Effects of lesions of the human posterior thalamus on ocular fixation during voluntary and visually triggered saccades

When the central integrator disintegrates: A review of the role of the thalamus in cognition and dementia

The thalamus is a complex neural structure with numerous anatomical subdivisions and intricate connectivity patterns. In recent decades, the traditional view of the thalamus as a relay station and "gateway to the cortex" has expanded in recognition of its role as a central integrator of inputs from sensory systems, cortex, basal ganglia, limbic systems, brain stem nuclei, and cerebellum. As such, the thalamus is critical for numerous aspects of human cognition, mood, and behavior, as well as serving sensory processing and motor functions. Thalamus pathology is an important contributor to cognitive and functional decline, and it might be argued that the thalamus has been somewhat overlooked as an important player in dementia. In this review, we provide a comprehensive overview of thalamus anatomy and function, with an emphasis on human cognition and behavior, and discuss emerging insights on the role of thalamus pathology in dementia.

Monoaminergic Degeneration and Ocular Motor Abnormalities in De Novo Parkinson's Disease

BACKGROUND

Evaluating eye movements in Parkinson's disease (PD) provides valuable insights into the underlying pathophysiological changes.

OBJECTIVE

The aim was to investigate the relationship between monoaminergic degeneration and ocular motor abnormalities in de novo PD.

METHODS

Drug-naive PD patients who underwent N-(3-[18 F]fluoropropyl)-2-carbomethoxy-3-(4-iodophenyl) nortropane positron emission tomography scans and video-oculography at diagnosis were eligible. Measurements of saccadic accuracy, latency, and smooth pursuit gain and square wave jerk frequency were collected. Patients underwent Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and detailed cognitive tests. We investigated the associations between ocular motor measurements and specific tracer uptake ratios (SUR) in the caudate nucleus, anterior and posterior putamen, thalamus, and dorsal raphe nuclei, along with motor and cognitive symptoms.

RESULTS

One-hundred twenty-four subjects were included in this study. Saccadic accuracy was positively associated with parkinsonian motor severity expressed as Hoehn and Yahr stages, MDS-UPDRS Part III scores, and subscores for bradykinesia and rigidity but not with tremor scores (PFDR  < 0.05). Saccadic accuracy correlated with poor performances in the Rey-Complex-Figure copy, and latency with the Digit Symbol Coding and the Montreal Cognitive Assessment scores (PFDR  < 0.05). Prolonged saccadic latency correlated with reduced thalamic SUR, whereas decreased saccadic accuracy correlated with reduced SUR in the anterior and posterior putamen (PFDR  < 0.05). Reduced smooth pursuit gain showed associations with reduced SUR in the dorsal raphe, a serotonin-predominant region, but did not correlate with parkinsonism severity scores.

CONCLUSION

Defective dopaminergic and nondopaminergic neural systems may discretely influence ocular motor function in de novo PD patients. © 2023 International Parkinson and Movement Disorder Society.

Effective connectivity and spatial selectivity-dependent fMRI changes elicited by microstimulation of pulvinar and LIP

The thalamic pulvinar and the lateral intraparietal area (LIP) share reciprocal anatomical connections and are part of an extensive cortical and subcortical network involved in spatial attention and oculomotor processing. The goal of this study was to compare the effective connectivity of dorsal pulvinar (dPul) and LIP and to probe the dependency of microstimulation effects on task demands and spatial tuning properties of a given brain region. To this end, we applied unilateral electrical microstimulation in the dPul (mainly medial pulvinar) and LIP in combination with event-related BOLD fMRI in monkeys performing fixation and memory-guided saccade tasks. Microstimulation in both dPul and LIP enhanced task-related activity in monosynaptically-connected fronto-parietal cortex and along the superior temporal sulcus (STS) including putative face patch locations, as well as in extrastriate cortex. LIP microstimulation elicited strong activity in the opposite homotopic LIP while no homotopic activation was found with dPul stimulation. Both dPul and LIP stimulation also elicited activity in several heterotopic cortical areas in the opposite hemisphere, implying polysynaptic propagation of excitation. Despite extensive activation along the intraparietal sulcus evoked by LIP stimulation, there was a difference in frontal and occipital connectivity elicited by posterior and anterior LIP stimulation sites. Comparison of dPul stimulation with the adjacent but functionally dissimilar ventral pulvinar also showed distinct connectivity. On the level of single trial timecourses within each region of interest (ROI), most ROIs did not show task-dependence of stimulation-elicited response modulation. Across ROIs, however, there was an interaction between task and stimulation, and task-specific correlations between the initial spatial selectivity and the magnitude of stimulation effect were observed. Consequently, stimulation-elicited modulation of task-related activity was best fitted by an additive model scaled down by the initial response amplitude. In summary, we identified overlapping and distinct patterns of thalamocortical and corticocortical connectivity of pulvinar and LIP, highlighting the dorsal bank and fundus of STS as a prominent node of shared circuitry. Spatial task-specific and partly polysynaptic modulations of cue and saccade planning delay period activity in both hemispheres exerted by unilateral pulvinar and parietal stimulation provide insight into the distributed interhemispheric processing underlying spatial behavior.

Structural brain damage and visual disorders in children with cerebral palsy due to periventricular leukomalacia

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There is a strong correlation between brain lesion severity and visual function, evident also with a Structural MRI.

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It is confirmed the validity of MRI semi-quantitative scale published by Fiori et al. (2014).

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There is a frequent association of PVL with thalamic lesions with important repercussion on visual function.

Aim

To systematically explore the relationship between type and severity of brain lesion on Magnetic Resonance Imaging (MRI) and visual function in a large cohort of children with periventricular leukomalacia (PVL).

Methods

94 children with bilateral cerebral palsy (CP) and history of PVL were recruited at Stella Maris Scientific Institute in Pisa (Italy). We included data of participants (72) with at least one MRI after the age of three years and an evaluation of visual function including fixation, following, saccades, nystagmus, acuity, visual field, stereopsis and color perception.

Brain lesions location and extent were assessed by a semi-quantitative MRI-scale for children with CP.

Results

Brain lesion severity strongly correlated with visual function total score (global MRI score p = .000; hemispheric score p = .001 and subcortical score p = .000). Moreover, visual acuity, visual field, stereopsis and colour were compromised when a cortical damage was present, while ocular motricity (and in particular fixation and saccades) were compromised in presence of subcortical brain damage.

Interpretation

Structural MRI is valuable for understanding the relationship between brain lesion severity and visual function in children with CP.

Electrical Microstimulation of the Pulvinar Biases Saccade Choices and Reaction Times in a Time-Dependent Manner

The pulvinar complex is interconnected extensively with brain regions involved in spatial processing and eye movement control. Recent inactivation studies have shown that the dorsal pulvinar (dPul) plays a role in saccade target selection; however, it remains unknown whether it exerts effects on visual processing or at planning/execution stages. We used electrical microstimulation of the dPul while monkeys performed saccade tasks toward instructed and freely chosen targets. Timing of stimulation was varied, starting before, at, or after onset of target(s). Stimulation affected saccade properties and target selection in a time-dependent manner. Stimulation starting before but overlapping with target onset shortened saccadic reaction times (RTs) for ipsiversive (to the stimulation site) target locations, whereas stimulation starting at and after target onset caused systematic delays for both ipsiversive and contraversive locations. Similarly, stimulation starting before the onset of bilateral targets increased ipsiversive target choices, whereas stimulation after target onset increased contraversive choices. Properties of dPul neurons and stimulation effects were consistent with an overall contraversive drive, with varying outcomes contingent upon behavioral demands. RT and choice effects were largely congruent in the visually-guided task, but stimulation during memory-guided saccades, while influencing RTs and errors, did not affect choice behavior. Together, these results show that the dPul plays a primary role in action planning as opposed to visual processing, that it exerts its strongest influence on spatial choices when decision and action are temporally close, and that this choice effect can be dissociated from motor effects on saccade initiation and execution.

SIGNIFICANCE STATEMENT Despite a recent surge of interest, the core function of the pulvinar, the largest thalamic complex in primates, remains elusive. This understanding is crucial given the central role of the pulvinar in current theories of integrative brain functions supporting cognition and goal-directed behaviors, but electrophysiological and causal interference studies of dorsal pulvinar (dPul) are rare. Building on our previous studies that pharmacologically suppressed dPul activity for several hours, here we used transient electrical microstimulation at different periods while monkeys performed instructed and choice eye movement tasks, to determine time-specific contributions of pulvinar to saccade generation and decision making. We show that stimulation effects depend on timing and behavioral state and that effects on choices can be dissociated from motor effects.

Oculomotor neurocircuitry, a structural connectivity study of infantile nystagmus syndrome

Infantile nystagmus syndrome (INS) is one of the leading causes of significant vision loss in children and affects about 1 in 1000 to 6000 births. In the present study, we are the first to investigate the structural pathways of patients and controls using diffusion tensor imaging (DTI). Specifically, three female INS patients from the same family were scanned, two sisters and a mother. Six regions of interest (ROIs) were created manually to analyze the number of tracks. Additionally, three ROI masks were analyzed using TBSS (Tract-Based Spatial Statistics). The number of fiber tracks was reduced in INS subjects, compared to normal subjects, by 15.9%, 13.9%, 9.2%, 18.6%, 5.3%, and 2.5% for the pons, cerebellum (right and left), brainstem, cerebrum, and thalamus. Furthermore, TBSS results indicated that the fractional anisotropy (FA) values for the patients were lower in the superior ventral aspects of the pons of the brainstem than in those of the controls. We have identified some brain regions that may be actively involved in INS. These novel findings would be beneficial to the neuroimaging clinical and research community as they will give them new direction in further pursuing neurological studies related to oculomotor function and provide a rational approach to studying INS.

Synchronizing microelectrode and electronic goniometer data using a pseudo-random binary signal

Intra-operative investigation of the subthalamic nucleus (STN) requires concurrent measurement of microelectrode voltage, electrode depth and joint movement during deep brain stimulation (DBS) surgery. Commercial solutions to this problem exist but are more expensive. Multiple instruments from different manufacturers can collect the same data, but data from incompatible instruments are collected on disparate clocks, precluding quantitative analysis. A pseudo-random binary signal recorded simultaneously by each set of instruments allows for chronological reconciliation. A custom program collects microelectrode data while simultaneously sending a pseudo-random binary signal to instruments measuring joint movement. The record of this signal is later used to express microelectrode voltage and joint position in a single chronological frame of reference. ClockSynch was used in 15 DBS procedures. After each surgery, records of microelectrode and joint movement were successfully chronologically reconciled. In conclusion, a pseudo-random binary signal integrates disparate systems of instrumentation at a significantly decreased cost.

The anatomy and physiology of the ocular motor system

Accurate diagnosis of abnormal eye movements depends upon knowledge of the purpose, properties, and neural substrate of distinct functional classes of eye movement. Here, we summarize current concepts of the anatomy of eye movement control. Our approach is bottom-up, starting with the extraocular muscles and their innervation by the cranial nerves. Second, we summarize the neural circuits in the pons underlying horizontal gaze control, and the midbrain connections that coordinate vertical and torsional movements. Third, the role of the cerebellum in governing and optimizing eye movements is presented. Fourth, each area of cerebral cortex contributing to eye movements is discussed. Last, descending projections from cerebral cortex, including basal ganglionic circuits that govern different components of gaze, and the superior colliculus, are summarized. At each stage of this review, the anatomical scheme is used to predict the effects of lesions on the control of eye movements, providing clinical-anatomical correlation.

Oculomotor integration in patients with a pulvinar lesion

The pulvinar nucleus of the thalamus, with its connections to visual areas and to frontal and parietal oculomotor cortex, might serve as a nexus for integrating cortical control of voluntary eye movements with reflexive eye movements generated by the superior colliculus. To investigate this hypothesis, we tested five patients with a unilateral lesion of the pulvinar on the oculomotor capture paradigm. In this task, participants have to ignore a distractor item and make a saccade to a target in a visual search display. Results showed that the interference of the distractor was stronger when it was presented contralateral to their lesion compared to when it was presented in the ipsilesional visual field. These findings were confirmed by an additional single case experiment in which we measured saccade trajectory deviations as evoked by a single distractor. These results show that the pulvinar is involved in the successful influence of higher order signals (like our goals and intentions) on the guidance of our eye movements.

Pulvinar inactivation disrupts selection of movement plans

The coordinated movement of the eyes and hands under visual guidance is an essential part of goal-directed behavior. Several cortical areas known to be involved in this process exchange projections with the dorsal aspect of the thalamic pulvinar nucleus, suggesting that this structure may play a central role in visuomotor behavior. Here, we used reversible inactivation to investigate the role of the dorsal pulvinar in the selection and execution of visually guided manual and saccadic eye movements in macaque monkeys. We found that unilateral pulvinar inactivation resulted in a spatial neglect syndrome accompanied by visuomotor deficits including optic ataxia during visually guided limb movements. Monkeys were severely disrupted in their visually guided behavior regarding space contralateral to the side of the injection in several domains, including the following: (1) target selection in both manual and oculomotor tasks, (2) limb usage in a manual retrieval task, and (3) spontaneous visual exploration. In addition, saccades into the ipsilesional field had abnormally short latencies and tended to overshoot their mark. None of the deficits could be explained by a visual field defect or primary motor deficit. These findings highlight the importance of the dorsal aspect of the pulvinar nucleus as a critical hub for spatial attention and selection of visually guided actions.

Impaired control of the oculomotor reflexes in Parkinson's disease

To investigate the role of the basal ganglia in integrating voluntary and reflexive behaviour, the current study examined the ability of patients with Parkinson's disease to voluntarily control oculomotor reflexes. We measured the size of the fixation offset effect (the reduction in saccadic reaction time when a fixation point is removed) during a block of pro- and a block of anti-saccades. Healthy controls showed the expected reduction of the FOE during the anti-saccades, which results from efforts to suppress reflexive eye movements (a preparatory set characterized by increased internal control and reduced external control). However, there was no reduction of the FOE in the anti-saccade task in Parkinson's patients, indicating that they are impaired in exerting control over oculomotor reflexes.

The role of the human pulvinar in visual attention and action: evidence from temporal-order judgment, saccade decision, and antisaccade tasks

The pulvinar nucleus of the thalamus has been considered as a key structure for visual attention functions (Grieve, K.L. et al. (2000). Trends Neurosci., 23: 35-39; Shipp, S. (2003). Philos. Trans. R. Soc. Lond. B Biol. Sci., 358(1438): 1605-1624). During the past several years, we have studied the role of the human pulvinar in visual attention and oculomotor behaviour by testing a small group of patients with unilateral pulvinar lesions. Here we summarize some of these findings, and present new evidence for the role of this structure in both eye movements and visual attention through two versions of a temporal-order judgment task and an antisaccade task. Pulvinar damage induces an ipsilesional bias in perceptual temporal-order judgments and in saccadic decision, and also increases the latency of antisaccades away from contralesional targets. The demonstration that pulvinar damage affects both attention and oculomotor behaviour highlights the role of this structure in the integration of visual and oculomotor signals and, more generally, its role in flexibly linking visual stimuli with context-specific motor responses.