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Kroneberg D, Al-Fatly B, Morkos C, Steiner LA, Schneider GH, Kühn A. Kinematic Effects of Combined Subthalamic and Dorsolateral Nigral Deep Brain Stimulation in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:269-282. [PMID: 38363617 DOI: 10.3233/jpd-230181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background Additional stimulation of the substantia nigra (SNr) has been proposed to target axial symptoms and gait impairment in patients with Parkinson's disease (PD). Objective This study aimed to characterize effects of combined deep brain stimulation (DBS) of the subthalamic nucleus (STN) and SNr on gait performance in PD and to map stimulation sites within the SNr. Methods In a double-blinded crossover design, 10 patients with PD and gait impairment underwent clinical examination and kinematic assessment with STN DBS, combined STN+SNr DBS and OFF DBS 30 minutes after reprogramming. To confirm stimulation within the SNr, electrodes, active contacts, and stimulation volumes were modeled in a common space and overlap with atlases of SNr was computed. Results Overlap of stimulation volumes with dorsolateral SNr was confirmed for all patients. UPDRS III, scoring of freezing during turning and transitioning, stride length, stride velocity, and range of motion of shank, knee, arm, and trunk as well as peak velocities during turning and transitions and turn duration were improved with STN DBS compared to OFF. On cohort level, no further improvement was observed with combined STN+SNr DBS but additive improvement of spatiotemporal gait parameters was observed in individual subjects. Conclusions Combined high frequency DBS of the STN and dorsolateral SNr did not consistently result in additional short-term kinematic or clinical benefit compared to STN DBS. Stimulation intervals, frequency, and patient selection for target symptoms as well as target region within the SNr need further refinement in future trials.
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Affiliation(s)
- Daniel Kroneberg
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bassam Al-Fatly
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cornelia Morkos
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leon Amadeus Steiner
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Kühn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charite - Universitatsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Delgado-Zabalza L, Mallet NP, Glangetas C, Dabee G, Garret M, Miguelez C, Baufreton J. Targeting parvalbumin-expressing neurons in the substantia nigra pars reticulata restores motor function in parkinsonian mice. Cell Rep 2023; 42:113287. [PMID: 37843977 DOI: 10.1016/j.celrep.2023.113287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/31/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
The activity of substantia nigra pars reticulata (SNr) neurons, the main output structure of basal ganglia, is altered in Parkinson's disease (PD). However, neither the underlying mechanisms nor the type of neurons responsible for PD-related motor dysfunctions have been elucidated yet. Here, we show that parvalbumin-expressing SNr neurons (SNr-PV+) occupy dorsolateral parts and possess specific electrophysiological properties compared with other SNr cells. We also report that only SNr-PV+ neurons' intrinsic excitability is reduced by downregulation of sodium leak channels in a PD mouse model. Interestingly, in anesthetized parkinsonian mice in vivo, SNr-PV+ neurons display a bursty pattern of activity dependent on glutamatergic tone. Finally, we demonstrate that chemogenetic inhibition of SNr-PV+ neurons is sufficient to alleviate motor impairments in parkinsonian mice. Overall, our findings establish cell-type-specific dysfunction in experimental parkinsonism in the SNr and provide a potential cellular therapeutic target to alleviate motor symptoms in PD.
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Affiliation(s)
- Lorena Delgado-Zabalza
- University Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France; Department of Pharmacology. University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Nicolas P Mallet
- University Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France
| | | | - Guillaume Dabee
- University Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France
| | - Maurice Garret
- University Bordeaux, CNRS, INCIA, UMR 5287, 33000 Bordeaux, France
| | - Cristina Miguelez
- Department of Pharmacology. University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; Autonomic and Movement Disorders Unit, Neurodegenerative Diseases, Biocruces Health Research Institute, Barakaldo, Spain
| | - Jérôme Baufreton
- University Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France.
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3
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Horn MA, Gulberti A, Hidding U, Gerloff C, Hamel W, Moll CKE, Pötter-Nerger M. Comparison of Shod and Unshod Gait in Patients With Parkinson's Disease With Subthalamic and Nigral Stimulation. Front Hum Neurosci 2022; 15:751242. [PMID: 35095446 PMCID: PMC8790533 DOI: 10.3389/fnhum.2021.751242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The Parkinsonian [i.e., Parkinson's disease (PD)] gait disorder represents a therapeutical challenge with residual symptoms despite the use of deep brain stimulation of the subthalamic nucleus (STN DBS) and medical and rehabilitative strategies. The aim of this study was to assess the effect of different DBS modes as combined stimulation of the STN and substantia nigra (STN+SN DBS) and environmental rehabilitative factors as footwear on gait kinematics.Methods: This single-center, randomized, double-blind, crossover clinical trial assessed shod and unshod gait in patients with PD with medication in different DBS conditions (i.e., STIM OFF, STN DBS, and STN+SN DBS) during different gait tasks (i.e., normal gait, fast gait, and gait during dual task) and compared gait characteristics to healthy controls. Notably, 15 patients participated in the study, and 11 patients were analyzed after a dropout of four patients due to DBS-induced side effects.Results: Gait was modulated by both factors, namely, footwear and DBS mode, in patients with PD. Footwear impacted gait characteristics in patients with PD similarly to controls with longer step length, lower cadence, and shorter single-support time. Interestingly, DBS exerted specific effects depending on gait tasks with increased cognitive load. STN+SN DBS was the most efficient DBS mode compared to STIM OFF and STN DBS with intense effects as step length increment during dual task.Conclusion: The PD gait disorder is a multifactorial symptom, impacted by environmental factors as footwear and modulated by DBS. DBS effects on gait were specific depending on the gait task, with the most obvious effects with STN+SN DBS during gait with increased cognitive load.
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Affiliation(s)
- Martin A. Horn
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Hidding
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K. E. Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Monika Pötter-Nerger
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Paff M, Loh A, Sarica C, Lozano AM, Fasano A. Update on Current Technologies for Deep Brain Stimulation in Parkinson's Disease. J Mov Disord 2020; 13:185-198. [PMID: 32854482 PMCID: PMC7502302 DOI: 10.14802/jmd.20052] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 01/19/2023] Open
Abstract
Deep brain stimulation (DBS) is becoming increasingly central in the treatment of patients with Parkinson's disease and other movement disorders. Recent developments in DBS lead and implantable pulse generator design provide increased flexibility for programming, potentially improving the therapeutic benefit of stimulation. Directional DBS leads may increase the therapeutic window of stimulation by providing a means of avoiding current spread to structures that might give rise to stimulation-related side effects. Similarly, control of current to individual contacts on a DBS lead allows for shaping of the electric field produced between multiple active contacts. The following review aims to describe the recent developments in DBS system technology and the features of each commercially available DBS system. The advantages of each system are reviewed, and general considerations for choosing the most appropriate system are discussed.
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Affiliation(s)
- Michelle Paff
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Canada
- Krembil Brain Institute, Toronto, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
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5
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Li H, McConnell GC. Intraoperative Microelectrode Recordings in Substantia Nigra Pars Reticulata in Anesthetized Rats. Front Neurosci 2020; 14:367. [PMID: 32410946 PMCID: PMC7201294 DOI: 10.3389/fnins.2020.00367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/25/2020] [Indexed: 11/27/2022] Open
Abstract
The Substantia Nigra pars reticulata (SNr) is a promising target for deep brain stimulation (DBS) to treat the gait and postural disturbances in Parkinson’s disease (PD). Positioning the DBS electrode within the SNr is critical for the development of preclinical models of SNr DBS to investigate underlying mechanisms. However, a complete characterization of intraoperative microelectrode recordings in the SNr to guide DBS electrode placement is lacking. In this study, we recorded extracellular single-unit activity in anesthetized rats at multiple locations in the medial SNr (mSNr), lateral SNr (lSNr), and the Ventral Tegmental Area (VTA). Immunohistochemistry and fluorescently dyed electrodes were used to map neural recordings to neuroanatomy. Neural recordings were analyzed in the time domain (i.e., firing rate, interspike interval (ISI) correlation, ISI variance, regularity, spike amplitude, signal-to-noise ratio, half-width, asymmetry, and latency) and the frequency domain (i.e., spectral power in frequency bands of interest). Spike amplitude decreased and ISI correlation increased in the mSNr versus the lSNr. Spike amplitude, signal-to-noise ratio, and ISI correlation increased in the VTA versus the mSNr. ISI correlation increased in the VTA versus the lSNr. Spectral power in the VTA increased versus: (1) the mSNr in the 20–30 Hz band and (2) the lSNr in the 20–40 Hz band. No significant differences were observed between structures for any other feature analyzed. Our results shed light on the heterogeneity of the SNr and suggest electrophysiological features to promote precise targeting of SNr subregions during stereotaxic surgery.
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Affiliation(s)
- Hanyan Li
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, United States
| | - George C McConnell
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, United States
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6
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Modulation of inhibitory plasticity in basal ganglia output nuclei of patients with Parkinson's disease. Neurobiol Dis 2019; 124:46-56. [DOI: 10.1016/j.nbd.2018.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/17/2018] [Accepted: 10/31/2018] [Indexed: 01/07/2023] Open
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7
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Milosevic L, Kalia SK, Hodaie M, Lozano AM, Fasano A, Popovic MR, Hutchison WD. Neuronal inhibition and synaptic plasticity of basal ganglia neurons in Parkinson's disease. Brain 2019; 141:177-190. [PMID: 29236966 PMCID: PMC5917776 DOI: 10.1093/brain/awx296] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective treatment for Parkinson’s disease symptoms. The therapeutic benefits of deep brain stimulation are frequency-dependent, but the underlying physiological mechanisms remain unclear. To advance deep brain stimulation therapy an understanding of fundamental mechanisms is critical. The objectives of this study were to (i) compare the frequency-dependent effects on cell firing in subthalamic nucleus and substantia nigra pars reticulata; (ii) quantify frequency-dependent effects on short-term plasticity in substantia nigra pars reticulata; and (iii) investigate effects of continuous long-train high frequency stimulation (comparable to conventional deep brain stimulation) on synaptic plasticity. Two closely spaced (600 µm) microelectrodes were advanced into the subthalamic nucleus (n = 27) and substantia nigra pars reticulata (n = 14) of 22 patients undergoing deep brain stimulation surgery for Parkinson’s disease. Cell firing and evoked field potentials were recorded with one microelectrode during stimulation trains from the adjacent microelectrode across a range of frequencies (1–100 Hz, 100 µA, 0.3 ms, 50–60 pulses). Subthalamic firing attenuated with ≥20 Hz (P < 0.01) stimulation (silenced at 100 Hz), while substantia nigra pars reticulata decreased with ≥3 Hz (P < 0.05) (silenced at 50 Hz). Substantia nigra pars reticulata also exhibited a more prominent increase in transient silent period following stimulation. Patients with longer silent periods after 100 Hz stimulation in the subthalamic nucleus tended to have better clinical outcome after deep brain stimulation. At ≥30 Hz the first evoked field potential of the stimulation train in substantia nigra pars reticulata was potentiated (P < 0.05); however, the average amplitude of the subsequent potentials was rapidly attenuated (P < 0.01). This is suggestive of synaptic facilitation followed by rapid depression. Paired pulse ratios calculated at the beginning of the train revealed that 20 Hz (P < 0.05) was the minimum frequency required to induce synaptic depression. Lastly, the average amplitude of evoked field potentials during 1 Hz pulses showed significant inhibitory synaptic potentiation after long-train high frequency stimulation (P < 0.001) and these increases were coupled with increased durations of neuronal inhibition (P < 0.01). The subthalamic nucleus exhibited a higher frequency threshold for stimulation-induced inhibition than the substantia nigra pars reticulata likely due to differing ratios of GABA:glutamate terminals on the soma and/or the nature of their GABAergic inputs (pallidal versus striatal). We suggest that enhancement of inhibitory synaptic plasticity, and frequency-dependent potentiation and depression are putative mechanisms of deep brain stimulation. Furthermore, we foresee that future closed-loop deep brain stimulation systems (with more frequent off stimulation periods) may benefit from inhibitory synaptic potentiation that occurs after high frequency stimulation.
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Affiliation(s)
- Luka Milosevic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario, M5S 3G9, Canada.,Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario, M5T 1P5, Canada.,Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.,Krembil Research Institute, 135 Nassau St, Toronto, Ontario, M5T 1M8, Canada
| | - Mojgan Hodaie
- Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario, M5T 1P5, Canada.,Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.,Krembil Research Institute, 135 Nassau St, Toronto, Ontario, M5T 1M8, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario, M5T 1P5, Canada.,Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.,Krembil Research Institute, 135 Nassau St, Toronto, Ontario, M5T 1M8, Canada
| | - Alfonso Fasano
- Krembil Research Institute, 135 Nassau St, Toronto, Ontario, M5T 1M8, Canada.,Morton and Gloria Shulman Movement Disorders Center and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - University Health Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.,Division of Neurology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario, M5S 3G9, Canada.,Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada
| | - William D Hutchison
- Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario, M5T 1P5, Canada.,Krembil Research Institute, 135 Nassau St, Toronto, Ontario, M5T 1M8, Canada.,Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
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8
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Naduthota RM, Honnedevasthana AA, Lenka A, Saini J, Geethanath S, Bharath RD, Christopher R, Yadav R, Gupta AK, Pal PK. Association of freezing of gait with nigral iron accumulation in patients with Parkinson's disease. J Neurol Sci 2017; 382:61-65. [PMID: 29111022 DOI: 10.1016/j.jns.2017.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/08/2017] [Accepted: 09/22/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE The objective of this work was to investigate whether patients with and without freezing of gait (FOG) in Parkinson's disease (PD) have differences in iron accumulation in substantia nigra using R2* relaxometry. MATERIALS AND METHODS This study included seventeen PD patients with FOG [FOG (+)], equal number of age and gender matched patients without FOG [FOG (-)] and 34 healthy controls (HC). T2* images were obtained from a 3-Tesla MRI system using multi-echo sequence. R2* values were extracted from Substantia Nigra (SN) and red nucleus and were compared among the three groups and correlated with clinical findings. RESULTS R2* values were increased in PD group as a whole compared to HC in rostral and caudal segments of Substantia Nigra pars compacta (SNc) and in Substantia Nigra pars reticulata (SNr) but not in red nucleus. Within PD subgroups, FOG (+) group had increased iron accumulation in SNc compared to FOG (-) and HC. FOG score positively correlated with R2* values in the caudal region of SNc in FOG (+) group. CONCLUSIONS Our study reveals higher nigral iron content in FOG (+) compared to FOG (-) and HCs. In addition, we observed positive correlation of FOG score with iron accumulation in SNc. Results of this study emphasize possible role of higher nigral iron content in the pathogenesis of FOG in PD.
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Affiliation(s)
- Rajini M Naduthota
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Arush Arun Honnedevasthana
- Medical Imaging Research Center, Dayanand Sagar Institutions, Kumara Swamy Layout, Bangalore 560078, India
| | - Abhishek Lenka
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India; Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Sairam Geethanath
- Medical Imaging Research Center, Dayanand Sagar Institutions, Kumara Swamy Layout, Bangalore 560078, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Arun Kumar Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
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9
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Impact of Combined Subthalamic Nucleus and Substantia Nigra Stimulation on Neuropsychiatric Symptoms in Parkinson's Disease Patients. PARKINSONS DISEASE 2017; 2017:7306192. [PMID: 28246572 PMCID: PMC5299199 DOI: 10.1155/2017/7306192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
The goal of the study was to compare the tolerability and the effects of conventional subthalamic nucleus (STN) and combined subthalamic nucleus and substantia nigra (STN+SNr) high-frequency stimulation in regard to neuropsychiatric symptoms in Parkinson's disease patients. In this single center, randomized, double-blind, cross-over clinical trial, twelve patients with advanced Parkinson's disease (1 female; age: 61.3 ± 7.3 years; disease duration: 12.3 ± 5.4 years; Hoehn and Yahr stage: 2.2 ± 0.39) were included. Apathy, fatigue, depression, and impulse control disorder were assessed using a comprehensive set of standardized rating scales and questionnaires such as the Lille Apathy Rating Scale (LARS), Modified Fatigue Impact Scale (MFIS), Becks Depression Inventory (BDI-I), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS), and Parkinson's Disease Questionnaire (PDQ-39). Three patients that were initially assigned to the STN+SNr stimulation mode withdrew from the study within the first week due to discomfort. Statistical comparison of data retrieved from patients who completed the study revealed no significant differences between both stimulation conditions in terms of mean scores of scales measuring apathy, fatigue, depression, impulse control disorder, and quality of life. Individual cases showed an improvement of apathy under combined STN+SNr stimulation. In general, combined STN+SNr stimulation seems to be safe in terms of neuropsychiatric side effects, although careful patient selection and monitoring in the short-term period after changing stimulation settings are recommended.
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Pötter-Nerger M, Volkmann J. Deep brain stimulation for gait and postural symptoms in Parkinson's disease. Mov Disord 2014; 28:1609-15. [PMID: 24132849 DOI: 10.1002/mds.25677] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 11/06/2022] Open
Abstract
In patients with Parkinson's disease, gait and balance difficulties have emerged as some of the main therapeutic concerns. During earlier stages of the disease, the dopamine-responsive aspects of gait disorder can be treated initially with dopaminergic drugs or deep brain stimulation. However, certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant in both the short term and the long term. In this review, we summarize the effects of deep brain stimulation on gait and postural symptoms in the five currently available targets (subthalamic nucleus, globus pallidus, ventralis intermedius thalamic nucleus, pedunculopontine nucleus, and substantia nigra) and describe programming strategies for patients who are mainly disabled by gait problems.
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11
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Castrioto A, Moro E. New targets for deep brain stimulation treatment of Parkinson's disease. Expert Rev Neurother 2013; 13:1319-28. [PMID: 24215284 DOI: 10.1586/14737175.2013.859987] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus pars interna (GPi) has been shown to be an effective treatment for patients with Parkinson's disease. Strong clinical evidence supports the improvement of motor and non-motor complications and quality of life, with some data suggesting that GPi DBS might be less effective than STN DBS. However, neither STN nor GPi stimulation provides a satisfactory control of non-dopaminergic symptoms, such as gait and balance impairment and cognitive decline, which are frequent and disabling symptoms in advanced Parkinson's disease patients. Therefore, several efforts have been made to discover alternative and new targets to overcome these current DBS limitations. Among these new targets, the stimulation of the pedunculopontine nucleus has initially appeared encouraging. However, findings from different double-blind trials have mitigated the enthusiasm. A multi-target strategy aimed at improving symptoms with different pathogenetic mechanisms might be a promising approach in the next years.
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Affiliation(s)
- Anna Castrioto
- Movement Disorders Centre, Department of Psychiatry and Neurology, CHU de Grenoble - CS10217, 38043 Grenoble Cedex 09, France
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12
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Weiss D, Walach M, Meisner C, Fritz M, Scholten M, Breit S, Plewnia C, Bender B, Gharabaghi A, Wächter T, Krüger R. Nigral stimulation for resistant axial motor impairment in Parkinson's disease? A randomized controlled trial. ACTA ACUST UNITED AC 2013; 136:2098-108. [PMID: 23757762 PMCID: PMC3692032 DOI: 10.1093/brain/awt122] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gait and balance disturbances typically emerge in advanced Parkinson’s disease with generally limited response to dopaminergic medication and subthalamic nucleus deep brain stimulation. Therefore, advanced programming with interleaved pulses was put forward to introduce concomittant nigral stimulation on caudal contacts of a subthalamic lead. Here, we hypothesized that the combined stimulation of subthalamic nucleus and substantia nigra pars reticulata improves axial symptoms compared with standard subthalamic nucleus stimulation. Twelve patients were enrolled in this 2 × 2 cross-over double-blind randomized controlled clinical trial and both the safety and efficacy of combined subthalamic nucleus and substantia nigra pars reticulata stimulation were evaluated compared with standard subthalamic nucleus stimulation. The primary outcome measure was the change of a broad-scaled cumulative axial Unified Parkinson’s Disease Rating Scale score (Scale II items 13–15, Scale III items 27–31) at ‘3-week follow-up’. Secondary outcome measures specifically addressed freezing of gait, balance, quality of life, non-motor symptoms and neuropsychiatric symptoms. For the primary outcome measure no statistically significant improvement was observed for combined subthalamic nucleus and substantia nigra pars reticulata stimulation at the ‘3-week follow-up’. The secondary endpoints, however, revealed that the combined stimulation of subthalamic nucleus and substantia nigra pars reticulata might specifically improve freezing of gait, whereas balance impairment remained unchanged. The combined stimulation of subthalamic nucleus and substantia nigra pars reticulata was safe, and of note, no clinically relevant neuropsychiatric adverse effect was observed. Patients treated with subthalamic nucleus and substantia nigra pars reticulata stimulation revealed no ‘global’ effect on axial motor domains. However, this study opens the perspective that concomittant stimulation of the substantia nigra pars reticulata possibly improves otherwise resistant freezing of gait and, therefore, highly warrants a subsequent phase III randomized controlled trial.
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Affiliation(s)
- Daniel Weiss
- German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
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Sutton AC, Yu W, Calos ME, Smith AB, Ramirez-Zamora A, Molho ES, Pilitsis JG, Brotchie JM, Shin DS. Deep brain stimulation of the substantia nigra pars reticulata improves forelimb akinesia in the hemiparkinsonian rat. J Neurophysiol 2012; 109:363-74. [PMID: 23076106 DOI: 10.1152/jn.00311.2012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation (DBS) employing high-frequency stimulation (HFS) is commonly used in the globus pallidus interna (GPi) and the subthalamic nucleus (STN) for treating motor symptoms of patients with Parkinson's disease (PD). Although DBS improves motor function in most PD patients, disease progression and stimulation-induced nonmotor complications limit DBS in these areas. In this study, we assessed whether stimulation of the substantia nigra pars reticulata (SNr) improved motor function. Hemiparkinsonian rats predominantly touched with their unimpaired forepaw >90% of the time in the stepping and limb-use asymmetry tests. After SNr-HFS (150 Hz), rats touched equally with both forepaws, similar to naive and sham-lesioned rats. In vivo, SNr-HFS decreased beta oscillations (12-30 Hz) in the SNr of freely moving hemiparkinsonian rats and decreased SNr neuronal spiking activity from 28 ± 1.9 Hz before stimulation to 0.8 ± 1.9 Hz during DBS in anesthetized animals; also, neuronal spiking activity increased from 7 ± 1.6 to 18 ± 1.6 Hz in the ventromedial portion of the thalamus (VM), the primary SNr efferent. In addition, HFS of the SNr in brain slices from normal and reserpine-treated rat pups resulted in a depolarization block of SNr neuronal activity. We demonstrate improvement of forelimb akinesia with SNr-HFS and suggest that this motor effect may have resulted from the attenuation of SNr neuronal activity, decreased SNr beta oscillations, and increased activity of VM thalamic neurons, suggesting that the SNr may be a plausible DBS target for treating motor symptoms of DBS.
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Affiliation(s)
- Alexander C Sutton
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY 12208, USA
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Weiss D, Brockmann K, Srulijes K, Meisner C, Klotz R, Reinbold S, Hauser AK, Schulte C, Berg D, Gasser T, Plewnia C, Gharabaghi A, Breit S, Wächter T, Krüger R. Long-term follow-up of subthalamic nucleus stimulation in glucocerebrosidase-associated Parkinson's disease. J Neurol 2012; 259:1970-2. [PMID: 22427207 DOI: 10.1007/s00415-012-6469-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
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