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Liu CW, Wang YM, Chen SY, Lu LY, Liang TY, Fang KC, Chen P, Lee IC, Liu WC, Kumar A, Kuo SH, Lee JC, Lo CC, Wu SC, Pan MK. The cerebellum shapes motions by encoding motor frequencies with precision and cross-individual uniformity. Nat Biomed Eng 2025:10.1038/s41551-025-01409-5. [PMID: 40425805 DOI: 10.1038/s41551-025-01409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 04/16/2025] [Indexed: 05/29/2025]
Abstract
Understanding brain behaviour encoding or designing neuroprosthetics requires identifying precise, consistent neural algorithms across individuals. However, cerebral microstructures and activities are individually variable, posing challenges for identifying precise codes. Here, despite cerebral variability, we report that the cerebellum shapes motor kinematics by encoding dynamic motor frequencies with remarkable numerical precision and cross-individual uniformity. Using in vivo electrophysiology and optogenetics in mice, we confirm that deep cerebellar neurons encode frequencies using populational tuning of neuronal firing probabilities, creating cerebellar oscillations and motions with matched frequencies. The mechanism is consistently presented in self-generated rhythmic and non-rhythmic motions triggered by a vibrational platform or skilled tongue movements of licking in all tested mice with cross-individual uniformity. The precision and uniformity allowed us to engineer complex motor kinematics with designed frequencies. We further validate the frequency-coding function of the human cerebellum using cerebellar electroencephalography recordings and alternating current stimulation during voluntary tapping tasks. Our findings reveal a cerebellar algorithm for motor kinematics with precision and uniformity, the mathematical foundation for a brain-computer interface for motor control.
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Grants
- NTUMC 110C101-011 NTU | College of Medicine, National Taiwan University (College of Medicine, National Taiwan University)
- NSC-145-11 National Taiwan University Hospital (NTUH)
- 113-UN0013 National Taiwan University Hospital (NTUH)
- 108-039 National Taiwan University Hospital (NTUH)
- 112-UN0024 National Taiwan University Hospital (NTUH)
- 113-E0001 National Taiwan University Hospital (NTUH)
- AS-TM-112-01-02 Academia Sinica
- NHRI-EX113-11303NI National Health Research Institutes (NHRI)
- 109-2326-B-002-013-MY4 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 107-2321-B-002-020 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 108-2321-B-002-011 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 108-2321-002-059-MY2 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 110-2321-B-002-012 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 111-2628-B-002-036 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 112-2628-B-002-011 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 113-2628-B-002-002 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- R01NS118179 Foundation for the National Institutes of Health (Foundation for the National Institutes of Health, Inc.)
- R01NS104423 Foundation for the National Institutes of Health (Foundation for the National Institutes of Health, Inc.)
- R01NS124854 Foundation for the National Institutes of Health (Foundation for the National Institutes of Health, Inc.)
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Affiliation(s)
- Chia-Wei Liu
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Yi-Mei Wang
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Shun-Ying Chen
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Liang-Yin Lu
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ting-Yu Liang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Ke-Chu Fang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Peng Chen
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - I-Chen Lee
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Wen-Chuan Liu
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Ami Kumar
- The Initiative for Columbia Ataxia and Tremor, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Sheng-Han Kuo
- The Initiative for Columbia Ataxia and Tremor, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Jye-Chang Lee
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chuan Lo
- Institute of Systems Neuroscience, National Tsing Hua University, Hsinchu, Taiwan
| | - Shun-Chi Wu
- Department of Engineering and Bioinformatics, National Tsing Hua University, Hsinchu, Taiwan
| | - Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan.
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan.
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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Kumar A, Wang YM, Pan MK, Kuo SH. Protocol for recording physiological signals from the human cerebellum using electroencephalography. STAR Protoc 2025; 6:103601. [PMID: 39869480 PMCID: PMC11799949 DOI: 10.1016/j.xpro.2025.103601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 12/09/2024] [Accepted: 01/03/2025] [Indexed: 01/29/2025] Open
Abstract
As Purkinje cells of the cerebellum have a very fast firing rate, techniques with high temporal resolution are required to capture cerebellar physiology. Here, we present a protocol to record physiological signals in humans using cerebellar electroencephalography (cEEG). We describe steps for electrode placement and recording. We then detail solutions for dealing with potential muscle, ocular, and electrical artifacts. This protocol has applications in recording patients with cerebellar disorders such as essential tremor, cerebellar ataxia, and dystonia. For complete details on the use and execution of this protocol, please refer to Pan et al.,1 Wong et al.,2 and Wang et al.3.
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Affiliation(s)
- Ami Kumar
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Yi-Mei Wang
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan; Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan.
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA.
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3
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Lin CC, Fang KC, Balbo I, Liang TY, Liu CW, Liu WC, Wang YM, Hung YL, Yang KC, Geng SK, Ni CL, Driscoll CP, Ruff DS, Kumar A, Amokrane N, Desai N, Faust PL, Louis ED, Kuo SH, Pan MK. Reduced cerebellar rhythm by climbing fiber denervation is linked to motor rhythm deficits in mice and ataxia severity in patients. Sci Transl Med 2025; 17:eadk3922. [PMID: 40009696 DOI: 10.1126/scitranslmed.adk3922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 06/18/2024] [Accepted: 02/04/2025] [Indexed: 02/28/2025]
Abstract
Cerebellar ataxia results from various genetic and nongenetic disorders and is characterized by involuntary movements that impair precision and motor rhythm. Here, we report that climbing fiber (CF) denervation is a common pathophysiology underlying motor rhythm loss in cerebellar ataxia. By examining cerebellar pathology in patients with spinocerebellar ataxia (SCA) types 1, 2, and 6 and multiple system atrophy, we identified CF degeneration with synaptic loss as a shared pathophysiology. Optogenetic silencing of CF synaptic activity in mice induced ataxia-like motor dysfunctions and loss of motor precision. In addition, CF silencing resulted in cerebellar and motor rhythm loss, another core feature of ataxia. This rhythm loss was predominantly CF dependent and resistant to Purkinje cell-specific lesioning by diphtheria toxin. Correspondingly, two patients with inferior olive pathology, the brain site that provides CFs to Purkinje cells, presented with ataxia and cerebellar rhythm loss. Patients with genetic or nongenetic cerebellar ataxia exhibited cerebellar rhythm loss that correlated with the Scale for the Assessment and Rating of Ataxia. Chemogenetic stimulation of CFs improved cerebellar and motor rhythms as well as motor performance in the SCA type 1 mouse model of ataxia. These results suggest that CF-dependent cerebellar rhythm loss occurs across different types of cerebellar ataxia, contributing to motor imprecision and motor rhythm loss, two defining features of ataxia.
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Affiliation(s)
- Chih-Chun Lin
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Ke-Chu Fang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
| | - Ilaria Balbo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Ting-Yu Liang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Chia-Wei Liu
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
| | - Wen-Chuan Liu
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Yi-Mei Wang
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
| | - Yen-Ling Hung
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
| | - Kai-Chien Yang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
| | - Scott Kun Geng
- Department of Computer Science, Columbia University, New York, NY 10027, USA
| | - Chun-Lun Ni
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Christopher P Driscoll
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - David S Ruff
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Ami Kumar
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Nadia Amokrane
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Natasha Desai
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY 10032, USA
| | - Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei 10638, Taiwan
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Pan MK. Targeting the fundamentals for tremors: the frequency and amplitude coding in essential tremor. J Biomed Sci 2025; 32:18. [PMID: 39924504 PMCID: PMC11809078 DOI: 10.1186/s12929-024-01112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 12/12/2024] [Indexed: 02/11/2025] Open
Abstract
Essential tremor (ET) is one of the most common movement disorders with heterogeneous pathogenesis involving both genetic and environmental factors, which often results in variable therapeutic outcomes. Despite the diverse etiology, ET is defined by a core symptom of action tremor, an involuntary rhythmic movement that can be mathematically characterized by two parameters: tremor frequency and tremor amplitude. Recent advances in neural dynamics and clinical electrophysiology have provided valuable insights to explain how tremor frequency and amplitude are generated within the central nervous system. This review summarizes both animal and clinical evidence, encompassing the kinematic features of tremors, circuitry dynamics, and the neuronal coding mechanisms for the two parameters. Neural population coding within the olivocerebellum is implicated in determining tremor frequency, while the cerebellar circuitry synchrony and cerebellar-thalamo-cortical interactions play key roles in regulating tremor amplitude. Novel therapeutic strategies aimed at tuning tremor frequency and amplitude are also discussed. These neural dynamic approaches target the conserved mechanisms across ET patients with varying etiologies, offering the potential to develop universally effective therapies for ET.
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Affiliation(s)
- Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Road, Taipei, 100, Taiwan.
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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5
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Bosch TJ, Groth C, Espinoza AI, Bharmauria V, Flouty O, Singh A. Cerebellar Oscillatory Patterns in Essential Tremor: Modulatory Effects of VIM-DBS. CEREBELLUM (LONDON, ENGLAND) 2025; 24:40. [PMID: 39891875 PMCID: PMC11787153 DOI: 10.1007/s12311-025-01787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2025] [Indexed: 02/03/2025]
Abstract
Essential tremor (ET) is a common movement disorder, and while ventral intermediate nucleus deep brain stimulation (VIM-DBS) is a well-established treatment, its precise mechanisms or modulatory effects, particularly in relation to cerebellar oscillations, remain unclear. In this study, we hypothesized that VIM-DBS would modulate cerebellar oscillatory activity across both resting and motor task conditions, reflecting its impact on cerebello-thalamic pathways. Ten patients diagnosed with ET participated in this study. We examined the effects of VIM-DBS on mid-cerebellar oscillations during resting-state and lower-limb pedaling motor tasks. Frequency analysis was conducted on the resting-state signal and time-frequency analysis was performed on motor task-related signals. We explored the modulatory effects of VIM-DBS on oscillatory activity across delta, theta, alpha, beta, and gamma frequency bands. We found that ON VIM-DBS increased mid-cerebellar relative theta power during resting-state conditions, with no significant changes in other frequency bands. During a pedaling motor task, VIM-DBS led to significant reductions in theta, alpha, and gamma power, highlighting the frequency-specific effects of stimulation. VIM-DBS also increased peak acceleration of leg movements during the pedaling task. Furthermore, VIM-DBS selectively increased mid-frontal relative theta and beta power as well as mid-occipital relative theta power during resting condition, suggesting localized mid-cerebellar modulation. Moreover, similarity analyses between mid-cerebellar and nearby mid-occipital signals revealed differences in coherence, phase coherence, and cross-spectrum phase coherence. Overall, these results support the role of VIM-DBS in modulating mid-cerebellar oscillations in ET and provide new insights into the neural mechanisms underlying DBS efficacy.
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Affiliation(s)
- Taylor J Bosch
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, USA
| | | | | | - Vishal Bharmauria
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Oliver Flouty
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Arun Singh
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, USA.
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, 414 E. Clark St. Vermillion, Vermillion, SD, 57069, USA.
- Department of Neuroscience, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
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Cui X, Wu L, Zhang C, Li Z. Implantable Self-Powered Systems for Electrical Stimulation Medical Devices. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2412044. [PMID: 39587936 DOI: 10.1002/advs.202412044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 10/27/2024] [Indexed: 11/27/2024]
Abstract
With the integration of bioelectronics and materials science, implantable self-powered systems for electrical stimulation medical devices have emerged as an innovative therapeutic approach, garnering significant attention in medical research. These devices achieve self-powering through integrated energy conversion modules, such as triboelectric nanogenerators (TENGs) and piezoelectric nanogenerators (PENGs), significantly enhancing the portability and long-term efficacy of therapeutic equipment. This review delves into the design strategies and clinical applications of implantable self-powered systems, encompassing the design and optimization of energy harvesting modules, the selection and fabrication of adaptable electrode materials, innovations in systematic design strategies, and the extensive utilization of implantable self-powered systems in biological therapies, including the treatment of neurological disorders, tissue regeneration engineering, drug delivery, and tumor therapy. Through a comprehensive analysis of the latest research progress, technical challenges, and future directions in these areas, this paper aims to provide valuable insights and inspiration for further research and clinical applications of implantable self-powered systems.
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Affiliation(s)
- Xi Cui
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, China
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, China
| | - Li Wu
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, China
- School of Nanoscience and Engineering, Chinese Academy of Sciences, Beijing, 100049, China
| | - Chao Zhang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, China
| | - Zhou Li
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, China
- School of Nanoscience and Engineering, Chinese Academy of Sciences, Beijing, 100049, China
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Balachandar A, Fasano A. Frequency Coding in Essential Tremor-The Olivocerebellar Orchestra Conducts Its Own Symphony. Mov Disord 2024; 39:1729-1730. [PMID: 39150273 DOI: 10.1002/mds.29984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/18/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024] Open
Affiliation(s)
- Arjun Balachandar
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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