings provide evidence that the second-order mode of functional connectivity in striatum maps onto dopaminergic projections, tracks inter-individual differences in PD symptom severity and L-DOPA sensitivity, and exhibits strong associations with levels of nicotine and alcohol use, thereby offering a new biomarker for dopamine-related (dys)function in the human brain.
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Affiliation(s)
- Marianne Oldehinkel
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behaviour, Radboud, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Myrthe Faber
- Donders Institute for Brain, Cognition and Behaviour, Radboud, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ismael Huertas
- Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Jan K Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Rick Helmich
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Koen V Haak
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Erro R, Fasano A, Barone P, Bhatia KP. Milestones in Tremor Research: ten years later. Mov Disord Clin Pract 2022; 9:429-435. [PMID: 35582314 PMCID: PMC9092753 DOI: 10.1002/mdc3.13418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” Neuroscience section, University of Salerno Baronissi Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
- Krembil Brain Institute Toronto Ontario Canada
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” Neuroscience section, University of Salerno Baronissi Italy
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery London United Kingdom
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26
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The pathophysiology of Parkinson's disease tremor. J Neurol Sci 2022; 435:120196. [DOI: 10.1016/j.jns.2022.120196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 01/18/2023]
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27
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Zhou C, Guo T, Bai X, Wu J, Gao T, Guan X, Liu X, Gu L, Huang P, Xuan M, Gu Q, Xu X, Zhang B, Zhang M. Locus coeruleus degeneration is associated with disorganized functional topology in Parkinson's disease. Neuroimage Clin 2022; 32:102873. [PMID: 34749290 PMCID: PMC8578042 DOI: 10.1016/j.nicl.2021.102873] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/07/2021] [Accepted: 10/30/2021] [Indexed: 10/26/2022]
Abstract
Degeneration of the locus coeruleus (LC) is recognized as a critical hallmark of Parkinson's disease (PD). Recent studies have reported that noradrenaline produced from the LC has critical effects on brain functional organization. However, it is unknown if LC degeneration in PD contributes to cognitive/motor manifestations through modulating brain functional organization. This study enrolled 94 PD patients and 68 healthy controls, and LC integrity was measured using the contrast-to-noise ratio of the LC (CNRLC) calculated from T1-weighted magnetic resonance imaging. We used graph-theory-based network analysis to characterize brain functional organization. The relationships among LC degeneration, network disruption, and cognitive/motor manifestations in PD were assessed. Whether network disruption was a mediator between LC degeneration and cognitive/motor impairments was assessed further. In addition, an independent PD subgroup (n = 35) having functional magnetic resonance scanning before and after levodopa administration was enrolled to evaluate whether LC degeneration-related network deficiencies were independent of dopamine deficiency. We demonstrated that PD patients have significant LC degeneration compared to healthy controls. CNRLC was positively correlated with Montreal Cognitive Assessment score and the nodal efficiency (NE) of several cognitive-related regions. Lower NE of the superior temporal gyrus was a mediator between LC degeneration and cognitive impairment in PD. However, levodopa treatment could not normalize the reduced NE of the superior temporal gyrus (mediator). In conclusion, we provided evidence for the relationship between LC degeneration and extensive network disruption in PD, and highlight the role of network disorganization in LC degeneration-related cognitive impairment.
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Affiliation(s)
- Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - JingJing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Min Xuan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Quanquan Gu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000 Hangzhou, China.
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28
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Cholinergic relevant functional reactivity is associated with dopamine responsiveness of tremor in Parkinson's disease. Brain Imaging Behav 2022; 16:1234-1245. [PMID: 34973120 PMCID: PMC9107430 DOI: 10.1007/s11682-021-00610-9] [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] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Tremor in Parkinson’s disease (PD) has distinct responsiveness to dopamine, which is supposed not be exclusively related to dopamine deficiency but has a close relationship with cholinergic system. This phenomenon indicates that cholinergic system may be an important regulatory for distinct dopamine responsiveness of parkinsonian tremor. Through investigating the alterations of cholinergic and dopaminergic network during levodopa administration, we aimed at exploring the mechanisms of differed dopamine responsiveness of parkinsonian tremor. Fifty-two PD patients with tremor were enrolled. MRI scanning, UPDRS III and its sub-symptom scores were collected in OFF and ON status (dopaminergic challenge test). Then, patients were divided into two groups (dopamine-resistant tremor and dopamine-responsive tremor) according to the tremor change rate median score. Dopaminergic and cholinergic network were obtained. LASSO regression was conducted to identify functional connectivity with distinct reactivity during levodopa administration between groups. Afterwards, detailed group comparisons, interaction and correlation analyses were performed. The reactivity of cholinergic connectivity showed the highest possibility to distinguish two groups, especially connectivity of right basal forebrain 123 to right parietal operculum cortex (R.BF123-R.PO). After levodopa administration, connectivity of R.BF123-R.PO was decreased for dopamine-responsive tremor while which remained unchanged for dopamine-resistant tremor. The reactivity of R.BF123-R.PO was negatively correlated with tremor change rate. Reduced cholinergic connectivity to parietal operculum may be an underlying mechanism for the responsive tremor in PD and the distinct cholinergic reactivity of parietal operculum to levodopa may be a core pathophysiology for the differed DA responsiveness of tremor in PD.
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29
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Deuschl G, Becktepe JS, Dirkx M, Haubenberger D, Hassan A, Helmich R, Muthuraman M, Panyakaew P, Schwingenschuh P, Zeuner KE, Elble RJ. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022; 136:93-129. [DOI: 10.1016/j.clinph.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/18/2023]
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30
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Nieuwhof F, Toni I, Dirkx MF, Gallea C, Vidailhet M, Buijink AWG, van Rootselaar AF, van de Warrenburg BPC, Helmich RC. Cerebello-thalamic activity drives an abnormal motor network into dystonic tremor. Neuroimage Clin 2021; 33:102919. [PMID: 34929584 PMCID: PMC8688717 DOI: 10.1016/j.nicl.2021.102919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 01/18/2023]
Abstract
Dystonic tremor syndromes are highly burdensome and treatment is often inadequate. This is partly due to poor understanding of the underlying pathophysiology. Several lines of research suggest involvement of the cerebello-thalamo-cortical circuit and the basal ganglia in dystonic tremor syndromes, but their role is unclear. Here we aimed to investigate the contribution of the cerebello-thalamo-cortical circuit and the basal ganglia to the pathophysiology of dystonic tremor syndrome, by directly linking tremor fluctuations to cerebral activity during scanning. In 27 patients with dystonic tremor syndrome (dystonic tremor: n = 23; tremor associated with dystonia: n = 4), we used concurrent accelerometery and functional MRI during a posture holding task that evoked tremor, alternated with rest. Using multiple regression analyses, we separated tremor-related activity from brain activity related to (voluntary) posture holding. Using dynamic causal modelling, we tested for altered effective connectivity between tremor-related brain regions as a function of tremor amplitude fluctuations. Finally, we compared grey matter volume between patients (n = 27) and matched controls (n = 27). We found tremor-related activity in sensorimotor regions of the bilateral cerebellum, contralateral posterior and anterior ventral lateral nuclei of the thalamus (VLp and VLa), contralateral primary motor cortex (hand area), contralateral pallidum, and the bilateral frontal cortex (laterality with respect to the tremor). Grey matter volume was increased in patients compared to controls in the portion of contralateral thalamus also showing tremor-related activity, as well as in bilateral medial and left lateral primary motor cortex, where no tremor-related activity was present. Effective connectivity analyses showed that inter-regional coupling in the cerebello-thalamic pathway, as well as the thalamic self-connection, were strengthened as a function of increasing tremor power. These findings indicate that the pathophysiology of dystonic tremor syndromes involves functional and structural changes in the cerebello-thalamo-cortical circuit and pallidum. Deficient input from the cerebellum towards the thalamo-cortical circuit, together with hypertrophy of the thalamus, may play a key role in the generation of dystonic tremor syndrome.
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Affiliation(s)
- Freek Nieuwhof
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HB Nijmegen, the Netherlands
| | - Ivan Toni
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HB Nijmegen, the Netherlands
| | - Michiel F Dirkx
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, 6500 HB Nijmegen, the Netherlands
| | - Cecile Gallea
- MOV'IT Section (Movement Investigations and Therapeutics), Paris Brain Institute (CNRS/INSERM UMR 7225/1127), Sorbonne Université, 75013 Paris, France
| | - Marie Vidailhet
- Institut du Cerveau et de la Moelle épinière (ICM) UMR 1127, Hôpital de la Pitié-Salpétrière, Department of Neurology, AP-HP, Sorbonne Université, 75013 Paris, France
| | - Arthur W G Buijink
- Department of Neurology, Amsterdam University Medical Centers, 1105 AZ Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology, Amsterdam University Medical Centers, 1105 AZ Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, 6500 HB Nijmegen, the Netherlands
| | - Rick C Helmich
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HB Nijmegen, the Netherlands; Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, 6500 HB Nijmegen, the Netherlands.
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31
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Subthalamic-Cortical Network Reorganization during Parkinson's Tremor. J Neurosci 2021; 41:9844-9858. [PMID: 34702744 DOI: 10.1523/jneurosci.0854-21.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/08/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
Tremor, a common and often primary symptom of Parkinson's disease, has been modeled with distinct onset and maintenance dynamics. To identify the neurophysiologic correlates of each state, we acquired intraoperative cortical and subthalamic nucleus recordings from 10 patients (9 male, 1 female) performing a naturalistic visual-motor task. From this task, we isolated short epochs of tremor onset and sustained tremor. Comparing these epochs, we found that the subthalamic nucleus was central to tremor onset, as it drove both motor cortical activity and tremor output. Once tremor became sustained, control of tremor shifted to cortex. At the same time, changes in directed functional connectivity across sensorimotor cortex further distinguished the sustained tremor state.SIGNIFICANCE STATEMENT Tremor is a common symptom of Parkinson's disease (PD). While tremor pathophysiology is thought to involve both basal ganglia and cerebello-thalamic-cortical circuits, it is unknown how these structures functionally interact to produce tremor. In this article, we analyzed intracranial recordings from the subthalamic nucleus and sensorimotor cortex in patients with PD undergoing deep brain stimulation surgery. Using an intraoperative task, we examined tremor in two separate dynamic contexts: when tremor first emerged, and when tremor was sustained. We believe that these findings reconcile several models of Parkinson's tremor, while describing the short-timescale dynamics of subcortical-cortical interactions during tremor for the first time. These findings may describe a framework for developing proactive and responsive neurostimulation models for specifically treating tremor.
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32
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van den Berg KRE, Helmich RC. The Role of the Cerebellum in Tremor - Evidence from Neuroimaging. Tremor Other Hyperkinet Mov (N Y) 2021; 11:49. [PMID: 34820148 PMCID: PMC8603856 DOI: 10.5334/tohm.660] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Neuroimaging research has played a key role in identifying which cerebral changes are associated with tremor. Here we will focus on the cerebellum, which may drive tremor oscillations, process tremor-related afferents, modulate activity in remote brain regions, or a combination. Methods On the 6th of October 2021, we conducted a PubMed search to select articles providing neuroimaging evidence for cerebellar involvement in essential tremor (ET), Parkinson's disease (PD) tremor, and dystonic tremor (DT). Results In ET, tremor-related activity is found in motor areas of the bilateral cerebellum, and altered functional connectivity within and outside the cerebellum correlates with tremor severity. Furthermore, ET is associated with cerebellar atrophy, but also with compensatory structural changes outside the cerebellum (e.g. supplementary motor area). In PD, tremor-related cerebellar activity and increased cerebello-thalamic coupling has been found. Emerging evidence suggests that the cerebellum plays a key role in dopamine-resistant rest tremor and in postural tremor. Cerebellar structural alterations have been identified in PD, but only some relate to tremor. DT is associated with more widespread cerebral networks than other tremor types. Discussion In ET, the cerebellum likely acts as an oscillator, potentially due to loss of inhibitory mechanisms. In contrast, in PD the cerebellum may be a modulator, which contributes to tremor oscillations by influencing the thalamo-cortical system. The precise role of the cerebellum in DT remains unclear. We recommend that future research measures tremor-related activity directly by combining electrophysiology with neuroimaging, while brain stimulation techniques may be used to establish causality. Highlights This review of neuroimaging studies has provided convincing evidence that the cerebellum plays a key role in the pathophysiology of ET, PD tremor, and dystonic tremor syndromes. This contribution may consist of driving tremor oscillations, processing tremor-related afferents, modulating activity in remote brain regions, or all the above.
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Affiliation(s)
- Kevin R. E. van den Berg
- Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rick C. Helmich
- Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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33
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Bohnen NI, Kanel P, Koeppe RA, Sanchez-Catasus CA, Frey KA, Scott P, Constantine GM, Albin RL, Müller MLTM. Regional cerebral cholinergic nerve terminal integrity and cardinal motor features in Parkinson's disease. Brain Commun 2021; 3:fcab109. [PMID: 34704022 PMCID: PMC8196256 DOI: 10.1093/braincomms/fcab109] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
Clinical effects of anti-cholinergic drugs implicate cholinergic systems alterations in the pathophysiology of some cardinal motor impairments in Parkinson’s disease. The topography of affected cholinergic systems deficits and motor domain specificity are poorly understood. Parkinson's disease patients (n = 108) underwent clinical and motor assessment and vesicular acetylcholine transporter [18F]-fluoroethoxybenzovesamicol PET imaging. Volumes-of-interest-based analyses included detailed thalamic and cerebellar parcellations. Successful PET sampling for most of the small-sized parcellations was available in 88 patients. A data-driven approach, stepwise regression using the forward selection method, was used to identify cholinergic brain regions associating with cardinal domain-specific motor ratings. Regressions with motor domain scores for model-selected regions followed by confounder analysis for effects of age of onset, duration of motor disease and levodopa equivalent dose were performed. Among 7 model-derived regions associating with postural instability and gait difficulties domain scores three retained significance in confounder variable analysis: medial geniculate nucleus (standardized β = −0.34, t = −3.78, P = 0.0003), lateral geniculate nucleus (β = −0.32, t = −3.4, P = 0.001) and entorhinal cortex (β = −0.23, t = −2.6, P = 0.011). A sub-analysis of non-episodic postural instability and gait difficulties scores demonstrated significant effects of the medial geniculate nucleus, entorhinal cortex and globus pallidus pars interna. Among 6 tremor domain model-selected regions two regions retained significance in confounder variable analysis: cerebellar vermis section of lobule VIIIb (β = −0.22, t = −2.4, P = 0.021) and the putamen (β = −0.23, t = −2.3, P = 0.024). None of the three model-selected variables for the rigidity domain survived confounder analysis. Two out of the four model-selected regions for the distal limb bradykinesia domain survived confounder analysis: globus pallidus pars externa (β = 0.36, t = 3.9, P = 0.0097) and the paracentral lobule (β = 0.26, t = 2.5, P = 0.013). Emphasizing the utility of a systems-network conception of the pathophysiology of Parkinson's disease cardinal motor features, our results are consistent with specific deficits in basal forebrain corticopetal, peduncupontine-laterodorsal tegmental complex, and medial vestibular nucleus cholinergic pathways, against the background of nigrostriatal dopaminergic deficits, contributing significantly to postural instability, gait difficulties, tremor and distal limb bradykinesia cardinal motor features of Parkinson’s disease. Our results suggest significant and distinct consequences of degeneration of cholinergic peduncupontine-laterodorsal tegmental complex afferents to both segments of the globus pallidus. Non-specific regional cholinergic nerve terminal associations with rigidity scores likely reflect more complex multifactorial signalling mechanisms with smaller contributions from cholinergic pathways.
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Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Carlos A Sanchez-Catasus
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Peter Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Gregory M Constantine
- Department of Mathematics, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Statistics, University of Pittsburgh, Pittsburgh, PA 15260, USA.,The McGowen Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA.,Critical Path Institute, Tucson, AZ 85718, USA
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34
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Morales-Briceno H, Fung VSC, Bhatia KP, Balint B. Parkinsonism and dystonia: Clinical spectrum and diagnostic clues. J Neurol Sci 2021; 433:120016. [PMID: 34642024 DOI: 10.1016/j.jns.2021.120016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/20/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
The links between the two archetypical basal ganglia disorders, dystonia and parkinsonism, are manifold and stem from clinical observations, imaging studies, animal models and genetics. The combination of both, i.e. the syndrome of dystonia-parkinsonism, is not uncommonly seen in movement disorders clinics and has a myriad of different underlying aetiologies, upon which treatment and prognosis depend. Based on a comprehensive literature review, we delineate the clinical spectrum of disorders presenting with dystonia-parkinsonism. The clinical approach depends primarily on the age at onset, associated neurological or systemic symptoms and neuroimaging. The tempo of disease progression, and the response to L-dopa are further important clues to tailor diagnostic approaches that may encompass dopamine transporter imaging, CSF analysis and, last but not least, genetic testing. Later in life, sporadic neurodegenerative conditions are the most frequent cause, but the younger the patient, the more likely the cause is unravelled by the recent advances of molecular genetics that are focus of this review. Here, knowledge of the associated phenotypic spectrum is key to guide genetic testing and interpretation of test results. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Hugo Morales-Briceno
- Neurology Department, Movement Disorders Unit, Westmead Hospital, NSW, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Victor S C Fung
- Neurology Department, Movement Disorders Unit, Westmead Hospital, NSW, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Kailash P Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London WC1N 3BG, United Kingdom
| | - Bettina Balint
- Department of Neurology, University Hospital Heidelberg, Germany.
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35
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Parkinsonism and tremor syndromes. J Neurol Sci 2021; 433:120018. [PMID: 34686357 DOI: 10.1016/j.jns.2021.120018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 09/29/2021] [Indexed: 01/22/2023]
Abstract
Tremor, the most common movement disorder, may occur in isolation or may co-exist with a variety of other neurologic and movement disorders including parkinsonism, dystonia, and ataxia. When associated with Parkinson's disease, tremor may be present at rest or as an action tremor overlapping in phenomenology with essential tremor. Essential tremor may be associated not only with parkinsonism but other neurological disorders, suggesting the possibility of essential tremor subtypes. Besides Parkinson's disease, tremor can be an important feature of other parkinsonian disorders, such as atypical parkinsonism and drug-induced parkinsonism. In addition, tremor can be a prominent feature in patients with other movement disorders such as fragile X-associated tremor/ataxia syndrome, and Wilson's disease in which parkinsonian features may be present. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Zhou C, Guo T, Wu J, Wang L, Bai X, Gao T, Guan X, Gu L, Huang P, Xuan M, Gu Q, Xu X, Zhang B, Cheng W, Feng J, Zhang M. Locus Coeruleus Degeneration Correlated with Levodopa Resistance in Parkinson's Disease: A Retrospective Analysis. JOURNAL OF PARKINSONS DISEASE 2021; 11:1631-1640. [PMID: 34366373 PMCID: PMC8609680 DOI: 10.3233/jpd-212720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The widely divergent responsiveness of Parkinson’s disease (PD) patients to levodopa is an important clinical issue because of its relationship with quality of life and disease prognosis. Preliminary animal experiments have suggested that degeneration of the locus coeruleus (LC) attenuates the efficacy of levodopa treatment. Objective: To explore the relationship between LC degeneration and levodopa responsiveness in PD patients in vivo. Methods: Neuromelanin-sensitive magnetic resonance imaging (NM-MRI), a good indicator of LC and substantia nigra (SN) degeneration, and levodopa challenge tests were conducted in 57 PD patients. Responsiveness to levodopa was evaluated by the rates of change of the Unified Parkinson’s Disease Rating Scale Part III score and somatomotor network synchronization calculated from resting-state functional MRI before and after levodopa administration. Next, we assessed the relationship between the contrast-to-noise ratio of LC (CNRLC) and levodopa responsiveness. Multiple linear regression analysis was conducted to rule out the potential influence of SN degeneration on levodopa responsiveness. Results: A significant positive correlation was found between CNRLC and the motor improvement after levodopa administration (R = 0.421, p = 0.004). CNRLC also correlated with improvement in somatomotor network synchronization (R = –0.323, p = 0.029). Furthermore, the relationship between CNRLC and levodopa responsiveness was independent of SN degeneration. Conclusion: LC degeneration might be an essential factor for levodopa resistance. LC evaluation using NM-MRI might be an alternative tool for predicting levodopa responsiveness and for helping to stratify patients into clinical trials aimed at improving the efficacy of levodopa.
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Affiliation(s)
- Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - JingJing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linbo Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyan Gu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Xuan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.,Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Paparella G, Angelini L, De Biase A, Cannavacciuolo A, Colella D, Di Bonaventura C, Giallonardo AT, Berardelli A, Bologna M. Clinical and Kinematic Features of Valproate-Induced Tremor and Differences with Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2021; 20:374-383. [PMID: 33200286 PMCID: PMC8213593 DOI: 10.1007/s12311-020-01216-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
Tremor is a common movement disorder that can be induced by medications, including valproate, which is used for the treatment of epilepsy. However, the clinical and neurophysiological features of valproate-induced tremor are still under-investigated. We performed a clinical and kinematic assessment of valproate-induced tremor by considering tremor body distribution and activation conditions. We investigated possible correlations between demographic and clinical data and kinematic features. Valproate-induced tremor results were also compared with those collected in a large sample of patients with essential tremor. Sixteen valproate-induced tremor patients and 93 essential tremor patients were enrolled. All participants underwent a standardised neurological examination and video recording. Patients also underwent an objective assessment of postural, kinetic and rest tremor of the upper limbs and head tremor through kinematic analysis. Nonparametric tests were used for statistical comparisons between the two groups. Clinical evaluation showed a higher occurrence of rest tremor as well as head or voice, and lower limb involvement in patients with valproate-induced tremor. Kinematic analysis showed a substantial variability in the tremor features of patients with valproate-induced tremor. Compared to essential tremor, we found a higher occurrence of rest tremor of the upper limbs and the involvement of more body segments in valproate-induced tremor patients. Valproate-induced tremor has distinctive clinical and kinematic features, which may suggest that valproate interferes with the cerebellar functions.
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Affiliation(s)
| | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alessandro De Biase
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Antonio Cannavacciuolo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
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Fois AF, Chang FC, Barnett R, London K, Mahant N, Ha A, Aldaajani Z, Cruse B, Morales-Briceno H, Ma KK, Farlow D, Fung VS. Rest tremor correlates with reduced contralateral striatal dopamine transporter binding in Parkinson's disease. Parkinsonism Relat Disord 2021; 85:102-108. [PMID: 33799200 DOI: 10.1016/j.parkreldis.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In vivo dopamine transporter imaging is a useful tool for distinguishing nigrostriatal pathologies (e.g. Parkinson's disease) from other causes of tremor. However, while many of the motoric features of Parkinson's disease (e.g. bradykinesia, rigidity, hypomimia) correlate well with reduced striatal dopamine transporter binding, the same relationship has not been demonstrated for tremor. We investigated the relationship between striatal dopamine transporter binding and quantitative measures of tremor. METHODS 23 participants with Parkinson's disease underwent standardised clinical assessment including structured, videotaped clinical examination, tremor neurophysiology study of both upper limbs using accelerometry and surface EMG, and Technitium-99 m TRODAT-1 brain SPECT imaging. Normalised striatal uptake values were calculated. Tremor EMG and accelerometry time series were processed with Fourier transformation to identify peak tremor power within a window of 3-10Hz and to calculate the tremor stability index (TSI). RESULTS Spearman correlation analyses revealed an association between tremor power and contralaterally reduced striatal uptake in a number of recording conditions. This association was strongest for rest tremor, followed by postural tremor, with the weakest association observed for kinetic tremor. Lower TSI was also associated with lower contralateral striatal uptake in a number of rest and postural conditions. CONCLUSION These data suggest a relationship between Parkinsonian rest tremor and contralateral reduction in striatal dopamine binding. Use of quantitative neurophysiology techniques may allow the demonstration of clinico-pathophysiological relationships in tremor that have remained occult to previous studies.
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Affiliation(s)
- Alessandro F Fois
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Florence Cf Chang
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Robert Barnett
- Department of Medical Physics, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, Australia; Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, NSW, 2006, Australia
| | - Neil Mahant
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Ainhi Ha
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Zakiyah Aldaajani
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Present Address: Neurology Unit, King Fahad Medical Military Complex, Dhahran, Saudi Arabia
| | - Belinda Cruse
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - Hugo Morales-Briceno
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Kit Kwan Ma
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - David Farlow
- Department of Nuclear Medicine, PET, and Ultrasound, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - Victor Sc Fung
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia.
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Lin Z, Zhang X, Wang L, Zhang Y, Zhou H, Sun Q, Sun B, Huang P, Li D. Revisiting the L-Dopa Response as a Predictor of Motor Outcomes After Deep Brain Stimulation in Parkinson's Disease. Front Hum Neurosci 2021; 15:604433. [PMID: 33613209 PMCID: PMC7889513 DOI: 10.3389/fnhum.2021.604433] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the correlation between preoperative response to the L-dopa challenge test and efficacy of deep brain stimulation (DBS) on motor function in Parkinson's disease (PD). Methods: We retrospectively reviewed the data of 38 patients with idiopathic PD who underwent DBS surgery with a median follow-up duration of 7 months. Twenty underwent bilateral globus pallidus interna (GPi) DBS, and 18 underwent bilateral subthalamic nucleus (STN) DBS. The Movement Disorder Society Unified Parkinson Disease Rating Scale-Motor Part (MDS UPDRS-III) was assessed before surgery and at the last follow-up in different medication and stimulation conditions, respectively. Results: Pearson's correlation analysis revealed a positive correlation between preoperative L-dopa challenge responsiveness and GPi-DBS responsiveness on the total score (R 2 = 0.283, p = 0.016) but not on the non-tremor total score (R 2 = 0.158, p = 0.083) of MDS UPDRS-III. Such correlation remained significant (R 2' = 0.332, p = 0.010) after controlling for age at the time of surgery as confounding factor by partial correlation analysis. The preoperative L-dopa challenge responsiveness was significantly correlated with the tremor-controlling outcome of GPi-DBS (R 2 = 0.390, p = 0.003). In contrast, we found a positive correlation between preoperative L-dopa challenge responsiveness and STN-DBS responsiveness on the non-tremor total score (R 2 = 0.290, p = 0.021), but not on the total score (R 2 = 0.130, p = 0.141) of MDS UPDRS-III. The partial correlation analysis further demonstrated that the predictive value of preoperative L-dopa challenge responsiveness on the non-tremor motor outcome of STN-DBS was eliminated (R 2' = 0.120, p = 0.174) after controlling for age at the time of surgery as confounding factor. Interpretation: The short-term predictive value of preoperative response to the L-dopa challenge test for the motor outcome of GPi-DBS in PD was systematically described. Our findings suggest: (1) a solid therapeutic effect of GPi-DBS in treating L-dopa-responsive tremors; (2) a negative effect of age at the time of surgery on motor outcomes of STN-DBS, (3) a possible preference of STN- to GPi-DBS in L-dopa-resistant tremor control, and (4) a possible preference of GPi- to STN-DBS in elderly PD patients who have a satisfactory dopamine response.
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Affiliation(s)
- Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxiao Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Zhou
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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van Nuland AJ, Helmich RC, Dirkx MF, Zach H, Toni I, Cools R, den Ouden HEM. Effects of dopamine on reinforcement learning in Parkinson's disease depend on motor phenotype. Brain 2020; 143:3422-3434. [PMID: 33147621 PMCID: PMC7719026 DOI: 10.1093/brain/awaa335] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 07/10/2020] [Accepted: 08/06/2020] [Indexed: 01/16/2023] Open
Abstract
Parkinson's disease is clinically defined by bradykinesia, along with rigidity and tremor. However, the severity of these motor signs is greatly variable between individuals, particularly the presence or absence of tremor. This variability in tremor relates to variation in cognitive/motivational impairment, as well as the spatial distribution of neurodegeneration in the midbrain and dopamine depletion in the striatum. Here we ask whether interindividual heterogeneity in tremor symptoms could account for the puzzlingly large variability in the effects of dopaminergic medication on reinforcement learning, a fundamental cognitive function known to rely on dopamine. Given that tremor-dominant and non-tremor Parkinson's disease patients have different dopaminergic phenotypes, we hypothesized that effects of dopaminergic medication on reinforcement learning differ between tremor-dominant and non-tremor patients. Forty-three tremor-dominant and 20 non-tremor patients with Parkinson's disease were recruited to be tested both OFF and ON dopaminergic medication (200/50 mg levodopa-benserazide), while 22 age-matched control subjects were recruited to be tested twice OFF medication. Participants performed a reinforcement learning task designed to dissociate effects on learning rate from effects on motivational choice (i.e. the tendency to 'Go/NoGo' in the face of reward/threat of punishment). In non-tremor patients, dopaminergic medication improved reward-based choice, replicating previous studies. In contrast, in tremor-dominant patients, dopaminergic medication improved learning from punishment. Formal modelling showed divergent computational effects of dopaminergic medication as a function of Parkinson's disease motor phenotype, with a modulation of motivational choice bias and learning rate in non-tremor and tremor patients, respectively. This finding establishes a novel cognitive/motivational difference between tremor and non-tremor Parkinson's disease patients, and highlights the importance of considering motor phenotype in future work.
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Affiliation(s)
- Annelies J van Nuland
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6500 HB Nijmegen, The Netherlands
| | - Rick C Helmich
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6500 HB Nijmegen, The Netherlands
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, 6500 HB Nijmegen, The Netherlands
| | - Michiel F Dirkx
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, 6500 HB Nijmegen, The Netherlands
| | - Heidemarie Zach
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6500 HB Nijmegen, The Netherlands
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, 6500 HB Nijmegen, The Netherlands
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Ivan Toni
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6500 HB Nijmegen, The Netherlands
| | - Roshan Cools
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6500 HB Nijmegen, The Netherlands
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Nijmegen, The Netherlands
| | - Hanneke E M den Ouden
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6500 HB Nijmegen, The Netherlands
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Chen J, Cai T, Li Y, Chi J, Rong S, He C, Li X, Zhang P, Wang L, Zhang Y. Different iron deposition patterns in Parkinson's disease subtypes: a quantitative susceptibility mapping study. Quant Imaging Med Surg 2020; 10:2168-2176. [PMID: 33139996 DOI: 10.21037/qims-20-285] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder with various subtypes and uncertain pathogenesis. Iron deposition is considered to be involved in the pathological mechanisms of PD. The present study aimed to investigate the iron deposition in deep gray matter in patients with different PD subtypes using quantitative susceptibility mapping (QSM). Methods Forty-six PD patients and 22 healthy controls (HCs) were recruited for the study. PD patients were allocated to the tremor-dominant (TD) group (n=22), postural instability and gait disorder-dominant (PIGD) group (n=19), and intermediate group (n=5). Susceptibility values in deep gray matter nuclei measured by QSM among the PD-TD and PD-PIGD groups and the HCs, as well as the relationship between iron accumulation and clinical motor features, were investigated. Results Susceptibility values in the dentate nucleus (DN) were greater in the PD-TD (118.73±70.45) group than in the PD-PIGD (72.14±39.85, P=0.02) group and HCs (78.26±41.38, P=0.042). Further, a significant positive correlation was observed between the DN susceptibility values and tremor scores (r=0.324, P=0.028). Compared with the HCs (182.60±85.35), both the PD-TD (282.00±102.49, P=0.006) and PD-PIGD groups (284.91±118.54, P=0.007) exhibited greater susceptibility values in the substantia nigra (SN) pars reticulata. The susceptibility values in the SN pars compacta were also greater in the PD-PIGD group (164.51±89.44) than in the HCs (107.78±63.11, P=0.048). Conclusions The present study demonstrated various iron deposition patterns in different PD phenotypes. These findings give insight into the pathophysiology underlying different PD phenotypes, and potentially illustrate the involvement of iron deposition in the PD-TD and PD-PIGD subtypes.
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Affiliation(s)
- Junling Chen
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Neurology, Shantou Central Hospital, Shantou, China
| | - Tongtong Cai
- Department of Neurology, Shantou Central Hospital, Shantou, China
| | - Yan Li
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jieshan Chi
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siming Rong
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chentao He
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohong Li
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Piao Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lijuan Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Ingram TL, Shephard F, Sarmad S, Ortori CA, Barrett DA, Chakrabarti L. Sex specific inflammatory profiles of cerebellar mitochondria are attenuated in Parkinson's disease. Aging (Albany NY) 2020; 12:17713-17737. [PMID: 32855358 PMCID: PMC7521528 DOI: 10.18632/aging.103937] [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: 06/04/2020] [Accepted: 08/01/2020] [Indexed: 01/24/2023]
Abstract
Response to inflammation is a key determinant in many diseases and their outcomes. Diseases that commonly affect older people are frequently associated with altered inflammatory processes. Neuroinflammation has been described in Parkinson's disease (PD) brain. PD is characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta and at the sub-cellular level, mitochondrial dysfunction is a key feature. However, there is evidence that a different region of the brain, the cerebellum, is involved in the pathophysiology of PD. We report relative levels of 40 pro- and anti-inflammatory cytokines measured in PD and control cerebellar mitochondria. These data were obtained by screening cytokine antibody arrays. In parallel, we present concentrations of 29 oxylipins and 4 endocannabinoids measured in mitochondrial fractions isolated from post-mortem PD cerebellum with age and sex matched controls. Our oxylipin and endocannabinoid data were acquired via quantitation by LC-ESI-MS/MS. The separate sample sets both show there are clearly different inflammatory profiles between the sexes in control samples. Sex specific profiles were not maintained in cerebellar mitochondria isolated from PD brains.
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Affiliation(s)
- Thomas L. Ingram
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - Freya Shephard
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - Sarir Sarmad
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Catherine A. Ortori
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - David A. Barrett
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Lisa Chakrabarti
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, UK
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Nieuwhof F, de Bie RMA, Praamstra P, van den Munckhof P, Helmich RC. The cerebral tremor circuit in a patient with Holmes tremor. Ann Clin Transl Neurol 2020; 7:1453-1458. [PMID: 32725752 PMCID: PMC7448163 DOI: 10.1002/acn3.51143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
The cerebral network associated with Holmes tremor has never been determined directly. A previous study reported a brain network that is functionally connected, in healthy individuals, to different lesions that cause Holmes tremor (lesion connectome). We report a 71-year-old man with severe left-sided tremor caused by a microbleed near the right red nucleus. Using accelerometry-fMRI, we show tremor-related activity in contralateral sensorimotor cortex and cerebellar vermis. This network was distinct from, but functionally coupled to, the Holmes lesion connectome. We propose that Holmes tremor involves three distinct cerebral mechanisms: a structural lesion, an intermediate lesion connectome, and symptom-related activity.
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Affiliation(s)
- Freek Nieuwhof
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam UMC - Locatie AMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Peter Praamstra
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick C Helmich
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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Zach H, Dirkx MF, Roth D, Pasman JW, Bloem BR, Helmich RC. Dopamine-responsive and dopamine-resistant resting tremor in Parkinson disease. Neurology 2020; 95:e1461-e1470. [PMID: 32651292 DOI: 10.1212/wnl.0000000000010316] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/30/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE We tested the hypothesis that there are 2 distinct phenotypes of Parkinson tremor, based on interindividual differences in the response of resting tremor to dopaminergic medication. We also investigated whether this pattern is specific to tremor by comparing interindividual differences in the dopamine response of tremor to that of bradykinesia. METHODS In this exploratory study, we performed a levodopa challenge in 76 tremulous patients with Parkinson tremor. Clinical scores (Movement Disorders Society-sponsored version of the Unified Parkinson's Disease Rating Scale part III) were collected "off" and "on" a standardized dopaminergic challenge (200/50 mg dispersible levodopa-benserazide). In both sessions, resting tremor intensity was quantified using accelerometry, both during rest and during cognitive coactivation. Bradykinesia was quantified using a speeded keyboard test. We calculated the distribution of dopamine-responsiveness for resting tremor and bradykinesia. In 41 patients, a double-blinded, placebo-controlled dopaminergic challenge was repeated after approximately 6 months. RESULTS The dopamine response of resting tremor, but not bradykinesia, significantly departed from a normal distribution. A cluster analysis on 3 clinical and electrophysiologic markers of tremor dopamine-responsiveness revealed 3 clusters: dopamine-responsive, intermediate, and dopamine-resistant tremor. A repeated levodopa challenge after 6 months confirmed this classification. Patients with dopamine-responsive tremor had greater disease severity and tended to have a higher prevalence of dyskinesia. CONCLUSION Parkinson resting tremor can be divided into 3 partially overlapping phenotypes, based on the dopamine response. These tremor phenotypes may be associated with different underlying pathophysiologic mechanisms, requiring a different therapeutic approach.
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Affiliation(s)
- Heidemarie Zach
- From the Department of Neurology (H.Z., M.F.D., J.W.P., B.R.B., R.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; and Departments of Neurology (H.Z.) and Emergency Medicine (D.R.), Medical University Vienna, Austria
| | - Michiel F Dirkx
- From the Department of Neurology (H.Z., M.F.D., J.W.P., B.R.B., R.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; and Departments of Neurology (H.Z.) and Emergency Medicine (D.R.), Medical University Vienna, Austria
| | - Dominik Roth
- From the Department of Neurology (H.Z., M.F.D., J.W.P., B.R.B., R.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; and Departments of Neurology (H.Z.) and Emergency Medicine (D.R.), Medical University Vienna, Austria
| | - Jaco W Pasman
- From the Department of Neurology (H.Z., M.F.D., J.W.P., B.R.B., R.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; and Departments of Neurology (H.Z.) and Emergency Medicine (D.R.), Medical University Vienna, Austria
| | - Bastiaan R Bloem
- From the Department of Neurology (H.Z., M.F.D., J.W.P., B.R.B., R.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; and Departments of Neurology (H.Z.) and Emergency Medicine (D.R.), Medical University Vienna, Austria
| | - Rick C Helmich
- From the Department of Neurology (H.Z., M.F.D., J.W.P., B.R.B., R.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; and Departments of Neurology (H.Z.) and Emergency Medicine (D.R.), Medical University Vienna, Austria.
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Human brain connectivity: Clinical applications for clinical neurophysiology. Clin Neurophysiol 2020; 131:1621-1651. [DOI: 10.1016/j.clinph.2020.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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