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James JG, McCall NM, Hsu AI, Oswell CS, Salimando GJ, Mahmood M, Wooldridge LM, Wachira M, Jo A, Sandoval Ortega RA, Wojick JA, Beattie K, Farinas SA, Chehimi SN, Rodrigues A, Ejoh LSL, Kimmey BA, Lo E, Azouz G, Vasquez JJ, Banghart MR, Creasy KT, Beier KT, Ramakrishnan C, Crist RC, Reiner BC, Deisseroth K, Yttri EA, Corder G. Mimicking opioid analgesia in cortical pain circuits. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.26.591113. [PMID: 38746090 PMCID: PMC11092437 DOI: 10.1101/2024.04.26.591113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
The anterior cingulate cortex plays a pivotal role in the cognitive and affective aspects of pain perception. Both endogenous and exogenous opioid signaling within the cingulate mitigate cortical nociception, reducing pain unpleasantness. However, the specific functional and molecular identities of cells mediating opioid analgesia in the cingulate remain elusive. Given the complexity of pain as a sensory and emotional experience, and the richness of ethological pain-related behaviors, we developed a standardized, deep-learning platform for deconstructing the behavior dynamics associated with the affective component of pain in mice-LUPE (Light aUtomated Pain Evaluator). LUPE removes human bias in behavior quantification and accelerated analysis from weeks to hours, which we leveraged to discover that morphine altered attentional and motivational pain behaviors akin to affective analgesia in humans. Through activity-dependent genetics and single-nuclei RNA sequencing, we identified specific ensembles of nociceptive cingulate neuron-types expressing mu-opioid receptors. Tuning receptor expression in these cells bidirectionally modulated morphine analgesia. Moreover, we employed a synthetic opioid receptor promoter-driven approach for cell-type specific optical and chemical genetic viral therapies to mimic morphine's pain-relieving effects in the cingulate, without reinforcement. This approach offers a novel strategy for precision pain management by targeting a key nociceptive cortical circuit with on-demand, non-addictive, and effective analgesia.
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Affiliation(s)
- Justin G. James
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nora M. McCall
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alex I. Hsu
- Dept. of Biobehavioral Health Sciences, School of Nursing, and Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Dept. of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Corinna S. Oswell
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory J. Salimando
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Malaika Mahmood
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M. Wooldridge
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Meghan Wachira
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrienne Jo
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jessica A. Wojick
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Beattie
- Dept. of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sofia A. Farinas
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Samar N. Chehimi
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amrith Rodrigues
- Dept. of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lind-say L. Ejoh
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Blake A. Kimmey
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Lo
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ghalia Azouz
- Dept. of Physiology and Biophysics, University of California Irvine, CA, USA
| | - Jose J. Vasquez
- Dept. of Physiology and Biophysics, University of California Irvine, CA, USA
| | - Matthew R. Banghart
- Dept. of Neurobiology, School of Biological Sciences, University of California San Diego, CA, USA
| | - Kate Townsend Creasy
- Dept. of Biobehavioral Health Sciences, School of Nursing, and Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin T. Beier
- Dept. of Physiology and Biophysics, University of California Irvine, CA, USA
| | | | - Richard C. Crist
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin C. Reiner
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karl Deisseroth
- CNC Program, Stanford University, Stanford, CA, USA
- Dept. of Bioengineering, Stanford University, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
- Dept. of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Eric A. Yttri
- Dept. of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Gregory Corder
- Dept. of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Dept. of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Dept. of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Moghaddam HS, Parsaei M, Taghavizanjani F, Cattarinussi G, Aarabi MH, Sambataro F. White matter alterations in affective and non-affective early psychosis: A diffusion MRI study. J Affect Disord 2024; 351:615-623. [PMID: 38290585 DOI: 10.1016/j.jad.2024.01.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/06/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The early years after the onset of psychotic disorders, known as "early psychosis" (EP) are critical to determining the path of psychosis trajectory. We used a Diffusion Magnetic Resonance Imaging (DMRI) connectometry approach to assess the microstructural changes of white matter (WM) associated with EP. METHODS We used the Human Connectome Project in Early Psychosis (HCP-EP) dataset to collect DMRI data from patients with EP. The imaging data were processed in the Montreal Neuroimaging Initiative space and transformed into quantitative anisotropy (QA). The QA value was translated into the WM connectivity of each tract and used in the subsequent analysis. RESULTS 121 patients with EP (94 non-affective/27 affective) and 56 healthy controls were recruited. EP was associated with increased QA in the body and tapetum of corpus callosum (CC) and decreased QA in the bilateral cerebellum, and middle cerebellar peduncle. Compared to non-affective psychosis, affective psychosis showed increased QA in the bilateral cerebellum and vermis and decreased QA in the forceps minor, body of CC, right cingulum, and bilateral inferior fronto-occipital fasciculus. Furthermore, QA changes in several WM tracts were correlated with positive and negative symptom scale scores. LIMITATIONS DMRI intrinsic limitations, limited sample size, and neurobiological effects of psychotropic treatment. CONCLUSIONS EP is associated with alterations in WM connectivity primarily in the CC and cerebellar regions. Also, affective and non-affective psychosis have distinct alterations in WM connectivity. These results can be used for the early diagnosis and differentiation of psychotic disorders.
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Affiliation(s)
| | - Mohammadamin Parsaei
- Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Taghavizanjani
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mohammad Hadi Aarabi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy.
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Toba MN, Malkinson TS, Howells H, Mackie MA, Spagna A. Same, Same but Different? A Multi-Method Review of the Processes Underlying Executive Control. Neuropsychol Rev 2023:10.1007/s11065-023-09577-4. [DOI: 10.1007/s11065-023-09577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/26/2022] [Indexed: 03/29/2023]
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Sherif MA, Fotros A, Greenberg BD, McLaughlin NCR. Understanding cingulotomy's therapeutic effect in OCD through computer models. Front Integr Neurosci 2023; 16:889831. [PMID: 36704759 PMCID: PMC9871832 DOI: 10.3389/fnint.2022.889831] [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: 03/04/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Cingulotomy is therapeutic in OCD, but what are the possible mechanisms? Computer models that formalize cortical OCD abnormalities and anterior cingulate cortex (ACC) function can help answer this. At the neural dynamics level, cortical dynamics in OCD have been modeled using attractor networks, where activity patterns resistant to change denote the inability to switch to new patterns, which can reflect inflexible thinking patterns or behaviors. From that perspective, cingulotomy might reduce the influence of difficult-to-escape ACC attractor dynamics on other cortical areas. At the functional level, computer formulations based on model-free reinforcement learning (RL) have been used to describe the multitude of phenomena ACC is involved in, such as tracking the timing of expected outcomes and estimating the cost of exerting cognitive control and effort. Different elements of model-free RL models of ACC could be affected by the inflexible cortical dynamics, making it challenging to update their values. An agent can also use a world model, a representation of how the states of the world change, to plan its actions, through model-based RL. OCD has been hypothesized to be driven by reduced certainty of how the brain's world model describes changes. Cingulotomy might improve such uncertainties about the world and one's actions, making it possible to trust the outcomes of these actions more and thus reduce the urge to collect more sensory information in the form of compulsions. Connecting the neural dynamics models with the functional formulations can provide new ways of understanding the role of ACC in OCD, with potential therapeutic insights.
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Affiliation(s)
- Mohamed A. Sherif
- Department of Psychiatry, Brown University, Providence, RI, United States,Carney Institute for Brain Science, Brown University, Providence, RI, United States,Department of Psychiatry Lifespan Health System, Providence, RI, United States,*Correspondence: Mohamed A. Sherif,
| | - Aryandokht Fotros
- Department of Psychiatry, Brown University, Providence, RI, United States,Department of Psychiatry Lifespan Health System, Providence, RI, United States
| | - Benjamin D. Greenberg
- Department of Psychiatry, Brown University, Providence, RI, United States,Carney Institute for Brain Science, Brown University, Providence, RI, United States,Butler Hospital, Providence, RI, United States,United States Department of Veterans Affairs, Providence VA Medical Center, Providence, RI, United States
| | - Nicole C. R. McLaughlin
- Department of Psychiatry, Brown University, Providence, RI, United States,Carney Institute for Brain Science, Brown University, Providence, RI, United States,Butler Hospital, Providence, RI, United States
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Kimmey BA, McCall NM, Wooldridge LM, Satterthwaite T, Corder G. Engaging endogenous opioid circuits in pain affective processes. J Neurosci Res 2022; 100:66-98. [PMID: 33314372 PMCID: PMC8197770 DOI: 10.1002/jnr.24762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 01/03/2023]
Abstract
The pervasive use of opioid compounds for pain relief is rooted in their utility as one of the most effective therapeutic strategies for providing analgesia. While the detrimental side effects of these compounds have significantly contributed to the current opioid epidemic, opioids still provide millions of patients with reprieve from the relentless and agonizing experience of pain. The human experience of pain has long recognized the perceived unpleasantness entangled with a unique sensation that is immediate and identifiable from the first-person subjective vantage point as "painful." From this phenomenological perspective, how is it that opioids interfere with pain perception? Evidence from human lesion, neuroimaging, and preclinical functional neuroanatomy approaches is sculpting the view that opioids predominately alleviate the affective or inferential appraisal of nociceptive neural information. Thus, opioids weaken pain-associated unpleasantness rather than modulate perceived sensory qualities. Here, we discuss the historical theories of pain to demonstrate how modern neuroscience is revisiting these ideas to deconstruct the brain mechanisms driving the emergence of aversive pain perceptions. We further detail how targeting opioidergic signaling within affective or emotional brain circuits remains a strong avenue for developing targeted pharmacological and gene-therapy analgesic treatments that might reduce the dependence on current clinical opioid options.
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Affiliation(s)
- Blake A. Kimmey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Equal contributions
| | - Nora M. McCall
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Equal contributions
| | - Lisa M. Wooldridge
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Corder
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Rasmussen SA, Goodman WK. The prefrontal cortex and neurosurgical treatment for intractable OCD. Neuropsychopharmacology 2022; 47:349-360. [PMID: 34433915 PMCID: PMC8616947 DOI: 10.1038/s41386-021-01149-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023]
Abstract
Over the past two decades, circuit-based neurosurgical procedures have gained increasing acceptance as a safe and efficacious approach to the treatment of the intractable obsessive-compulsive disorder (OCD). Lesions and deep brain stimulation (DBS) of the longitudinal corticofugal white matter tracts connecting the prefrontal cortex with the striatum, thalamus, subthalamic nucleus (STN), and brainstem implicate orbitofrontal, medial prefrontal, frontopolar, and ventrolateral cortical networks in the symptoms underlying OCD. The highly parallel distributed nature of these networks may explain the relative lack of adverse effects observed following surgery. Additional pre-post studies of cognitive tasks in more surgical patients are needed to confirm the role of these networks in OCD and to define therapeutic responses to surgical intervention.
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Affiliation(s)
- Steven A. Rasmussen
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI USA ,grid.40263.330000 0004 1936 9094Carney Brain Science Institute, Brown University, Providence, RI USA
| | - Wayne K. Goodman
- grid.39382.330000 0001 2160 926XMenninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
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Seamans JK, Floresco SB. Event-based control of autonomic and emotional states by the anterior cingulate cortex. Neurosci Biobehav Rev 2021; 133:104503. [PMID: 34922986 DOI: 10.1016/j.neubiorev.2021.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022]
Abstract
Despite being an intensive area of research, the function of the anterior cingulate cortex (ACC) remains somewhat of a mystery. Human imaging studies implicate the ACC in various cognitive functions, yet surgical ACC lesions used to treat emotional disorders have minimal lasting effects on cognition. An alternative view is that ACC regulates autonomic states, consistent with its interconnectivity with autonomic control regions and that stimulation evokes changes in autonomic/emotional states. At the cellular level, ACC neurons are highly multi-modal and promiscuous, and can represent a staggering array of task events. These neurons nevertheless combine to produce highly event-specific ensemble patterns that likely alter activity in downstream regions controlling emotional and autonomic tone. Since neuromodulators regulate the strength of the ensemble activity patterns, they would regulate the impact these patterns have on downstream targets. Through these mechanisms, the ACC may determine how strongly to react to the very events its ensembles represent. Pathologies arise when specific event-related representations gain excessive control over autonomic/emotional states.
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Affiliation(s)
- Jeremy K Seamans
- Depts. of Psychiatry, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6B2T5, Canada.
| | - Stan B Floresco
- Depts. of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6B2T5, Canada
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8
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Optogenetic Stimulation of the Anterior Cingulate Cortex Modulates the Pain Processing in Neuropathic Pain: A Review. J Mol Neurosci 2021; 72:1-8. [PMID: 34505976 DOI: 10.1007/s12031-021-01898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022]
Abstract
Neuropathic pain is characterized by hypersensitivity, hyperalgesia, and allodynia, which is caused by damage to the somatosensory nervous system. It substantially impairs the quality of life. The management of neuropathic pain is challenging and should comprise alternative therapies. Researchers working on neural modulation methods in the field of optogenetics have recently referred to novel techniques that involve the activation or inhibition of signaling proteins by specific wavelengths of light. The use of optogenetics in neuropathic pain facilitates the investigation of pain pathways involved in chronic pain and has the potential for therapeutic use. Neuropathic pain is often accompanied by negative stimuli involving a broad network of brain regions. In particular, the anterior cingulate cortex (ACC) is a part of the limbic system that has highly interconnected structures involved in processing components of pain. The ACC is a key region for acute pain perception as well as the development of neuropathic pain, characterized by long-term potentiation induced in pain pathways. The exact mechanism for neuropathic pain in the ACC is unclear. Current evidence supports the potential of optogenetics methods to modulate the neuronal activity in the ACC for neuropathic pain. We anticipate the neuronal modulation in the ACC will be used widely to manage neuropathic pain.
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Brenner RG, Smyser CD, Lean RE, Kenley JK, Smyser TA, Cyr PEP, Shimony JS, Barch DM, Rogers CE. Microstructure of the Dorsal Anterior Cingulum Bundle in Very Preterm Neonates Predicts the Preterm Behavioral Phenotype at 5 Years of Age. Biol Psychiatry 2021; 89:433-442. [PMID: 32828528 PMCID: PMC8064762 DOI: 10.1016/j.biopsych.2020.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The cingulum bundle (CB), specifically the dorsal anterior portion of the CB, plays an important role in psychiatric illnesses; however, its role during early development is unclear. This study investigated whether neonatal white matter microstructure in the CB and its subregions is associated with subsequent preterm behavioral phenotype symptoms (internalizing, inattention, and social deficits) in very preterm (VPT) children. METHODS Diffusion magnetic resonance imaging data were obtained on a 3T scanner in 138 sleeping nonsedated neonates: 55 full-term neonates (gestational age ≥ 36 weeks) and 83 VPT neonates (gestational age < 30 weeks). The CB was tracked using probabilistic tractography and split into anterior and posterior portions. When children were 5 years of age, parents (n = 80) and teachers (n = 63) of VPT children completed questionnaires of preterm behavioral phenotype symptoms. Linear regression models were used to relate measures of neonatal CB microstructure and childhood preterm behavioral phenotype symptoms (n = 56 parent report, n = 45 teacher report). RESULTS Mean diffusivity in the anterior and posterior CB was increased in VPT neonates compared with full-term neonates. Increased fractional anisotropy and decreased mean diffusivity in the right anterior CB, but not in the posterior CB, were related to increased preterm behavioral phenotype symptoms in VPT children as reported by parents and teachers. CONCLUSIONS Aberrations in the anterior portion of the right CB may underlie the early development of the preterm behavioral phenotype. This finding provides the foundation for future mechanistic and therapeutic investigations into the role of the anterior cingulum in the development of psychopathology in VPT infants.
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Affiliation(s)
- Rebecca G Brenner
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri; Mallinckrot Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Jeanette K Kenley
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Peppar E P Cyr
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- Mallinckrot Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Deanna M Barch
- Mallinckrot Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Cynthia E Rogers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Seamans JK. The anterior cingulate cortex and event-based modulation of autonomic states. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 158:135-169. [PMID: 33785144 DOI: 10.1016/bs.irn.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In spite of being an intensive area of research focus, the anterior cingulate cortex (ACC) remains somewhat of an enigma. Many theories have focused on its role in various aspects of cognition yet surgically precise lesions of the ACC, used to treat severe emotional disorders in human patients, typically have no lasting effects on cognition. An alternative view is that the ACC has a prominent role in regulating autonomic states. This view is consistent with anatomical data showing that a main target of the ACC are regions involved in autonomic control and with the observation that stimulation of the ACC evokes changes in autonomic states in both animals and humans. From an electrophysiological perspective, ACC neurons appear able to represent virtually any event or internal state, even though there is not always a strong link between these representations and behavior. Ensembles of neurons form robust contextual representations that strongly influence how specific events are encoded. The activity patterns associated with these contextually-based event representations presumably impact activity in downstream regions that control autonomic state. As a result, the ACC may regulate the autonomic and perhaps emotional reactions to events it is representing. This event-based control of autonomic tone by the ACC would likely arise during all types of cognitive and affective processes, without necessarily being critical for any of them.
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Affiliation(s)
- Jeremy K Seamans
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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11
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Monosov IE, Haber SN, Leuthardt EC, Jezzini A. Anterior Cingulate Cortex and the Control of Dynamic Behavior in Primates. Curr Biol 2020; 30:R1442-R1454. [PMID: 33290716 PMCID: PMC8197026 DOI: 10.1016/j.cub.2020.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The brain mechanism for controlling continuous behavior in dynamic contexts must mediate action selection and learning across many timescales, responding differentially to the level of environmental uncertainty and volatility. In this review, we argue that a part of the frontal cortex known as the anterior cingulate cortex (ACC) is particularly well suited for this function. First, the ACC is interconnected with prefrontal, parietal, and subcortical regions involved in valuation and action selection. Second, the ACC integrates diverse, behaviorally relevant information across multiple timescales, producing output signals that temporally encapsulate decision and learning processes and encode high-dimensional information about the value and uncertainty of future outcomes and subsequent behaviors. Third, the ACC signals behaviorally relevant information flexibly, displaying the capacity to represent information about current and future states in a valence-, context-, task- and action-specific manner. Fourth, the ACC dynamically controls instrumental- and non-instrumental information seeking behaviors to resolve uncertainty about future outcomes. We review electrophysiological and circuit disruption studies in primates to develop this point, discuss its relationship to novel therapeutics for neuropsychiatric disorders in humans, and conclude by relating ongoing research in primates to studies of medial frontal cortical regions in rodents.
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Affiliation(s)
- Ilya E Monosov
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO 63130, USA; Department of Electrical Engineering, Washington University, St. Louis, MO 63130, USA; Department of Neurosurgery School of Medicine, Washington University, St. Louis, MO 63110, USA; Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester, Rochester, NY 14627, USA; Basic Neuroscience, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Eric C Leuthardt
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63130, USA; Department of Neurosurgery School of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Ahmad Jezzini
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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Zhao Y, Sallie SN, Cui H, Zeng N, Du J, Yuan T, Li D, De Ridder D, Zhang C. Anterior Cingulate Cortex in Addiction: New Insights for Neuromodulation. Neuromodulation 2020; 24:S1094-7159(21)00082-9. [PMID: 33090660 DOI: 10.1111/ner.13291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Substance use disorder (SUD) is characterized by compulsive use of addictive substances with considerable impact on both the medical system and society as a whole. The craving of substances leads to relapse in the majority of patients within one year of traditional treatments. In recent decades, neuromodulation approaches have emerged as potential novel treatments of SUD, but the ideal neural target remains contentious. MATERIALS AND METHODS In this review, we discuss new insights on the anterior cingulate cortex (ACC) as a neuromodulation target for SUD. RESULTS AND CONCLUSION First, we illustrate that the ACC serves as a central "hub" in addiction-related neural networks of cognitive functions, including, but not limited to, decision-making, cognitive inhibition, emotion, and motivation. Then, we summarize the literature targeting the ACC to treat SUDs via available neuromodulation approaches. Finally, we propose potential directions to improve the effect of stimulating the ACC in SUD treatment. We emphasize that the ACC can be divided into at least four sub-regions, which have distinctive functions and connections. Studies focusing on these sub-regions may help to develop more precise and effective ACC stimulation according to patients' symptom profiles and cognitive deficits.
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Affiliation(s)
- Yijie Zhao
- 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 Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Samantha N Sallie
- Department of Psychiatry, University of Cambridge, Level E4, Addenbrooke's Hospital, Cambridge, UK
| | - Hailun Cui
- Department of Psychiatry, University of Cambridge, Level E4, Addenbrooke's Hospital, Cambridge, UK
| | - Ningning Zeng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wong HJ, Chew QH, Lee RD, Sim K. Illness remission status and commissural and associative brain white matter fiber changes in schizophrenia. Psych J 2020; 9:894-902. [PMID: 32881375 DOI: 10.1002/pchj.399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 01/01/2023]
Abstract
There is a paucity of studies clarifying biological basis of illness remission in schizophrenia related to white matter abnormalities, hence this study aimed to examine brain white matter anomalies via combinatorial diffusion tensor imaging (DTI) indices between remitted and nonremitted patients and evaluate predictors of remission. We examined DTI data of 178 patients who met the DSM-IV criteria for schizophrenia (120 nonremitted, 58 remitted) and 111 healthy controls. Remission was determined using Global Assessment of Functioning (GAF) and Positive and Negative Syndrome Scale (PANSS) scores. Analysis of covariance identified significantly different white matter tracts between groups, whilst covarying for clinical variables. Correlation and regression analyses were performed to determine clinical-imaging predictors of remission. Compared to controls, both nonremitted and remitted patients had reduced fractional anisotropy in the body of corpus callosum (BCC) and posterior thalamic radiation. Nonremitted patients had higher axial diffusivity (AD)/mean diffusivity (MD) values in the right cingulum than remitted patients after controlling for duration of illness, number of hospitalizations, and daily total chlorpromazine equivalents. The MD and AD of right cingulum correlated positively with the severity of psychotic psychopathology in nonremitted subjects. In addition, female sex and longer duration of illness were also significant predictors of remission. Specific DTI indices reflecting axonal processes and inflammation/edema of associative fibers (right cingulum) differentiated nonremitted from remitted patients, and together with relevant clinical factors, could serve as potential prognostic markers in schizophrenia.
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Affiliation(s)
- Hong Jie Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | - Renick D Lee
- Research Division, Institute of Mental Health, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore
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14
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De Ridder D, Vanneste S. The Bayesian brain in imbalance: Medial, lateral and descending pathways in tinnitus and pain: A perspective. PROGRESS IN BRAIN RESEARCH 2020; 262:309-334. [PMID: 33931186 DOI: 10.1016/bs.pbr.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tinnitus and pain share similarities in their anatomy, pathophysiology, clinical picture and treatments. Based on what is known in the pain field, a heuristic model can be proposed for the pathophysiolgy of tinnitus. This heuristic pathophysiological model suggests that pain and tinnitus are the consequence of an imbalance between two pain/tinnitus evoking pathways, i.e., a lateral sensory pathway and a medial affective pathway, both of which are not balanced anymore by a pain/noise inhibitory pathway. Mechanistically, based on the Bayesian brain concept, it can be explained by a switch occuring under influence of the rostral to dorsal anterior cingulate cortex of its prior predictions, i.e., a reference resetting, in which the pain/tinnitus state is considered as the new reference state. This reference resetting is confirmed by the nucleus accumbens as part of the reward system and maintained by connectivity changes between the nucleus accumbens and the pregenual anterior cingulate cortex. As a consequence it can be suggested to treat pain/tinnitus via reconditioning, either surgically or non-surgically. The model can also be used to develop objective measures for tinnitus and pain via supervised machine learning.
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Affiliation(s)
- Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Sven Vanneste
- Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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15
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Lustberg D, Iannitelli AF, Tillage RP, Pruitt M, Liles LC, Weinshenker D. Central norepinephrine transmission is required for stress-induced repetitive behavior in two rodent models of obsessive-compulsive disorder. Psychopharmacology (Berl) 2020; 237:1973-1987. [PMID: 32313981 PMCID: PMC7961804 DOI: 10.1007/s00213-020-05512-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE Obsessive-compulsive disorder (OCD) is characterized by repetitive behaviors exacerbated by stress. Many OCD patients do not respond to available pharmacotherapies, but neurosurgical ablation of the anterior cingulate cortex (ACC) can provide symptomatic relief. Although the ACC receives noradrenergic innervation and expresses adrenergic receptors (ARs), the involvement of norepinephrine (NE) in OCD has not been investigated. OBJECTIVE To determine the effects of genetic or pharmacological disruption of NE neurotransmission on marble burying (MB) and nestlet shredding (NS), two animal models of OCD. METHODS We assessed NE-deficient (Dbh -/-) mice and NE-competent (Dbh +/-) controls in MB and NS tasks. We also measured the effects of anti-adrenergic drugs on NS and MB in control mice and the effects of pharmacological restoration of central NE in Dbh -/- mice. Finally, we compared c-fos induction in the locus coeruleus (LC) and ACC of Dbh -/- and control mice following both tasks. RESULTS Dbh -/- mice virtually lacked MB and NS behaviors seen in control mice but did not differ in the elevated zero maze (EZM) model of general anxiety-like behavior. Pharmacological restoration of central NE synthesis in Dbh -/- mice completely rescued NS behavior, while NS and MB were suppressed in control mice by anti-adrenergic drugs. Expression of c-fos in the ACC was attenuated in Dbh -/- mice after MB and NS. CONCLUSION These findings support a role for NE transmission to the ACC in the expression of stress-induced compulsive behaviors and suggest further evaluation of anti-adrenergic drugs for OCD is warranted.
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Affiliation(s)
- Daniel Lustberg
- Department of Human Genetics, Emory University School of Medicine, 615 Michael St., Whitehead 301, Atlanta, GA, 30322, USA
| | - Alexa F Iannitelli
- Department of Human Genetics, Emory University School of Medicine, 615 Michael St., Whitehead 301, Atlanta, GA, 30322, USA
| | - Rachel P Tillage
- Department of Human Genetics, Emory University School of Medicine, 615 Michael St., Whitehead 301, Atlanta, GA, 30322, USA
| | - Molly Pruitt
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - L Cameron Liles
- Department of Human Genetics, Emory University School of Medicine, 615 Michael St., Whitehead 301, Atlanta, GA, 30322, USA
| | - David Weinshenker
- Department of Human Genetics, Emory University School of Medicine, 615 Michael St., Whitehead 301, Atlanta, GA, 30322, USA.
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16
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Kirketeig T, Schultheis C, Zuidema X, Hunter CW, Deer T. Burst Spinal Cord Stimulation: A Clinical Review. PAIN MEDICINE 2020; 20:S31-S40. [PMID: 31152175 PMCID: PMC6544556 DOI: 10.1093/pm/pnz003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective Clinical review on outcomes using burst spinal cord stimulation (SCS) in the treatment of chronic, intractable pain. Design Narrative clinical literature review conducted utilizing a priori search terms including key words for burst spinal cord stimulation. Synthesis and reporting of data from publications including an overview of comparative SCS outcomes. Results Burst SCS demonstrated greater pain relief over tonic stimulation in multiple studies, which included blinded, sham-controlled, randomized trials. Additionally, burst stimulation impacts multiple dimensions of pain, including somatic pain as well as emotional and psychological elements. Patient preference is weighted toward burst over tonic due to increased pain relief, a lack of paresthesias, and impression of change in condition. Conclusion Burst SCS has been shown to be both statistically and clinically superior to tonic stimulation and may provide additional benefits through different mechanisms of action. Further high-quality controlled studies are warranted to not only elucidate the basic mechanisms of burst SCS but also address how this unique stimulation signature/pattern may more adequately handle the multiple affective dimensions of pain in varying patient populations.
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Affiliation(s)
- Terje Kirketeig
- Multidisciplinary Pain Clinic, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Carsten Schultheis
- Departement für Interventionelle Schmerzmedizin, Krankenhaus Neuwerk "Maria von den Aposteln" Muskulo-Skeletales Zentrum Mönchengladbach, Germany
| | - Xander Zuidema
- Department of Anesthesiology and Pain Management, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Corey W Hunter
- Ainsworth Institute of Pain Management, New York, New York
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
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17
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André N, Audiffren M, Baumeister RF. An Integrative Model of Effortful Control. Front Syst Neurosci 2019; 13:79. [PMID: 31920573 PMCID: PMC6933500 DOI: 10.3389/fnsys.2019.00079] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/06/2019] [Indexed: 11/21/2022] Open
Abstract
This article presents an integrative model of effortful control, a resource-limited top-down control mechanism involved in mental tasks and physical exercises. Based on recent findings in the fields of neuroscience, social psychology and cognitive psychology, this model posits the intrinsic costs related to a weakening of the connectivity of neural networks underpinning effortful control as the main cause of mental fatigue in long and high-demanding tasks. In this framework, effort reflects three different inter-related aspects of the same construct. First, effort is a mechanism comprising a limited number of interconnected processing units that integrate information regarding the task constraints and subject’s state. Second, effort is the main output of this mechanism, namely, the effort signal that modulates neuronal activity in brain regions involved in the current task to select pertinent information. Third, effort is a feeling that emerges in awareness during effortful tasks and reflects the costs associated with goal-directed behavior. Finally, the model opens new avenues for research investigating effortful control at the behavioral and neurophysiological levels.
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Affiliation(s)
- Nathalie André
- Research Centre on Cognition and Learning, UMR CNRS 7295, University of Poitiers, Poitiers, France
| | - Michel Audiffren
- Research Centre on Cognition and Learning, UMR CNRS 7295, University of Poitiers, Poitiers, France
| | - Roy F Baumeister
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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18
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Rainville P, Streff A, Chen JI, Houzé B, Desmarteaux C, Piché M. HYPNOTIC AUTOMATICITY IN THE BRAIN AT REST: An Arterial Spin Labelling Study. Int J Clin Exp Hypn 2019; 67:512-542. [PMID: 31526265 DOI: 10.1080/00207144.2019.1650578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The feeling of automaticity reported by individuals undergoing a hypnotic procedure is an essential dimension of hypnosis phenomenology. In the present study, healthy participants rated their subjective experience of automaticity and resting-state arterial spin labelling (ASL) scans were acquired before and after a standard hypnotic induction (i.e., "neutral hypnosis"). The increase in perceived automaticity was positively associated with activity in the parietal operculum (PO) and seed-based coactivation analysis revealed additional associations in the anterior part of the supracallosal cingulate cortex (aMCC). This is consistent with the role of these regions in perceived self-agency and volition and demonstrates that these effects can be evidenced at rest, in the absence of overt motor challenges. Future studies should further examine if/how these changes in brain activity associated with automaticity might facilitate the responses to suggestions and contribute to clinical benefits of hypnosis.
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Affiliation(s)
- Pierre Rainville
- Department of Stomatology, University of Montreal, Research Centre of the University Institute of Geriatrics of Montreal , Canada
| | - Anouk Streff
- Research Centre of the University Institute of Geriatrics of Montreal , Canada
| | - Jen-I Chen
- Department of Stomatology, University of Montreal, Research Centre of the University Institute of Geriatrics of Montreal , Canada
| | - Bérengère Houzé
- Research Centre of the University Institute of Geriatrics of Montreal , Canada
| | - Carolane Desmarteaux
- Department of Psychology, University of Montreal, Research Centre of the University Institute of Geriatrics of Montreal , Canada
| | - Mathieu Piché
- Department of Chiropractic and CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières , Canada
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19
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Huang Y, Cheeran B, Green AL, Denison TJ, Aziz TZ. Applying a Sensing-Enabled System for Ensuring Safe Anterior Cingulate Deep Brain Stimulation for Pain. Brain Sci 2019; 9:brainsci9070150. [PMID: 31247982 PMCID: PMC6680545 DOI: 10.3390/brainsci9070150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/18/2022] Open
Abstract
Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) was offered to chronic pain patients who had exhausted medical and surgical options. However, several patients developed recurrent seizures. This work was conducted to assess the effect of ACC stimulation on the brain activity and to guide safe DBS programming. A sensing-enabled neurostimulator (Activa PC + S) allowing wireless recording through the stimulating electrodes was chronically implanted in three patients. Stimulation patterns with different amplitude levels and variable ramping rates were tested to investigate whether these patterns could provide pain relief without triggering after-discharges (ADs) within local field potentials (LFPs) recorded in the ACC. In the absence of ramping, AD activity was detected following stimulation at amplitude levels below those used in chronic therapy. Adjustment of stimulus cycling patterns, by slowly ramping on/off (8-s ramp duration), was able to prevent ADs at higher amplitude levels while maintaining effective pain relief. The absence of AD activity confirmed from the implant was correlated with the absence of clinical seizures. We propose that AD activity in the ACC could be a biomarker for the likelihood of seizures in these patients, and the application of sensing-enabled techniques has the potential to advance safer brain stimulation therapies, especially in novel targets.
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Affiliation(s)
- Yongzhi Huang
- Oxford Functional Neurosurgery Group, Nuffield Departments of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Binith Cheeran
- Oxford Functional Neurosurgery Group, Nuffield Departments of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Alexander L Green
- Oxford Functional Neurosurgery Group, Nuffield Departments of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Timothy J Denison
- Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK.
| | - Tipu Z Aziz
- Oxford Functional Neurosurgery Group, Nuffield Departments of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK.
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20
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Attentional control abnormalities in posttraumatic stress disorder: Functional, behavioral, and structural correlates. J Affect Disord 2019; 253:343-351. [PMID: 31078834 PMCID: PMC6857173 DOI: 10.1016/j.jad.2019.04.098] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/19/2019] [Accepted: 04/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Attentional disruptions are common in PTSD, but findings across neuropsychological and neuroimaging studies have been variable. Few PTSD studies have investigated abnormalities in attention networks using a multi-modal imaging approach and attentional tasks that include emotionally-salient images. This study combined a behavioral task that included these images (emotional Stroop) with functional and structural neuroimaging (fMRI and diffusion tensor imaging; DTI) methods to comprehensively investigate attentional control abnormalities in a highly-traumatized civilian sample. METHODS 48 traumatized women with and without PTSD received clinical assessments, fMRI and DTI. During fMRI, the Affective Stroop (AS), an attentional control task that includes emotionally-salient distractor images (trauma-relevant, positive, neutral) and variable task demands, was administered. RESULTS In response to more difficult AS trials, participants with PTSD demonstrated lower activation in the dorsal and rostral anterior cingulate cortex and greater activation in the insula. This group also showed comparatively poorer performance on positive AS distractor trials, even after adjusting for trauma exposure. Performance on these trials inversely correlated with structural integrity of the cingulum bundle and uncinate fasciculus. CONCLUSIONS Even after adjusting for trauma exposure, participants with PTSD showed worse performance on an attentional control task in the context of emotional stimuli. They also showed relatively lower cognitive control network activation and greater salience network activation. Fronto-parietal and fronto-limbic white matter connectivity corresponded with AS performance. Our findings indicate that attentional control impairments in PTSD are most evident in the context of emotional cues, and are related to decrements in function and structure of cognitive control and salience networks.
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21
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Kirino E, Hayakawa Y, Inami R, Inoue R, Aoki S. Simultaneous fMRI-EEG-DTI recording of MMN in patients with schizophrenia. PLoS One 2019; 14:e0215023. [PMID: 31071097 PMCID: PMC6508624 DOI: 10.1371/journal.pone.0215023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/25/2019] [Indexed: 12/02/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI), electroencephalogram (EEG), and diffusion tensor imaging (DTI) recording have complementary spatiotemporal resolution limitations but can be powerful methods when used together to enable both functional and anatomical modeling, with each neuroimaging procedure used to maximum advantage. We recorded EEGs during event-related fMRI followed by DTI in 15 healthy volunteers and 12 patients with schizophrenia using an omission mismatch negativity (MMN) paradigm. Blood oxygenation level-dependent (BOLD) signal changes were calculated in a region of interest (ROI) analysis, and fractional anisotropy (FA) in the white matter fibers related to each area was compared between groups using tract-specific analysis. Patients with schizophrenia had reduced BOLD activity in the left middle temporal gyrus, and BOLD activity in the right insula and right parahippocampal gyrus significantly correlated with positive symptoms on the Positive and Negative Syndrome Scale (PANSS) and hostility subscores. BOLD activation of Heschl’s gyri also correlated with the limbic system, including the insula. FA values in the left anterior cingulate cortex (ACC) significantly correlated with changes in the BOLD signal in the right superior temporal gyrus (STG), and FA values in the right ACC significantly correlated with PANSS scores. This is the first study to examine MMN using simultaneous fMRI, EEG, and DTI recording in patients with schizophrenia to investigate the potential implications of abnormalities in the ACC and limbic system, including the insula and parahippocampal gyrus, as well as the STG. Structural changes in the ACC during schizophrenia may represent part of the neural basis for the observed MMN deficits. The deficits seen in the feedback/feedforward connections between the prefrontal cortex and STG modulated by the ACC and insula may specifically contribute to impaired MMN generation and clinical manifestations.
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Affiliation(s)
- Eiji Kirino
- Department of Psychiatry, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
- Department of Psychiatry, Juntendo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
- Juntendo Institute of Mental Health, Fukuroyama, Koshigaya City, Saitama, Japan
- * E-mail:
| | - Yayoi Hayakawa
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rie Inami
- Department of Psychiatry, Juntendo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Reiichi Inoue
- Juntendo Institute of Mental Health, Fukuroyama, Koshigaya City, Saitama, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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22
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Kumral E, Erdoğan CE, Bayam FE, Arslan H. Cingulate infarction: A neuropsychological and neuroimaging study. J Neurol Sci 2019; 402:1-6. [PMID: 31085360 DOI: 10.1016/j.jns.2019.04.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic lesions rarely affect the cingulate cortex (CC) in isolation, restricting human lesion/behavioural change correlational analysis. The aim of this study was to determine clinical, neuropsychological and neuroimaging features of isolated cingulate infarcts. METHODS We studied, 3800 patients with first-ever ischemic stroke included in our Stroke Registry between 2012 and 2018. Among them we studied 7 patients with an acute isolated cingulate infarct confirmed by MRI. RESULTS Among all patients, 7 patients (0.01%) showed ischemic lesions in the territory of cingulate cortex territory, allowing us to delineate 2 substantial distributions; (1) Anterior cingulate cortex (ACC) infarction (4 patients [57%]) was presented low vigilance level with apathy, mutism, deficits in executive function, attention, and disturbances of working, episodic and verbal memory; (2) Posterior cingulate cortex (PCC) infarction (3 patients [43%]) developed topographic disorientation, visual memory deficit and affective-emotional behavioural changes. CONCLUSIONS According rarely seen CC infarction events, we suggest that anterior and posterior CC are functionally separated and differences in clinical presentation are explained by considering; ACC plays a role in executive functions, episodic and working memory, set maintenance, and PCC is focused on spatial and verbal attention, and memory system. We considered that different patterns of cingulate infarcts are the result of variation in cingulate arterial supply or suggest a source of embolism.
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Affiliation(s)
- Emre Kumral
- Ege University, Medical School Hospital, Neurology Department, İzmir, Turkey.
| | - Can Emre Erdoğan
- Ege University, Medical School Hospital, Neurology Department, İzmir, Turkey
| | - Fatma Ece Bayam
- Ege University, Medical School Hospital, Neurology Department, İzmir, Turkey
| | - Hasan Arslan
- Ege University, Medical School Hospital, Neurology Department, İzmir, Turkey
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Abstract
Our perception of free will is composed of a desire to act (volition) and a sense of responsibility for our actions (agency). Brain damage can disrupt these processes, but which regions are most important for free will perception remains unclear. Here, we study focal brain lesions that disrupt volition, causing akinetic mutism (n = 28), or disrupt agency, causing alien limb syndrome (n = 50), to better localize these processes in the human brain. Lesion locations causing either syndrome were highly heterogeneous, occurring in a variety of different brain locations. We next used a recently validated technique termed lesion network mapping to determine whether these heterogeneous lesion locations localized to specific brain networks. Lesion locations causing akinetic mutism all fell within one network, defined by connectivity to the anterior cingulate cortex. Lesion locations causing alien limb fell within a separate network, defined by connectivity to the precuneus. Both findings were specific for these syndromes compared with brain lesions causing similar physical impairments but without disordered free will. Finally, our lesion-based localization matched network localization for brain stimulation locations that disrupt free will and neuroimaging abnormalities in patients with psychiatric disorders of free will without overt brain lesions. Collectively, our results demonstrate that lesions in different locations causing disordered volition and agency localize to unique brain networks, lending insight into the neuroanatomical substrate of free will perception.
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Bubb EJ, Metzler-Baddeley C, Aggleton JP. The cingulum bundle: Anatomy, function, and dysfunction. Neurosci Biobehav Rev 2018; 92:104-127. [PMID: 29753752 PMCID: PMC6090091 DOI: 10.1016/j.neubiorev.2018.05.008] [Citation(s) in RCA: 391] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/16/2022]
Abstract
The cingulum bundle is a prominent white matter tract that interconnects frontal, parietal, and medial temporal sites, while also linking subcortical nuclei to the cingulate gyrus. Despite its apparent continuity, the cingulum's composition continually changes as fibres join and leave the bundle. To help understand its complex structure, this review begins with detailed, comparative descriptions of the multiple connections comprising the cingulum bundle. Next, the impact of cingulum bundle damage in rats, monkeys, and humans is analysed. Despite causing extensive anatomical disconnections, cingulum bundle lesions typically produce only mild deficits, highlighting the importance of parallel pathways and the distributed nature of its various functions. Meanwhile, non-invasive imaging implicates the cingulum bundle in executive control, emotion, pain (dorsal cingulum), and episodic memory (parahippocampal cingulum), while clinical studies reveal cingulum abnormalities in numerous conditions, including schizophrenia, depression, post-traumatic stress disorder, obsessive compulsive disorder, autism spectrum disorder, Mild Cognitive Impairment, and Alzheimer's disease. Understanding the seemingly diverse contributions of the cingulum will require better ways of isolating pathways within this highly complex tract.
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Affiliation(s)
- Emma J Bubb
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK
| | | | - John P Aggleton
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK.
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25
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Boschin EA, Brkic MM, Simons JS, Buckley MJ. Distinct Roles for the Anterior Cingulate and Dorsolateral Prefrontal Cortices During Conflict Between Abstract Rules. Cereb Cortex 2018; 27:34-45. [PMID: 28365775 PMCID: PMC5939207 DOI: 10.1093/cercor/bhw350] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Indexed: 11/14/2022] Open
Abstract
Distinct patterns of activity within the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (dlPFC) reported in neuroimaging studies during tasks involving conflict between competing responses have often been cited as evidence for their key contributions to conflict-monitoring and behavioral adaptation, respectively. However, supporting evidence from neuropsychological patients has been scarce and contradictory. We administered a well-studied analog of the Wisconsin Card Sorting Test, designed to elicit conflict between 2 abstract rules, to a cohort of 6 patients with damage to ACC or dlPFC. Patients who had sustained more significant damage to the ACC were not impaired either on a measure of "conflict cost" nor on measures of "conflict-induced behavioral adaptation." In contrast, damage to dlPFC did not affect the conflict cost measure but abolished the patients' ability to adapt their behavior following exposure to conflict, compared with controls. This pattern of results complements the findings from nonhuman primates with more circumscribed lesions to ACC or dlPFC on the same task and provides converging evidence that ACC is not necessary for performance when conflict is elicited between 2 abstract rules, whereas dlPFC plays a fundamental role in behavioral adaptation.
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Affiliation(s)
- Erica A Boschin
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
| | - Merima M Brkic
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
| | - Jon S Simons
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK
| | - Mark J Buckley
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
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Peng K, Steele SC, Becerra L, Borsook D. Brodmann area 10: Collating, integrating and high level processing of nociception and pain. Prog Neurobiol 2017; 161:1-22. [PMID: 29199137 DOI: 10.1016/j.pneurobio.2017.11.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 02/08/2023]
Abstract
Multiple frontal cortical brain regions have emerged as being important in pain processing, whether it be integrative, sensory, cognitive, or emotional. One such region, Brodmann Area 10 (BA 10), is the largest frontal brain region that has been shown to be involved in a wide variety of functions including risk and decision making, odor evaluation, reward and conflict, pain, and working memory. BA 10, also known as the anterior prefrontal cortex, frontopolar prefrontal cortex or rostral prefrontal cortex, is comprised of at least two cytoarchitectonic sub-regions, medial and lateral. To date, the explicit role of BA 10 in the processing of pain hasn't been fully elucidated. In this paper, we first review the anatomical pathways and functional connectivity of BA 10. Numerous functional imaging studies of experimental or clinical pain have also reported brain activations and/or deactivations in BA 10 in response to painful events. The evidence suggests that BA 10 may play a critical role in the collation, integration and high-level processing of nociception and pain, but also reveals possible functional distinctions between the subregions of BA 10 in this process.
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Affiliation(s)
- Ke Peng
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States.
| | - Sarah C Steele
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
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Integrating Spatial Working Memory and Remote Memory: Interactions between the Medial Prefrontal Cortex and Hippocampus. Brain Sci 2017; 7:brainsci7040043. [PMID: 28420200 PMCID: PMC5406700 DOI: 10.3390/brainsci7040043] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 12/22/2022] Open
Abstract
In recent years, two separate research streams have focused on information sharing between the medial prefrontal cortex (mPFC) and hippocampus (HC). Research into spatial working memory has shown that successful execution of many types of behaviors requires synchronous activity in the theta range between the mPFC and HC, whereas studies of memory consolidation have shown that shifts in area dependency may be temporally modulated. While the nature of information that is being communicated is still unclear, spatial working memory and remote memory recall is reliant on interactions between these two areas. This review will present recent evidence that shows that these two processes are not as separate as they first appeared. We will also present a novel conceptualization of the nature of the medial prefrontal representation and how this might help explain this area’s role in spatial working memory and remote memory recall.
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Wang GC, Harnod T, Chiu TL, Chen KP. Effect of an Anterior Cingulotomy on Pain, Cognition, and Sensory Pathways. World Neurosurg 2017; 102:593-597. [PMID: 28342924 DOI: 10.1016/j.wneu.2017.03.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anterior cingulotomy (AC) was originally used to treat patients with a psychiatric disorder, but it is also useful for treating patients with chronic intractable pain. We reviewed 24 patients at our hospital who underwent AC for chronic intractable pain to determine whether surgery influenced patient cognition and the pain circuit. METHODS A visual analog scale (VAS) was used to evaluate patients' pain scale preoperatively, at 1 month and 3-6 months postoperatively, and at the final follow-up. Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI) were used to evaluate postoperative cognitive function. The latencies of peaks P20 and P37 of the somatosensory evoked potential (SSEP) conductive time were used to evaluate the intactness of the thalamocortical tract after AC. RESULTS The median preoperative VAS score was 8, MMSE score was 27, and CASI score was 86.8. Six patients underwent a reoperation because of recurrent pain. Pain was significantly reduced after AC, and the median VAS score at the last follow-up was 5. There was no significant pain improvement in patients who underwent a reoperation. There were no significant changes in MMSE and CASI scores or SSEP after cingulotomy. There were no operation-related complications in the patients. CONCLUSIONS A stereotactic AC was safe and effective in resolving chronic refractory pain. It did not affect patient cognition or the sensory conductive pathway. However, patients who had recurrent intractable pain after a cingulotomy did not respond well to the reoperation.
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Affiliation(s)
- Guan-Chyuan Wang
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tomor Harnod
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tsung-Lang Chiu
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Kuan-Pin Chen
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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The rostromedial zona incerta is involved in attentional processes while adjacent LHA responds to arousal: c-Fos and anatomical evidence. Brain Struct Funct 2017; 222:2507-2525. [DOI: 10.1007/s00429-016-1353-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 12/16/2016] [Indexed: 01/27/2023]
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Agarwal N, Choi PA, Shin SS, Hansberry DR, Mammis A. Anterior cingulotomy for intractable pain. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2016. [DOI: 10.1016/j.inat.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Complex behavior requires a flexible system that maintains task performance in the context of specific goals, evaluating behavioral progress, adjusting behavior as needed, and adapting to changing contingencies. Generically referred to as performance monitoring, a key component concerns the identification and correction of differences between an intended and an executed response (i.e., an error). Brain mapping experiments have now identified the temporal and spatial components of a putative error-processing system in the large-scale networks of the human brain. Most of this work has focused on the medial frontal cortex and an associated electrophysiological component known as the error-related negativity (or error negativity). Although the precise role, or roles, of this region still remain unknown, investigations of error processing have identified a cluster of modules in the medial frontal cortex involved in monitoring/maintaining ongoing behavior and motivating task sets. Other regions include bilateral anterior insula/inferior operculum and lateral prefrontal cortex. Recent work has begun to uncover how individual differences might affect the modules recruited for a task, in addition to the identification of associations between pathological states and aberrant error signals, leading to insights about possible mechanisms of neuropsychiatric illness. NEUROSCIENTIST 13(2):160—172, 2007.
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Affiliation(s)
- Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
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Tolomeo S, Christmas D, Jentzsch I, Johnston B, Sprengelmeyer R, Matthews K, Douglas Steele J. A causal role for the anterior mid-cingulate cortex in negative affect and cognitive control. Brain 2016; 139:1844-54. [DOI: 10.1093/brain/aww069] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/05/2016] [Indexed: 11/12/2022] Open
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Neural circuitry involved in quitting after repeated failures: role of the cingulate and temporal parietal junction. Sci Rep 2016; 6:24713. [PMID: 27097529 PMCID: PMC4838821 DOI: 10.1038/srep24713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/31/2016] [Indexed: 11/26/2022] Open
Abstract
The more times people fail the more likely they are to give up, however little is known about the neural mechanisms underlying this impact of repeated failure on decision making. Here we have used a visual shape discrimination task with computer-controlled feedback combined with functional magnetic resonance imaging (fMRI) to investigate the neural circuits involved. The behavioral task confirmed that the more times subjects experienced failure the more likely they were to give up, with three successive failures being the key threshold and the majority of subjects reaching the point where they decided to quit and try a new stimulus set after three or four failures. The fMRI analysis revealed activity changes in frontal, parietal, temporal, limbic and striatal regions, especially anterior cingulate cortex (ACC), posterior cingulate cortex (PCC) and temporal parietal junction (TPJ) associated with the number of previous failures experienced. Furthermore, their parameter estimates were predictive of subjects’ quitting rate. Thus, subjects reach the point where they decide to quit after three/four failures and this is associated with differential changes in brain regions involved in error monitoring and reward which regulate both failure detection and changes in decision-making strategy.
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De Ridder D, Manning P, Glue P, Cape G, Langguth B, Vanneste S. Anterior Cingulate Implant for Alcohol Dependence. Neurosurgery 2016; 78:E883-93. [DOI: 10.1227/neu.0000000000001248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Alcohol dependence is related to dysfunctional brain processes, in which a genetic background and environmental factors shape brain mechanisms involved with alcohol consumption. Craving, a major component determining relapses in alcohol abuse, has been linked to abnormal brain activity.
CLINICAL PRESENTATION:
We report the results of a treatment-intractable, alcohol-addicted patient with associated agoraphobia and anxiety. Functional imaging studies consisting of functional magnetic resonance imaging and resting-state electroencephalogram were performed as a means to localize craving-related brain activation and for identification of a target for repetitive transcranial magnetic stimulation and implant insertion. Repetitive transcranial magnetic stimulation of the dorsal anterior cingulate cortex with a double-cone coil transiently suppressed his very severe alcohol craving for up to 6 weeks. For ongoing stimulation, 2 “back-to-back” paddle electrodes were implanted with functional magnetic resonance imaging neuronavigation guidance for bilateral dorsal anterior cingulate cortex stimulation. Using a recently developed novel stimulation design, burst stimulation, a quick improvement was obtained on craving, agoraphobia, and associated anxiety without the expected withdrawal symptoms. The patient has remained free of alcohol intake and relieved of agoraphobia and anxiety for over 18 months, associated with normalization of his alpha and beta activity on electroencephalogram in the stimulated area. He perceives a mental freedom by not being constantly focused on alcohol.
CONCLUSION:
This case report proposes a new pathophysiology-based target for the surgical treatment of alcohol dependence and suggests that larger studies are warranted to explore this potentially promising avenue for the treatment of intractable alcohol dependence with or without anxiety and agoraphobia.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Patrick Manning
- Section of Endocrinology, Department of Internal Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gavin Cape
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, Texas
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Russo JF, Sheth SA. Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain. Neurosurg Focus 2016; 38:E11. [PMID: 26030699 DOI: 10.3171/2015.3.focus1543] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic neuropathic pain is estimated to affect 3%-4.5% of the worldwide population. It is associated with significant loss of productive time, withdrawal from the workforce, development of mood disorders such as depression and anxiety, and disruption of family and social life. Current medical therapeutics often fail to adequately treat chronic neuropathic pain. Deep brain stimulation (DBS) targeting subcortical structures such as the periaqueductal gray, the ventral posterior lateral and medial thalamic nuclei, and the internal capsule has been investigated for the relief of refractory neuropathic pain over the past 3 decades. Recent work has identified the dorsal anterior cingulate cortex (dACC) as a new potential neuromodulation target given its central role in cognitive and affective processing. In this review, the authors briefly discuss the history of DBS for chronic neuropathic pain in the United States and present evidence supporting dACC DBS for this indication. They review existent literature on dACC DBS and summarize important findings from imaging and neurophysiological studies supporting a central role for the dACC in the processing of chronic neuropathic pain. The available neurophysiological and empirical clinical evidence suggests that dACC DBS is a viable therapeutic option for the treatment of chronic neuropathic pain and warrants further investigation.
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Affiliation(s)
- Jennifer F Russo
- 1Columbia University College of Physicians and Surgeons and.,2Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Sameer A Sheth
- 2Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Chemogenetic Inactivation of Dorsal Anterior Cingulate Cortex Neurons Disrupts Attentional Behavior in Mouse. Neuropsychopharmacology 2016; 41. [PMID: 26224620 PMCID: PMC4748426 DOI: 10.1038/npp.2015.229] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attention is disrupted commonly in psychiatric disorders, yet mechanistic insight remains limited. Deficits in this function are associated with dorsal anterior cingulate cortex (dACC) excitotoxic lesions and pharmacological disinhibition; however, a causal relationship has not been established at the cellular level. Moreover, this association has not yet been examined in a genetically tractable species such as mice. Here, we reveal that dACC neurons causally contribute to attention processing by combining a chemogenetic approach that reversibly suppresses neural activity with a translational, touchscreen-based attention task in mice. We virally expressed inhibitory hM4Di DREADD (designer receptor exclusively activated by a designer drug) in dACC neurons, and examined the effects of this inhibitory action with the attention-based five-choice serial reaction time task. DREADD inactivation of the dACC neurons during the task significantly increased omission and correct response latencies, indicating that the neuronal activities of dACC contribute to attention and processing speed. Selective inactivation of excitatory neurons in the dACC not only increased omission, but also decreased accuracy. The effect of inactivating dACC neurons was selective to attention as response control, motivation, and locomotion remain normal. This finding suggests that dACC excitatory neurons play a principal role in modulating attention to task-relevant stimuli. This study establishes a foundation to chemogenetically dissect specific cell-type and circuit mechanisms underlying attentional behaviors in a genetically tractable species.
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De Ridder D, Vanneste S, Gillett G, Manning P, Glue P, Langguth B. Psychosurgery Reduces Uncertainty and Increases Free Will? A Review. Neuromodulation 2016; 19:239-48. [DOI: 10.1111/ner.12405] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/20/2015] [Accepted: 12/17/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Dirk De Ridder
- Department of Surgical Sciences; Section of Neurosurgery, Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - Sven Vanneste
- Laboratory for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences; University of Texas at Dallas; Dallas TX USA
| | - Grant Gillett
- Department of Philosophy; Section of Medical Ethics, Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - Patrick Manning
- Department of Internal Medicine; Section of Endocrinology, Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - Paul Glue
- Department of Psychological Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy; Interdisciplinary Tinnitus Clinic, University of Regensburg; Regensburg Germany
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De Ridder D, Vanneste S. Burst and Tonic Spinal Cord Stimulation: Different and Common Brain Mechanisms. Neuromodulation 2015; 19:47-59. [DOI: 10.1111/ner.12368] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/05/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery; Dunedin School of Medicine; University of Otago; Dunedin New Zealand
| | - Sven Vanneste
- Lab for Clinical & Integrative Neuroscience; School of Behavioral and Brain Sciences; The University of Texas at Dallas; Dallas TX USA
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Abstract
The capacity for self-regulation allows people to control their thoughts, behaviors, emotions, and desires. In spite of this impressive ability, failures of self-regulation are common and contribute to numerous societal problems, from obesity to drug addiction. Such failures frequently occur following exposure to highly tempting cues, during negative moods, or after self-regulatory resources have been depleted. Here we review the available neuroscientific evidence regarding self-regulation and its failures. At its core, self-regulation involves a critical balance between the strength of an impulse and an individual's ability to inhibit the desired behavior. Although neuroimaging and patient studies provide consistent evidence regarding the reward aspects of impulses and desires, the neural mechanisms that underlie the capacity for control have eluded consensus, with various executive control regions implicated in different studies. We outline the necessary properties for a self-regulation control system and suggest that the use of resting-state functional connectivity analyses may be useful for understanding how people regulate their behavior and why they sometimes fail in their attempts.
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Affiliation(s)
- William M. Kelley
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire 03755;
| | - Dylan D. Wagner
- Department of Psychology, The Ohio State University, Columbus, Ohio 43210
| | - Todd F. Heatherton
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire 03755;
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Peeters SCT, Gronenschild EHBM, van de Ven V, Habets P, Goebel R, van Os J, Marcelis M. Altered mesocorticolimbic functional connectivity in psychotic disorder: an analysis of proxy genetic and environmental effects. Psychol Med 2015; 45:2157-2169. [PMID: 25804977 DOI: 10.1017/s0033291715000161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Altered dopaminergic neurotransmission in the mesocorticolimbic (MCL) system may mediate psychotic symptoms. In addition, pharmacological dopaminergic manipulation may coincide with altered functional connectivity (fc) 'in rest'. We set out to test whether MCL-fc is conditional on (familial risk for) psychotic disorder and/or interactions with environmental exposures. METHOD Resting-state functional magnetic resonance imaging data were obtained from 63 patients with psychotic disorder, 73 non-psychotic siblings of patients with psychotic disorder and 59 healthy controls. With the nucleus accumbens (NAcc) as seed region, fc within the MCL system was estimated. Regression analyses adjusting for a priori hypothesized confounders were used to assess group differences in MCL connectivity as well as gene (group) × environmental exposure interactions (G × E) (i.e., to cannabis, developmental trauma and urbanicity). RESULTS Compared with controls, patients and siblings had decreased fc between the right NAcc seed and the right orbitofrontal cortex (OFC) as well as the left middle cingulate cortex (MCC). Siblings showed decreased connectivity between the NAcc seed and lentiform nucleus compared with patients and controls. In addition, patients had decreased left NAcc connectivity compared with siblings in the left middle frontal gyrus. There was no evidence for a significant interaction between group and the three environmental exposures in the model of MCL-fc. CONCLUSIONS Reduced NAcc-OFC/MCC connectivity was seen in patients and siblings, suggesting that altered OFC connectivity and MCC connectivity are vulnerability markers for psychotic disorder. Differential exposure to environmental risk factors did not make an impact on the association between familial risk and MCL connectivity.
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Affiliation(s)
- S C T Peeters
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - E H B M Gronenschild
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - V van de Ven
- Department of Cognitive Neuroscience,Maastricht University,Maastricht,the Netherlands
| | - P Habets
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - R Goebel
- Department of Cognitive Neuroscience,Maastricht University,Maastricht,the Netherlands
| | - J van Os
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - M Marcelis
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
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Eisenberger NI. Social Pain and the Brain: Controversies, Questions, and Where to Go from Here. Annu Rev Psychol 2015; 66:601-29. [DOI: 10.1146/annurev-psych-010213-115146] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naomi I. Eisenberger
- Department of Psychology, University of California, Los Angeles, California 90095-1563;
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Cox SR, MacPherson SE, Ferguson KJ, Nissan J, Royle NA, MacLullich AM, Wardlaw JM, Deary IJ. Correlational structure of 'frontal' tests and intelligence tests indicates two components with asymmetrical neurostructural correlates in old age. INTELLIGENCE 2014; 46:94-106. [PMID: 25278641 PMCID: PMC4175012 DOI: 10.1016/j.intell.2014.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/05/2014] [Accepted: 05/08/2014] [Indexed: 12/01/2022]
Abstract
Both general fluid intelligence (gf) and performance on some 'frontal tests' of cognition decline with age. Both types of ability are at least partially dependent on the integrity of the frontal lobes, which also deteriorate with age. Overlap between these two methods of assessing complex cognition in older age remains unclear. Such overlap could be investigated using inter-test correlations alone, as in previous studies, but this would be enhanced by ascertaining whether frontal test performance and gf share neurobiological variance. To this end, we examined relationships between gf and 6 frontal tests (Tower, Self-Ordered Pointing, Simon, Moral Dilemmas, Reversal Learning and Faux Pas tests) in 90 healthy males, aged ~ 73 years. We interpreted their correlational structure using principal component analysis, and in relation to MRI-derived regional frontal lobe volumes (relative to maximal healthy brain size). gf correlated significantly and positively (.24 ≤ r ≤ .53) with the majority of frontal test scores. Some frontal test scores also exhibited shared variance after controlling for gf. Principal component analysis of test scores identified units of gf-common and gf-independent variance. The former was associated with variance in the left dorsolateral (DL) and anterior cingulate (AC) regions, and the latter with variance in the right DL and AC regions. Thus, we identify two biologically-meaningful components of variance in complex cognitive performance in older age and suggest that age-related changes to DL and AC have the greatest cognitive impact.
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Affiliation(s)
- Simon R. Cox
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Department of Psychology, University of Edinburgh, UK
| | - Sarah E. MacPherson
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Department of Psychology, University of Edinburgh, UK
| | - Karen J. Ferguson
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Geriatric Medicine, University of Edinburgh, UK
| | - Jack Nissan
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
| | - Natalie A. Royle
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, UK
| | - Alasdair M.J. MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Geriatric Medicine, University of Edinburgh, UK
- Endocrinology Unit, University of Edinburgh, UK
| | - Joanna M. Wardlaw
- Brain Research Imaging Centre, Neuroimaging Sciences, University of Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, UK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Department of Psychology, University of Edinburgh, UK
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Gilmartin MR, Balderston NL, Helmstetter FJ. Prefrontal cortical regulation of fear learning. Trends Neurosci 2014; 37:455-64. [PMID: 24929864 PMCID: PMC4119830 DOI: 10.1016/j.tins.2014.05.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/29/2022]
Abstract
The prefrontal cortex regulates the expression of fear based on previously learned information. Recently, this brain area has emerged as being crucial in the initial formation of fear memories, providing new avenues to study the neurobiology underlying aberrant learning in anxiety disorders. Here we review the circumstances under which the prefrontal cortex is recruited in the formation of memory, highlighting relevant work in laboratory animals and human subjects. We propose that the prefrontal cortex facilitates fear memory through the integration of sensory and emotional signals and through the coordination of memory storage in an amygdala-based network.
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Affiliation(s)
- Marieke R Gilmartin
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 E. Hartford Ave., Milwaukee, WI 53211, USA; Department of Biomedical Sciences, Marquette University, 561 N 15th Street, Milwaukee, WI 53233, USA.
| | - Nicholas L Balderston
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 E. Hartford Ave., Milwaukee, WI 53211, USA
| | - Fred J Helmstetter
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 E. Hartford Ave., Milwaukee, WI 53211, USA
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De Ridder D, Vanneste S, Freeman W. The Bayesian brain: Phantom percepts resolve sensory uncertainty. Neurosci Biobehav Rev 2014; 44:4-15. [PMID: 22516669 DOI: 10.1016/j.neubiorev.2012.04.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/13/2012] [Accepted: 04/01/2012] [Indexed: 12/23/2022]
Affiliation(s)
- Dirk De Ridder
- Brai(2)n, TRI & Department of Neurosurgery, University Hospital Antwerp, Belgium.
| | - Sven Vanneste
- Brai(2)n, TRI & Department of Neurosurgery, University Hospital Antwerp, Belgium; Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Belgium
| | - Walter Freeman
- Department of Molecular & Cell Biology, University of California at Berkeley, USA
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Bocquillon P, Bourriez JL, Palmero-Soler E, Molaee-Ardekani B, Derambure P, Dujardin K. The spatiotemporal dynamics of early attention processes: A high-resolution electroencephalographic study of N2 subcomponent sources. Neuroscience 2014; 271:9-22. [DOI: 10.1016/j.neuroscience.2014.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/10/2014] [Indexed: 11/29/2022]
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Ullsperger M, Danielmeier C, Jocham G. Neurophysiology of performance monitoring and adaptive behavior. Physiol Rev 2014; 94:35-79. [PMID: 24382883 DOI: 10.1152/physrev.00041.2012] [Citation(s) in RCA: 399] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Successful goal-directed behavior requires not only correct action selection, planning, and execution but also the ability to flexibly adapt behavior when performance problems occur or the environment changes. A prerequisite for determining the necessity, type, and magnitude of adjustments is to continuously monitor the course and outcome of one's actions. Feedback-control loops correcting deviations from intended states constitute a basic functional principle of adaptation at all levels of the nervous system. Here, we review the neurophysiology of evaluating action course and outcome with respect to their valence, i.e., reward and punishment, and initiating short- and long-term adaptations, learning, and decisions. Based on studies in humans and other mammals, we outline the physiological principles of performance monitoring and subsequent cognitive, motivational, autonomic, and behavioral adaptation and link them to the underlying neuroanatomy, neurochemistry, psychological theories, and computational models. We provide an overview of invasive and noninvasive systemic measures, such as electrophysiological, neuroimaging, and lesion data. We describe how a wide network of brain areas encompassing frontal cortices, basal ganglia, thalamus, and monoaminergic brain stem nuclei detects and evaluates deviations of actual from predicted states indicating changed action costs or outcomes. This information is used to learn and update stimulus and action values, guide action selection, and recruit adaptive mechanisms that compensate errors and optimize goal achievement.
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Proactive and reactive processes in the medial frontal cortex: an electrophysiological study. PLoS One 2014; 9:e84351. [PMID: 24404160 PMCID: PMC3880274 DOI: 10.1371/journal.pone.0084351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/13/2013] [Indexed: 12/30/2022] Open
Abstract
The posterior medial frontal cortex (pMFC) is known to be involved in adaptive goal-directed behavior, but its specific function is not yet clear. Most theories have proposed that the pMFC monitors performance in a reactive manner only, but it is possible that the pMFC also contributes to performance monitoring in a proactive manner. To date, the evidence for proactive pMFC activity is equivocal. Here, we investigated pMFC activity before, during and after the performance of a challenging motor task. Participants navigated a cursor through narrow and wide mazes in randomly intermixed trials. On each trial, participants saw previews of the actual maze display prior to gaining control of the cursor. Event-related potentials (ERPs) to the preview displays were compared to ERPs elicited by no-go signals and errors. Compared to the wider maze, the preview display for the more challenging narrow maze elicited a medial-frontal negativity (MFN) similar to the ERP components elicited by no-go signals and errors. Like these known ERP components, the preview-elicited MFN appeared to be generated from a source in pMFC. This is consistent with the hypothesis that the pMFC participates in adaptive behavior whenever there is a need for increased effort to maintain successful task performance.
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Wager M, Du Boisgueheneuc F, Pluchon C, Bouyer C, Stal V, Bataille B, Guillevin CM, Gil R. Intraoperative monitoring of an aspect of executive functions: administration of the Stroop test in 9 adult patients during awake surgery for resection of frontal glioma. Neurosurgery 2013; 72:ons169-80; discussion ons180-1. [PMID: 23149965 DOI: 10.1227/neu.0b013e31827bf1d6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Awake brain surgery allows extensive intraoperative monitoring of not only motor and sensory functions and language but also executive functions. OBJECTIVE To administer the Stroop test intraoperatively to avoid dramatic side effects such as akinetic mutism and to monitor executive functions in an attempt to optimize the benefit/risk balance of surgery. METHODS A series of 9 adult patients with frontal glioma were operated on for gross tumor resection under local anesthesia. All procedures involved the anterior cingulate cortex (ACC). RESULTS Three types of response to the Stroop test were observed: 3 patients had a Stroop effect only for stimulation of the contralateral ACC; 3 patients had a Stroop effect for stimulation of the ipsilateral ACC; and 3 patients had no Stroop effect. Preoperative and postoperative neuropsychological and surgical results are presented and discussed. Stimulation sites eliciting a Stroop effect are compared with published image-based data, and insight provided by these surgical data regarding ACC function and plasticity is discussed. No operative complication related to intraoperative administration of the Stroop test was observed. CONCLUSION Administration of the Stroop test during resection of gliomas involving the ACC in adult patients is an option for intraoperative monitoring of executive functions during awake surgery. Globally, these results suggest functional compensation, mediated by plasticity mechanisms, by contralateral homologous regions of the ACC in adult patients with frontal glioma.
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Affiliation(s)
- Michel Wager
- Department of Neurosurgery, Imaging Laboratory, University Hospital Poitiers, 2 Rue de La Miletrie, Poitiers Cedex, France.
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De Ridder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst Spinal Cord Stimulation for Limb and Back Pain. World Neurosurg 2013; 80:642-649.e1. [DOI: 10.1016/j.wneu.2013.01.040] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 01/07/2013] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
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Magalona SC, Rasetti R, Chen J, Chen Q, Gold I, Decot H, Callicott JH, Berman KF, Apud JA, Weinberger DR, Mattay VS. Effect of tolcapone on brain activity during a variable attentional control task: a double-blind, placebo-controlled, counter-balanced trial in healthy volunteers. CNS Drugs 2013; 27:663-73. [PMID: 23794107 PMCID: PMC4135358 DOI: 10.1007/s40263-013-0082-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Attention is the capacity to flexibly orient behaviors and thoughts towards a goal by selecting and integrating relevant contextual information. The dorsal cingulate (dCC) and prefrontal (PFC) cortices play critical roles in attention. Evidence indicates that catechol-O-methyltransferase (COMT) modulates dopaminergic tone in the PFC and dCC. OBJECTIVE In this study, we explored the effect of tolcapone, a CNS penetrant COMT inhibitor that increases cortical dopamine levels, on brain activity during a Variable Attentional Control (VAC) task. STUDY DESIGN We performed a double-blinded, placebo-controlled, counter-balanced trial with tolcapone (Tasmar, tablets, 100 mg three times a day for 1 day and then 200 mg three times a day for 6 days; ClinicalTrials.gov identifier: NCT00044083). SETTING The study was conducted in the Clinical Center of the National Institute of Mental Health from 2005 to 2009. PATIENTS Twenty healthy volunteers (11 males; mean age = 32.7 years) with good imaging and performance data on both arms of the study were investigated. INTERVENTION Participants underwent 3T blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) while performing the event-related VAC task, which varies attention over three levels of load: LOW, INT (intermediate), and HIGH. MAIN OUTCOME MEASURE Changes in behavioral data and individual contrast images were analyzed using ANOVA with drug and task load as co-factors. RESULTS There was a significant main effect of increasing task load, with resulting decreased accuracy and increased reaction time. While there was no significant effect of tolcapone on these behavioral measures, the neuroimaging data showed a significant effect on load-related changes in dCC, with significantly lower dCC activation on tolcapone compared with placebo. Further, neural activity in dCC correlated positively with COMT enzyme activity (i.e., lower COMT activity and presumably more dopamine was associated with lower activation in dCC, i.e., more efficient information processing). CONCLUSION Our results show that pharmacological reduction of COMT activity modulates the engagement of attentional mechanisms, selectively enhancing the efficiency of dCC processing in healthy volunteers, reflected as decreased activity for the same level of performance.
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Affiliation(s)
- Sophia C. Magalona
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Roberta Rasetti
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jingshan Chen
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Qiang Chen
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 North Wolfe Street, Baltimore, MD 21205, USA
| | - Ian Gold
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Heather Decot
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Joseph H. Callicott
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Karen F. Berman
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - José A. Apud
- Clinical Brain Disorders Branch (CBDB), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Daniel R. Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 North Wolfe Street, Baltimore, MD 21205, USA,Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA,The McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Venkata S. Mattay
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 North Wolfe Street, Baltimore, MD 21205, USA
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