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Li Y, Wu J, Hua X, Zheng M, Xu J. The promotion-like effect of the M1-STN hyperdirect pathway induced by ccPAS enhanced balance performances: From the perspective of brain connectivity. CNS Neurosci Ther 2024; 30:e14710. [PMID: 38615363 PMCID: PMC11016345 DOI: 10.1111/cns.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
AIMS The present study aimed to explore the effect of cortico-cortical paired-associative stimulation (ccPAS) in modulating hyperdirect pathway and its influence on balance performance. METHODS Forty healthy participants were randomly allocated to the active ccPAS group (n = 20) or the sham ccPAS group (n = 20). The primary motor cortex and subthalamic nucleus were stimulated sequentially with ccPAS. Unlike the active ccPAS group, one wing of coil was tilted to form a 90° angle with scalp of stimulation locations for the sham ccPAS group. Magnetic resonance imaging, functional reach test (FRT), timed up and go (TUG) test, and limit of stability (LOS) test were performed, and correlation between them was also analyzed. RESULTS Three participants in the sham ccPAS group were excluded because of poor quality of NIfTI images. The active group had strengthened hyperdirect pathway, increased functional connectivity (FC) between orbital part of frontal cortex and bilateral precuneus, and decreased FC among basal ganglia (all p < 0.05). Regional network properties of triangular and orbital parts of IFG, middle cingulate cortex, and hippocampus increased. The active group performed better in FRT and LOS (all p < 0.05). FRT positively correlated with FC of the hyperdirect pathway (r = 0.439, p = 0.007) and FCs between orbital part of frontal cortex and bilateral precuneus (all p < 0.05). CONCLUSION The ccPAS enhanced balance performance by promotion-like plasticity mechanisms through the hyperdirect pathway.
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Affiliation(s)
- Yu‐Lin Li
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- Department of Rehabilitation Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Jia‐Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xu‐Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Mou‐Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jian‐Guang Xu
- Engineering Research Center of Traditional Chinese Medicine Intelligent RehabilitationMinistry of EducationShanghaiChina
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
- School of Rehabilitation ScienceShanghai University of Traditional Chinese MedicineShanghaiChina
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2
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Wang JB, Hassan U, Bruss JE, Oya H, Uitermarkt BD, Trapp NT, Gander PE, Howard MA, Keller CJ, Boes AD. Effects of transcranial magnetic stimulation on the human brain recorded with intracranial electrocorticography. Mol Psychiatry 2024:10.1038/s41380-024-02405-y. [PMID: 38317012 DOI: 10.1038/s41380-024-02405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
Transcranial magnetic stimulation (TMS) is increasingly used as a noninvasive technique for neuromodulation in research and clinical applications, yet its mechanisms are not well understood. Here, we present the neurophysiological effects of TMS using intracranial electrocorticography (iEEG) in neurosurgical patients. We first evaluated safety in a gel-based phantom. We then performed TMS-iEEG in 22 neurosurgical participants with no adverse events. We next evaluated intracranial responses to single pulses of TMS to the dorsolateral prefrontal cortex (dlPFC) (N = 10, 1414 electrodes). We demonstrate that TMS is capable of inducing evoked potentials both locally within the dlPFC and in downstream regions functionally connected to the dlPFC, including the anterior cingulate and insular cortex. These downstream effects were not observed when stimulating other distant brain regions. Intracranial dlPFC electrical stimulation had similar timing and downstream effects as TMS. These findings support the safety and promise of TMS-iEEG in humans to examine local and network-level effects of TMS with higher spatiotemporal resolution than currently available methods.
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Affiliation(s)
- Jeffrey B Wang
- Biophysics Graduate Program, Stanford University Medical Center, Stanford, CA, 94305, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Umair Hassan
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Joel E Bruss
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Brandt D Uitermarkt
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nicholas T Trapp
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, 52242, USA
| | - Phillip E Gander
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Radiology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, 52242, USA.
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3
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Widge AS. Closing the loop in psychiatric deep brain stimulation: physiology, psychometrics, and plasticity. Neuropsychopharmacology 2024; 49:138-149. [PMID: 37415081 PMCID: PMC10700701 DOI: 10.1038/s41386-023-01643-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
Deep brain stimulation (DBS) is an invasive approach to precise modulation of psychiatrically relevant circuits. Although it has impressive results in open-label psychiatric trials, DBS has also struggled to scale to and pass through multi-center randomized trials. This contrasts with Parkinson disease, where DBS is an established therapy treating thousands of patients annually. The core difference between these clinical applications is the difficulty of proving target engagement, and of leveraging the wide range of possible settings (parameters) that can be programmed in a given patient's DBS. In Parkinson's, patients' symptoms change rapidly and visibly when the stimulator is tuned to the correct parameters. In psychiatry, those same changes take days to weeks, limiting a clinician's ability to explore parameter space and identify patient-specific optimal settings. I review new approaches to psychiatric target engagement, with an emphasis on major depressive disorder (MDD). Specifically, I argue that better engagement may come by focusing on the root causes of psychiatric illness: dysfunction in specific, measurable cognitive functions and in the connectivity and synchrony of distributed brain circuits. I overview recent progress in both those domains, and how it may relate to other technologies discussed in companion articles in this issue.
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Affiliation(s)
- Alik S Widge
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
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4
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Bove F, Angeloni B, Sanginario P, Rossini PM, Calabresi P, Di Iorio R. Neuroplasticity in levodopa-induced dyskinesias: An overview on pathophysiology and therapeutic targets. Prog Neurobiol 2024; 232:102548. [PMID: 38040324 DOI: 10.1016/j.pneurobio.2023.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/29/2023] [Accepted: 11/26/2023] [Indexed: 12/03/2023]
Abstract
Levodopa-induced dyskinesias (LIDs) are a common complication in patients with Parkinson's disease (PD). A complex cascade of electrophysiological and molecular events that induce aberrant plasticity in the cortico-basal ganglia system plays a key role in the pathophysiology of LIDs. In the striatum, multiple neurotransmitters regulate the different forms of physiological synaptic plasticity to provide it in a bidirectional and Hebbian manner. In PD, impairment of both long-term potentiation (LTP) and long-term depression (LTD) progresses with disease and dopaminergic denervation of striatum. The altered balance between LTP and LTD processes leads to unidirectional changes in plasticity that cause network dysregulation and the development of involuntary movements. These alterations have been documented, in both experimental models and PD patients, not only in deep brain structures but also at motor cortex. Invasive and non-invasive neuromodulation treatments, as deep brain stimulation, transcranial magnetic stimulation, or transcranial direct current stimulation, may provide strategies to modulate the aberrant plasticity in the cortico-basal ganglia network of patients affected by LIDs, thus restoring normal neurophysiological functioning and treating dyskinesias. In this review, we discuss the evidence for neuroplasticity impairment in experimental PD models and in patients affected by LIDs, and potential neuromodulation strategies that may modulate aberrant plasticity.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetta Angeloni
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasquale Sanginario
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Di Iorio
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
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5
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Song YT, Liu YB, Xiang HB, Manyande A, He ZG. The Application of Deep Brain Stimulation for Parkinson's Disease on the Motor Pathway: A Bibliometric Analysis across 10 Years. Curr Med Sci 2023; 43:1247-1257. [PMID: 38153631 DOI: 10.1007/s11596-023-2811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Since its initial report by James Parkinson in 1817, Parkinson's disease (PD) has remained a central subject of research and clinical advancement. The disease is estimated to affect approximately 1% of adults aged 60 and above. Deep brain stimulation, emerging as an alternative therapy for end-stage cases, has offered a lifeline to numerous patients. This review aimed to analyze publications pertaining to the impact of deep brain stimulation on the motor pathway in patients with PD over the last decade. METHODS Data were obtained from the Web of Science Core Collection through the library of Huazhong University of Science and Technology (China). The search strategy encompassed the following keywords: "deep brain stimulation", "Parkinson's disease", "motor pathway", and "human", from January 1, 2012, to December 1, 2022. Additionally, this review visualized the findings using the Citespace software. RESULTS The results indicated that the United States, the United Kingdom, Germany, and China were the primary contributors to this research field. University College London, Capital Medical University, and Maastricht University were the top 3 research institutions in the research area. Tom Foltynie ranked first with 6 publications, and the journals of Brain and Brain Stimulation published the greatest number of relevant articles. The prevailing research focal points in this domain, as determined by keywords "burst analysis", "encompassed neuronal activity", "nucleus", "hyper direct pathway", etc. CONCLUSION: This study has provided a new perspective through bibliometric analysis of the deep brain stimulation therapy for treating patients with PD, which can shed light on future research to advance our comprehension of this particular field of study.
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Affiliation(s)
- Yong-Tang Song
- Medical Association of Hubei Province, Wuhan, 430060, China
| | - Yan-Bo Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Bing Xiang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, 0044, UK
| | - Zhi-Gang He
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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6
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Xu W, Wang J, Li XN, Liang J, Song L, Wu Y, Liu Z, Sun B, Li WG. Neuronal and synaptic adaptations underlying the benefits of deep brain stimulation for Parkinson's disease. Transl Neurodegener 2023; 12:55. [PMID: 38037124 PMCID: PMC10688037 DOI: 10.1186/s40035-023-00390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established and effective treatment for patients with advanced Parkinson's disease (PD), yet its underlying mechanisms remain enigmatic. Optogenetics, primarily conducted in animal models, provides a unique approach that allows cell type- and projection-specific modulation that mirrors the frequency-dependent stimulus effects of DBS. Opto-DBS research in animal models plays a pivotal role in unraveling the neuronal and synaptic adaptations that contribute to the efficacy of DBS in PD treatment. DBS-induced neuronal responses rely on a complex interplay between the distributions of presynaptic inputs, frequency-dependent synaptic depression, and the intrinsic excitability of postsynaptic neurons. This orchestration leads to conversion of firing patterns, enabling both antidromic and orthodromic modulation of neural circuits. Understanding these mechanisms is vital for decoding position- and programming-dependent effects of DBS. Furthermore, patterned stimulation is emerging as a promising strategy yielding long-lasting therapeutic benefits. Research on the neuronal and synaptic adaptations to DBS may pave the way for the development of more enduring and precise modulation patterns. Advanced technologies, such as adaptive DBS or directional electrodes, can also be integrated for circuit-specific neuromodulation. These insights hold the potential to greatly improve the effectiveness of DBS and advance PD treatment to new levels.
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Affiliation(s)
- Wenying Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xin-Ni Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Jingxue Liang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Wei-Guang Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China.
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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7
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Sun W, Wu Q, Gao L, Zheng Z, Xiang H, Yang K, Yu B, Yao J. Advancements in Transcranial Magnetic Stimulation Research and the Path to Precision. Neuropsychiatr Dis Treat 2023; 19:1841-1851. [PMID: 37641588 PMCID: PMC10460597 DOI: 10.2147/ndt.s414782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has become increasingly popular in clinical practice in recent years, and there have been significant advances in the principles and stimulation modes of TMS. With the development of multi-mode and precise stimulation technology, it is crucial to have a comprehensive understanding of TMS. The neuroregulatory effects of TMS can vary depending on the specific mode of stimulation, highlighting the importance of exploring these effects through multimodal application. Additionally, the use of precise TMS therapy can help enhance our understanding of the neural mechanisms underlying these effects, providing us with a more comprehensive perspective. This article aims to review the mechanism of action, stimulation mode, multimodal application, and precision of TMS.
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Affiliation(s)
- Wei Sun
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Qiao Wu
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Li Gao
- Department of Neurology, The Third People’s Hospital of Chengdu, Chengdu Institute of Neurological Diseases, Chengdu City, Sichuan Province, People’s Republic of China
| | - Zhong Zheng
- Neurobiological Detection Center, West China Hospital Affiliated to Sichuan University, Chengdu City, Sichuan Province, People’s Republic of China
| | - Hu Xiang
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Kun Yang
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Bo Yu
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Jing Yao
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
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8
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Passera B, Harquel S, Chauvin A, Gérard P, Lai L, Moro E, Meoni S, Fraix V, David O, Raffin E. Multi-scale and cross-dimensional TMS mapping: A proof of principle in patients with Parkinson's disease and deep brain stimulation. Front Neurosci 2023; 17:1004763. [PMID: 37214390 PMCID: PMC10192635 DOI: 10.3389/fnins.2023.1004763] [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: 07/27/2022] [Accepted: 03/29/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Transcranial magnetic stimulation (TMS) mapping has become a critical tool for exploratory studies of the human corticomotor (M1) organization. Here, we propose to gather existing cutting-edge TMS-EMG and TMS-EEG approaches into a combined multi-dimensional TMS mapping that considers local and whole-brain excitability changes as well as state and time-specific changes in cortical activity. We applied this multi-dimensional TMS mapping approach to patients with Parkinson's disease (PD) with Deep brain stimulation (DBS) of the sub-thalamic nucleus (STN) ON and OFF. Our goal was to identifying one or several TMS mapping-derived markers that could provide unprecedent new insights onto the mechanisms of DBS in movement disorders. Methods Six PD patients (1 female, mean age: 62.5 yo [59-65]) implanted with DBS-STN for 1 year, underwent a robotized sulcus-shaped TMS motor mapping to measure changes in muscle-specific corticomotor representations and a movement initiation task to probe state-dependent modulations of corticospinal excitability in the ON (using clinically relevant DBS parameters) and OFF DBS states. Cortical excitability and evoked dynamics of three cortical areas involved in the neural control of voluntary movements (M1, pre-supplementary motor area - preSMA and inferior frontal gyrus - IFG) were then mapped using TMS-EEG coupling in the ON and OFF state. Lastly, we investigated the timing and nature of the STN-to-M1 inputs using a paired pulse DBS-TMS-EEG protocol. Results In our sample of patients, DBS appeared to induce fast within-area somatotopic re-arrangements of motor finger representations in M1, as revealed by mediolateral shifts of corticomuscle representations. STN-DBS improved reaction times while up-regulating corticospinal excitability, especially during endogenous motor preparation. Evoked dynamics revealed marked increases in inhibitory circuits in the IFG and M1 with DBS ON. Finally, inhibitory conditioning effects of STN single pulses on corticomotor activity were found at timings relevant for the activation of inhibitory GABAergic receptors (4 and 20 ms). Conclusion Taken together, these results suggest a predominant role of some markers in explaining beneficial DBS effects, such as a context-dependent modulation of corticospinal excitability and the recruitment of distinct inhibitory circuits, involving long-range projections from higher level motor centers and local GABAergic neuronal populations. These combined measures might help to identify discriminative features of DBS mechanisms towards deep clinical phenotyping of DBS effects in Parkinson's Disease and in other pathological conditions.
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Affiliation(s)
- Brice Passera
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Sylvain Harquel
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
- CNRS, INSERM, IRMaGe, Grenoble, France
- Defitech Chair in Clinical Neuroengineering, Neuro-X Institute and Brain Mind Institute, EPFL, Geneva, Switzerland
| | - Alan Chauvin
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
| | - Pauline Gérard
- CNRS UMR 5105, Laboratoire Psychologie et Neurocognition, LPNC, Grenoble, France
| | - Lisa Lai
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Elena Moro
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Sara Meoni
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Valerie Fraix
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Olivier David
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
- Aix Marseille Univ, Inserm, U1106, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Estelle Raffin
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
- Defitech Chair in Clinical Neuroengineering, Neuro-X Institute and Brain Mind Institute, EPFL, Geneva, Switzerland
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9
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D’Onofrio V, Manzo N, Guerra A, Landi A, Baro V, Määttä S, Weis L, Porcaro C, Corbetta M, Antonini A, Ferreri F. Combining Transcranial Magnetic Stimulation and Deep Brain Stimulation: Current Knowledge, Relevance and Future Perspectives. Brain Sci 2023; 13:brainsci13020349. [PMID: 36831892 PMCID: PMC9954740 DOI: 10.3390/brainsci13020349] [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: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Deep brain stimulation (DBS) has emerged as an invasive neuromodulation technique for the treatment of several neurological disorders, but the mechanisms underlying its effects remain partially elusive. In this context, the application of Transcranial Magnetic Stimulation (TMS) in patients treated with DBS represents an intriguing approach to investigate the neurophysiology of cortico-basal networks. Experimental studies combining TMS and DBS that have been performed so far have mainly aimed to evaluate the effects of DBS on the cerebral cortex and thus to provide insights into DBS's mechanisms of action. The modulation of cortical excitability and plasticity by DBS is emerging as a potential contributor to its therapeutic effects. Moreover, pairing DBS and TMS stimuli could represent a method to induce cortical synaptic plasticity, the therapeutic potential of which is still unexplored. Furthermore, the advent of new DBS technologies and novel treatment targets will present new research opportunities and prospects to investigate brain networks. However, the application of the combined TMS-DBS approach is currently limited by safety concerns. In this review, we sought to present an overview of studies performed by combining TMS and DBS in neurological disorders, as well as available evidence and recommendations on the safety of their combination. Additionally, we outline perspectives for future research by highlighting knowledge gaps and possible novel applications of this approach.
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Affiliation(s)
| | - Nicoletta Manzo
- IRCCS San Camillo Hospital, Via Alberoni 70, 0126 Venice, Italy
| | - Andrea Guerra
- IRCCS Neuromed, 86077 Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Landi
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
| | - Valentina Baro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, 70211 Kuopio, Finland
| | - Luca Weis
- Parkinson’s Disease and Movement Disorders Unit, Department of Neuroscience, Centre for Rare Neurological Diseases (ERN-RND), University of Padova, 35128 Padova, Italy
| | - Camillo Porcaro
- Padova Neuroscience Center (PNC), University of Padova, 35129 Padova, Italy
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Institute of Cognitive Sciences, and Technologies (ISTC)-National Research Council (CNR), 00185 Rome, Italy
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Maurizio Corbetta
- Padova Neuroscience Center (PNC), University of Padova, 35129 Padova, Italy
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Venetian Institute of Molecular Medicine, 35129 Padova, Italy
| | - Angelo Antonini
- Parkinson’s Disease and Movement Disorders Unit, Department of Neuroscience, Centre for Rare Neurological Diseases (ERN-RND), University of Padova, 35128 Padova, Italy
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Department of Neurology, Washington University, St. Louis, MO 63108, USA
- Department of Neuroscience, Washington University, St. Louis, MO 63108, USA
- Correspondence: (A.A.); (F.F.)
| | - Florinda Ferreri
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, 70211 Kuopio, Finland
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Correspondence: (A.A.); (F.F.)
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Xu M, Hu B, Zhou W, Wang Z, Zhu L, Lin J, Wang D. The mechanism of Parkinson oscillation in the cortex: Possible evidence in a feedback model projecting from the globus pallidus to the cortex. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:6517-6550. [PMID: 37161117 DOI: 10.3934/mbe.2023281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The origin, location and cause of Parkinson's oscillation are not clear at present. In this paper, we establish a new cortex-basal ganglia model to study the origin mechanism of Parkinson beta oscillation. Unlike many previous models, this model includes two direct inhibitory projections from the globus pallidus external (GPe) segment to the cortex. We first obtain the critical calculation formula of Parkinson's oscillation by using the method of Quasilinear analysis. Different from previous studies, the formula obtained in this paper can include the self-feedback connection of GPe. Then, we use the bifurcation analysis method to systematically explain the influence of some key parameters on the oscillation. We find that the bifurcation principle of different cortical nuclei is different. In general, the increase of the discharge capacity of the nuclei will cause oscillation. In some special cases, the sharp reduction of the discharge rate of the nuclei will also cause oscillation. The direction of bifurcation simulation is consistent with the critical condition curve. Finally, we discuss the characteristics of oscillation amplitude. At the beginning of the oscillation, the amplitude is relatively small; with the evolution of oscillation, the amplitude will gradually strengthen. This is consistent with the experimental phenomenon. In most cases, the amplitude of cortical inhibitory nuclei (CIN) is greater than that of cortical excitatory nuclei (CEX), and the two direct inhibitory projections feedback from GPe can significantly reduce the amplitude gap between them. We calculate the main frequency of the oscillation generated in this model, which basically falls between 13 and 30 Hz, belonging to the typical beta frequency band oscillation. Some new results obtained in this paper can help to better understand the origin mechanism of Parkinson's disease and have guiding significance for the development of experiments.
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Affiliation(s)
- Minbo Xu
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
| | - Bing Hu
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
| | - Weiting Zhou
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
| | - Zhizhi Wang
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
| | - Luyao Zhu
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
| | - Jiahui Lin
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
| | - Dingjiang Wang
- Department of Applied Mathematics, Zhejiang University of Technology, Hangzhou 310023, China
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11
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Asp AJ, Chintaluru Y, Hillan S, Lujan JL. Targeted neuroplasticity in spatiotemporally patterned invasive neuromodulation therapies for improving clinical outcomes. Front Neuroinform 2023; 17:1150157. [PMID: 37035718 PMCID: PMC10080034 DOI: 10.3389/fninf.2023.1150157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Anders J. Asp
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Yaswanth Chintaluru
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Neurology and Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
| | - Sydney Hillan
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
- *Correspondence: J. Luis Lujan
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12
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Kromer JA, Tass PA. Synaptic reshaping of plastic neuronal networks by periodic multichannel stimulation with single-pulse and burst stimuli. PLoS Comput Biol 2022; 18:e1010568. [PMID: 36327232 PMCID: PMC9632832 DOI: 10.1371/journal.pcbi.1010568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Synaptic dysfunction is associated with several brain disorders, including Alzheimer's disease, Parkinson's disease (PD) and obsessive compulsive disorder (OCD). Utilizing synaptic plasticity, brain stimulation is capable of reshaping synaptic connectivity. This may pave the way for novel therapies that specifically counteract pathological synaptic connectivity. For instance, in PD, novel multichannel coordinated reset stimulation (CRS) was designed to counteract neuronal synchrony and down-regulate pathological synaptic connectivity. CRS was shown to entail long-lasting therapeutic aftereffects in PD patients and related animal models. This is in marked contrast to conventional deep brain stimulation (DBS) therapy, where PD symptoms return shortly after stimulation ceases. In the present paper, we study synaptic reshaping by periodic multichannel stimulation (PMCS) in networks of leaky integrate-and-fire (LIF) neurons with spike-timing-dependent plasticity (STDP). During PMCS, phase-shifted periodic stimulus trains are delivered to segregated neuronal subpopulations. Harnessing STDP, PMCS leads to changes of the synaptic network structure. We found that the PMCS-induced changes of the network structure depend on both the phase lags between stimuli and the shape of individual stimuli. Single-pulse stimuli and burst stimuli with low intraburst frequency down-regulate synapses between neurons receiving stimuli simultaneously. In contrast, burst stimuli with high intraburst frequency up-regulate these synapses. We derive theoretical approximations of the stimulation-induced network structure. This enables us to formulate stimulation strategies for inducing a variety of network structures. Our results provide testable hypotheses for future pre-clinical and clinical studies and suggest that periodic multichannel stimulation may be suitable for reshaping plastic neuronal networks to counteract pathological synaptic connectivity. Furthermore, we provide novel insight on how the stimulus type may affect the long-lasting outcome of conventional DBS. This may strongly impact parameter adjustment procedures for clinical DBS, which, so far, primarily focused on acute effects of stimulation.
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Affiliation(s)
- Justus A Kromer
- Department of Neurosurgery, Stanford University, Stanford, California, United States of America
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, California, United States of America
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13
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Siebner HR, Funke K, Aberra AS, Antal A, Bestmann S, Chen R, Classen J, Davare M, Di Lazzaro V, Fox PT, Hallett M, Karabanov AN, Kesselheim J, Beck MM, Koch G, Liebetanz D, Meunier S, Miniussi C, Paulus W, Peterchev AV, Popa T, Ridding MC, Thielscher A, Ziemann U, Rothwell JC, Ugawa Y. Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper. Clin Neurophysiol 2022; 140:59-97. [PMID: 35738037 PMCID: PMC9753778 DOI: 10.1016/j.clinph.2022.04.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/14/2022] [Accepted: 04/15/2022] [Indexed: 12/11/2022]
Abstract
Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool.
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Affiliation(s)
- Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Klaus Funke
- Department of Neurophysiology, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - Aman S Aberra
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Sven Bestmann
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Robert Chen
- Krembil Brain Institute, University Health Network and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Marco Davare
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Anke N Karabanov
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Nutrition and Exercise, University of Copenhagen, Copenhagen, Denmark
| | - Janine Kesselheim
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mikkel M Beck
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Non-invasive Brain Stimulation Unit, Laboratorio di NeurologiaClinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Sabine Meunier
- Sorbonne Université, Faculté de Médecine, INSERM U 1127, CNRS 4 UMR 7225, Institut du Cerveau, F-75013, Paris, France
| | - Carlo Miniussi
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di DioFatebenefratelli, Brescia, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Angel V Peterchev
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA; Department of Electrical & Computer Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, School of Medicine, Duke University, Durham, NC, USA
| | - Traian Popa
- Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Michael C Ridding
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ulf Ziemann
- Department of Neurology & Stroke, University Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yoshikazu Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Centre, Advanced Clinical Research Centre, Fukushima Medical University, Fukushima, Japan
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14
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Wang K, Wang J, Zhu Y, Li H, Liu C, Fietkiewicz C, Loparo KA. Adaptive closed-loop control strategy inhibiting pathological basal ganglia oscillations. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Evidence of Neuroplastic Changes after Transcranial Magnetic, Electric, and Deep Brain Stimulation. Brain Sci 2022; 12:brainsci12070929. [PMID: 35884734 PMCID: PMC9313265 DOI: 10.3390/brainsci12070929] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Electric and magnetic stimulation of the human brain can be used to excite or inhibit neurons. Numerous methods have been designed over the years for this purpose with various advantages and disadvantages that are the topic of this review. Deep brain stimulation (DBS) is the most direct and focal application of electric impulses to brain tissue. Electrodes are placed in the brain in order to modulate neural activity and to correct parameters of pathological oscillation in brain circuits such as their amplitude or frequency. Transcranial magnetic stimulation (TMS) is a non-invasive alternative with the stimulator generating a magnetic field in a coil over the scalp that induces an electric field in the brain which, in turn, interacts with ongoing brain activity. Depending upon stimulation parameters, excitation and inhibition can be achieved. Transcranial electric stimulation (tES) applies electric fields to the scalp that spread along the skull in order to reach the brain, thus, limiting current strength to avoid skin sensations and cranial muscle pain. Therefore, tES can only modulate brain activity and is considered subthreshold, i.e., it does not directly elicit neuronal action potentials. In this review, we collect hints for neuroplastic changes such as modulation of behavior, the electric activity of the brain, or the evolution of clinical signs and symptoms in response to stimulation. Possible mechanisms are discussed, and future paradigms are suggested.
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16
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Breu MS, Schneider M, Klemt J, Cebi I, Gharabaghi A, Weiss D. People With Parkinson’s Disease and Freezing of Gait Show Abnormal Low Frequency Activity of Antagonistic Leg Muscles. Front Hum Neurosci 2022; 15:733067. [PMID: 35153698 PMCID: PMC8825470 DOI: 10.3389/fnhum.2021.733067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Freezing of gait is detrimental to patients with idiopathic Parkinson’s disease (PD). Its pathophysiology represents a multilevel failure of motor processing in the cortical, subcortical, and brainstem circuits, ultimately resulting in ineffective motor output of the spinal pattern generator. Electrophysiological studies pointed to abnormalities of oscillatory activity in freezers that covered a broad frequency range including the theta, alpha, and beta bands. We explored muscular frequency domain activity with respect to freezing, and used deep brain stimulation to modulate these rhythms thereby evaluating the supraspinal contributions to spinal motor neuron activity. Methods We analyzed 9 PD freezers and 16 healthy controls (HC). We studied the patients after overnight withdrawal of dopaminergic medication with stimulation off, stimulation of the subthalamic nucleus (STN-DBSonly) or the substantia nigra pars reticulate (SNr-DBSonly), respectively. Patients performed a walking paradigm passing a narrow obstacle. We analyzed the frequency-domain spectra of the tibialis anterior (TA) and gastrocnemius (GA) muscles in ‘regular gait’ and during the ‘freezing’ episodes. Results In stimulation off, PD freezers showed increased muscle activity of the alpha and low-beta band compared to HC in both TA and GA. This activity increase was present during straight walking and during the freezes to similar extent. STN- but not SNr-DBS decreased this activity and paralleled the clinical improvement of freezing. Conclusion We found increased muscle activation of the alpha and lower beta band in PD freezers compared to HC, and this was attenuated with STN-DBS. Future studies may use combined recordings of local field potentials, electroencephalography (EEG), and electromyography (EMG) to interrogate the supraspinal circuit mechanisms of the pathological activation pattern of the spinal pattern generator.
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Affiliation(s)
- Maria-Sophie Breu
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
- *Correspondence: Maria-Sophie Breu,
| | - Marlieke Schneider
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Johannes Klemt
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Idil Cebi
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Alireza Gharabaghi
- Centre for Neurosurgery, Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Daniel Weiss
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Daniel Weiss,
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17
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Parkinson's disease: Alterations of motor plasticity and motor learning. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:135-151. [PMID: 35034730 DOI: 10.1016/b978-0-12-819410-2.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This chapter reviews the alterations in motor learning and motor cortical plasticity in Parkinson's disease (PD), the most common movement disorder. Impairments in motor learning, which is a hallmark of basal ganglia disorders, influence the performance of motor learning-related behavioral tasks and have clinical implications for the management of disturbance in gait and posture, and for rehabilitative management of PD. Although plasticity is classically induced and assessed in sliced preparation in animal models, in this review we have concentrated on the results from non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS) and transcranial direct current stimulation (tDCS) in patients with PD, in addition to a few animal electrophysiologic studies. The chapter summarizes the results from different cortical and subcortical plasticity investigations. Plasticity induction protocols reveal deficient plasticity in PD and these plasticity measures are modulated by medications and deep brain stimulation. There is considerable variability in these measures that are related to inter-individual variations, different disease characteristics and methodological considerations. Nevertheless, these pathophysiologic studies expand our knowledge of cortical excitability, plasticity and the effects of different treatments in PD. These tools of modulating plasticity and motor learning improve our understanding of PD pathophysiology and help to develop new treatments for this disabling condition.
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18
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Cosentino G, Todisco M, Blandini F. Noninvasive neuromodulation in Parkinson's disease: Neuroplasticity implication and therapeutic perspectives. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:185-198. [PMID: 35034733 DOI: 10.1016/b978-0-12-819410-2.00010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Noninvasive brain stimulation techniques can be used to study in vivo the changes of cortical activity and plasticity in subjects with Parkinson's disease (PD). Also, an increasing number of studies have suggested a potential therapeutic effect of these techniques. High-frequency repetitive transcranial magnetic stimulation (rTMS) and anodal transcranial direct current stimulation (tDCS) represent the most used stimulation paradigms to treat motor and nonmotor symptoms of PD. Both techniques can enhance cortical activity, compensating for its reduction related to subcortical dysfunction in PD. However, the use of suboptimal stimulation parameters can lead to therapeutic failure. Clinical studies are warranted to clarify in PD the additional effects of these stimulation techniques on pharmacologic and neurorehabilitation treatments.
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Affiliation(s)
- Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Fabio Blandini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy
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19
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Subthalamic nucleus conditioning reduces premotor-motor interaction in Parkinson's disease. Parkinsonism Relat Disord 2022; 96:6-12. [DOI: 10.1016/j.parkreldis.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
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20
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Exploring the connections between basal ganglia and cortex revealed by transcranial magnetic stimulation, evoked potential and deep brain stimulation in dystonia. Eur J Paediatr Neurol 2022; 36:69-77. [PMID: 34922163 DOI: 10.1016/j.ejpn.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/30/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022]
Abstract
We review the findings for motor cortical excitability, plasticity and evoked potentials in dystonia. Plasticity can be induced and assessed in cortical areas by non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and the invasive technique of deep brain stimulation (DBS), which allows access to deep brain structures. Single-pulse TMS measures have been widely studied in dystonia and consistently showed reduced silent period duration. Paired pulse TMS measures showed reduced short and long interval intracortical inhibition, interhemispheric inhibition, long-latency afferent inhibition and increased intracortical facilitation in dystonia. Repetitive transcranial magnetic stimulation (rTMS) of the premotor cortex improved handwriting with prolongation of the silent period in focal hand dystonia patients. Continuous theta-burst stimulation (cTBS) of the cerebellum or cTBS of the dorsal premotor cortex improved dystonia in some studies. Plasticity induction protocols in dystonia demonstrated excessive motor cortical plasticity with the reduction in cortico-motor topographic specificity. Bilateral DBS of the globus pallidus internus (GPi) improves dystonia, associated pain and functional disability. Local field potentials recordings in dystonia patients suggested that there is increased power in the low-frequency band (4-12 Hz) in the GPi. Cortical evoked potentials at peak latencies of 10 and 25 ms can be recorded with GPi stimulation in dystonia. Plasticity induction protocols based on the principles of spike timing dependent plasticity that involved repeated pairing of GPi-DBS and motor cortical TMS at latencies of cortical evoked potentials induced motor cortical plasticity. These studies expanded our knowledge of the pathophysiology of dystonia and how cortical excitability and plasticity are altered with different treatments such as DBS.
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21
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Wendt K, Denison T, Foster G, Krinke L, Thomson A, Wilson S, Widge AS. Physiologically informed neuromodulation. J Neurol Sci 2021; 434:120121. [PMID: 34998239 PMCID: PMC8976285 DOI: 10.1016/j.jns.2021.120121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 01/09/2023]
Abstract
The rapid evolution of neuromodulation techniques includes an increasing amount of research into stimulation paradigms that are guided by patients' neurophysiology, to increase efficacy and responder rates. Treatment personalisation and target engagement have shown to be effective in fields such as Parkinson's disease, and closed-loop paradigms have been successfully implemented in cardiac defibrillators. Promising avenues are being explored for physiologically informed neuromodulation in psychiatry. Matching the stimulation frequency to individual brain rhythms has shown some promise in transcranial magnetic stimulation (TMS). Matching the phase of those rhythms may further enhance neuroplasticity, for instance when combining TMS with electroencephalographic (EEG) recordings. Resting-state EEG and event-related potentials may be useful to demonstrate connectivity between stimulation sites and connected areas. These techniques are available today to the psychiatrist to diagnose underlying sleep disorders, epilepsy, or lesions as contributing factors to the cause of depression. These technologies may also be useful in assessing the patient's brain network status prior to deciding on treatment options. Ongoing research using invasive recordings may allow for future identification of mood biomarkers and network structure. A core limitation is that biomarker research may currently be limited by the internal heterogeneity of psychiatric disorders according to the current DSM-based classifications. New approaches are being developed and may soon be validated. Finally, care must be taken when incorporating closed-loop capabilities into neuromodulation systems, by ensuring the safe operation of the system and understanding the physiological dynamics. Neurophysiological tools are rapidly evolving and will likely define the next generation of neuromodulation therapies.
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Affiliation(s)
- Karen Wendt
- Department of Engineering Science and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
| | - Timothy Denison
- Department of Engineering Science and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Gaynor Foster
- Welcony Inc., Plymouth, MN, United States of America
| | - Lothar Krinke
- Welcony Inc., Plymouth, MN, United States of America; Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Alix Thomson
- Welcony Inc., Plymouth, MN, United States of America
| | - Saydra Wilson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, United States of America; Medical Discovery Team on Additions, University of Minnesota, Minneapolis, MN, United States of America
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22
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Guidali G, Roncoroni C, Bolognini N. Paired associative stimulations: Novel tools for interacting with sensory and motor cortical plasticity. Behav Brain Res 2021; 414:113484. [PMID: 34302877 DOI: 10.1016/j.bbr.2021.113484] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 12/26/2022]
Abstract
In the early 2000s, a novel non-invasive brain stimulation protocol, the paired associative stimulation (PAS), was introduced, allowing to induce and investigate Hebbian associative plasticity within the humans' motor system, with patterns resembling spike-timing-dependent plasticity properties found in cellular models. Since this evidence, PAS efficacy has been proved in healthy, and to a lesser extent, in clinical populations. Recently, novel 'modified' protocols targeting sensorimotor and crossmodal networks appeared in the literature. In the present work, we have reviewed recent advances using these 'modified' PAS protocols targeting sensory and motor cortical networks. To better categorize them, we propose a novel classification according to the nature of the peripheral and cortical stimulations (i.e., within-system, cross-systems, and cortico-cortical PAS). For each protocol of the categories mentioned above, we describe and discuss their main features, how they have been used to study and promote brain plasticity, and their advantages and disadvantages. Overall, current evidence suggests that these novel non-invasive brain stimulation protocols represent very promising tools to study the plastic properties of humans' sensorimotor and crossmodal networks, both in the healthy and in the damaged central nervous system.
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Affiliation(s)
- Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.
| | - Camilla Roncoroni
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy; Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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23
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol 2021; 132:269-306. [PMID: 33243615 PMCID: PMC9094636 DOI: 10.1016/j.clinph.2020.10.003] [Citation(s) in RCA: 479] [Impact Index Per Article: 159.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
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Affiliation(s)
- Simone Rossi
- Department of Scienze Mediche, Chirurgiche e Neuroscienze, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Italy.
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany; Institue of Medical Psychology, Otto-Guericke University Magdeburg, Germany
| | - Sven Bestmann
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Carmen Brewer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Linda L Carpenter
- Butler Hospital, Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Massimo Cincotta
- Unit of Neurology of Florence - Central Tuscany Local Health Authority, Florence, Italy
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Jeff D Daskalakis
- Center for Addiction and Mental Health (CAMH), University of Toronto, Canada
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering (NBE), Aalto University School of Science, Aalto, Finland
| | - Jean Pascal Lefaucheur
- EA 4391, ENT Team, Faculty of Medicine, Paris Est Creteil University (UPEC), Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, (APHP), Créteil, France
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS-San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Angel V Peterchev
- Departments of Psychiatry & Behavioral Sciences, Biomedical Engineering, Electrical & Computer Engineering, and Neurosurgery, Duke University, Durham, NC, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alexander Rotenberg
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Rothwell
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Paolo M Rossini
- Department of Neuroscience and Rehabilitation, IRCCS San Raffaele-Pisana, Roma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikatzu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Eric M Wassermann
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Abraham Zangen
- Zlotowski Center of Neuroscience, Ben Gurion University, Beer Sheva, Israel
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
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24
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Yuan TF, Li WG, Zhang C, Wei H, Sun S, Xu NJ, Liu J, Xu TL. Targeting neuroplasticity in patients with neurodegenerative diseases using brain stimulation techniques. Transl Neurodegener 2020; 9:44. [PMID: 33280613 PMCID: PMC7720463 DOI: 10.1186/s40035-020-00224-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 11/19/2020] [Indexed: 01/17/2023] Open
Abstract
Deficits in synaptic transmission and plasticity are thought to contribute to the pathophysiology of Alzheimer’s disease (AD) and Parkinson’s disease (PD). Several brain stimulation techniques are currently available to assess or modulate human neuroplasticity, which could offer clinically useful interventions as well as quantitative diagnostic and prognostic biomarkers. In this review, we discuss several brain stimulation techniques, with a special emphasis on transcranial magnetic stimulation and deep brain stimulation (DBS), and review the results of clinical studies that applied these techniques to examine or modulate impaired neuroplasticity at the local and network levels in patients with AD or PD. The impaired neuroplasticity can be detected in patients at the earlier and later stages of both neurodegenerative diseases. However, current brain stimulation techniques, with a notable exception of DBS for PD treatment, cannot serve as adequate clinical tools to assist in the diagnosis, treatment, or prognosis of individual patients with AD or PD. Targeting the impaired neuroplasticity with improved brain stimulation techniques could offer a powerful novel approach for the treatment of AD and PD.
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Affiliation(s)
- Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.,Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, 226001, China
| | - Wei-Guang Li
- Center for Brain Science, Shanghai Children's Medical Center, and Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hongjiang Wei
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Suya Sun
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Nan-Jie Xu
- Center for Brain Science, Shanghai Children's Medical Center, and Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Tian-Le Xu
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, 226001, China.
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25
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Fomenko A, Chen KHS, Nankoo JF, Saravanamuttu J, Wang Y, El-Baba M, Xia X, Seerala SS, Hynynen K, Lozano AM, Chen R. Systematic examination of low-intensity ultrasound parameters on human motor cortex excitability and behavior. eLife 2020; 9:e54497. [PMID: 33236981 PMCID: PMC7728443 DOI: 10.7554/elife.54497] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
Low-intensity transcranial ultrasound (TUS) can non-invasively modulate human neural activity. We investigated how different fundamental sonication parameters influence the effects of TUS on the motor cortex (M1) of 16 healthy subjects by probing cortico-cortical excitability and behavior. A low-intensity 500 kHz TUS transducer was coupled to a transcranial magnetic stimulation (TMS) coil. TMS was delivered 10 ms before the end of TUS to the left M1 hotspot of the first dorsal interosseous muscle. Varying acoustic parameters (pulse repetition frequency, duty cycle, and sonication duration) on motor-evoked potential amplitude were examined. Paired-pulse measures of cortical inhibition and facilitation, and performance on a visuomotor task was also assessed. TUS safely suppressed TMS-elicited motor cortical activity, with longer sonication durations and shorter duty cycles when delivered in a blocked paradigm. TUS increased GABAA-mediated short-interval intracortical inhibition and decreased reaction time on visuomotor task but not when controlled with TUS at near-somatosensory threshold intensity.
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Affiliation(s)
- Anton Fomenko
- Krembil Research Institute, University Health NetworkTorontoCanada
| | - Kai-Hsiang Stanley Chen
- Krembil Research Institute, University Health NetworkTorontoCanada
- Department of Neurology, National Taiwan University Hospital Hsin-Chu BranchHsin-ChuTaiwan
| | | | | | - Yanqiu Wang
- Krembil Research Institute, University Health NetworkTorontoCanada
| | - Mazen El-Baba
- Krembil Research Institute, University Health NetworkTorontoCanada
| | - Xue Xia
- Division of Neurology, Department of Medicine, University of TorontoTorontoCanada
| | | | | | - Andres M Lozano
- Krembil Research Institute, University Health NetworkTorontoCanada
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of TorontoTorontoCanada
| | - Robert Chen
- Krembil Research Institute, University Health NetworkTorontoCanada
- Division of Neurology, Department of Medicine, University of TorontoTorontoCanada
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26
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Madrid J, Benninger DH. Non-invasive brain stimulation for Parkinson's disease: Clinical evidence, latest concepts and future goals: A systematic review. J Neurosci Methods 2020; 347:108957. [PMID: 33017643 DOI: 10.1016/j.jneumeth.2020.108957] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
Parkinson's disease (PD) is becoming a major public-health issue in an aging population. Available approaches to treat advanced PD still have limitations; new therapies are needed. The non-invasive brain stimulation (NIBS) may offer a complementary approach to treat advanced PD by personalized stimulation. Although NIBS is not as effective as the gold-standard levodopa, recent randomized controlled trials show promising outcomes in the treatment of PD symptoms. Nevertheless, only a few NIBS-stimulation paradigms have shown to improve PD's symptoms. Current clinical recommendations based on the level of evidence are reported in Table 1 through Table 3. Furthermore, novel technological advances hold promise and may soon enable the non-invasive stimulation of deeper brain structures for longer periods.
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Affiliation(s)
- Julian Madrid
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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27
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Naro A, Pignolo L, Sorbera C, Latella D, Billeri L, Manuli A, Portaro S, Bruschetta D, Calabrò RS. A Case-Controlled Pilot Study on Rhythmic Auditory Stimulation-Assisted Gait Training and Conventional Physiotherapy in Patients With Parkinson's Disease Submitted to Deep Brain Stimulation. Front Neurol 2020; 11:794. [PMID: 32849240 PMCID: PMC7417712 DOI: 10.3389/fneur.2020.00794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/25/2020] [Indexed: 01/13/2023] Open
Abstract
Deep brain stimulation (DBS) is indicated when motor disturbances in patients with idiopathic Parkinson's disease (PD) are refractory to current treatment options and significantly impair quality of life. However, post–DBS rehabilitation is essential, with particular regard to gait. Rhythmic auditory stimulation (RAS)-assisted treadmill gait rehabilitation within conventional physiotherapy program plays a major role in gait recovery. We explored the effects of a monthly RAS–assisted treadmill training within a conventional physiotherapy program on gait performance and gait-related EEG dynamics (while walking on the RAS–aided treadmill) in PD patients with (n = 10) and without DBS (n = 10). Patients with DBS achieved superior results than those without DBS concerning gait velocity, overall motor performance, and the timed velocity and self-confidence in balance, sit-to-stand (and vice versa) and walking, whereas both groups improved in dynamic and static balance, overall cognitive performance, and the fear of falling. The difference in motor outcomes between the two groups was paralleled by a stronger remodulation of gait cycle–related beta oscillations in patients with DBS as compared to those without DBS. Our work suggests that RAS-assisted gait training plus conventional physiotherapy is a useful strategy to improve gait performance in PD patients with and without DBS. Interestingly, patients with DBS may benefit more from this approach owing to a more focused and dynamic re–configuration of sensorimotor network beta oscillations related to gait secondary to the association between RAS-treadmill, conventional physiotherapy, and DBS. Actually, the coupling of these approaches may help restoring a residually altered beta–band response profile despite DBS intervention, thus better tailoring the gait rehabilitation of these PD patients.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Chiara Sorbera
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Desiree Latella
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Alfredo Manuli
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Simona Portaro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Daniele Bruschetta
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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28
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Toth R, Holt AB, Benjaber M, Sharott A, Denison T. Frequency and Phase Synchronization in Distributed (Implantable-Transcutaneous) Neural Interfaces. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3831-3834. [PMID: 31946709 DOI: 10.1109/embc.2019.8857895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Synchronized oscillations are a ubiquitous feature of neuronal circuits and can modulate online information transfer and plasticity between brain areas. The disruption of these oscillatory processes is associated with the symptoms of several brain disorders. While conventional therapeutic high-frequency deep brain stimulation can perturb neuronal oscillations, manipulating the timing of oscillatory activity between areas more precisely could provide a more efficient and effective method of modulating these activities. Here we describe a prototype circuit for synchronizing the clocks between an active implantable and an external sensing and stimulation system that could be used to achieve this goal. Our specific focus is on synchronizing the systems for paired-associative stimulation. The ability to repetitively drive two brain regions with a fixed latency has specific implications for neural plasticity. Furthermore, the general concept can be applied for many potential applications involving distributed neural interfaces.
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29
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Liu D, Chen J, Hu X, Hu G, Liu Y, Yang K, Xiao C, Zou Y, Liu H. Contralesional homotopic functional plasticity in patients with temporal glioma. J Neurosurg 2020; 134:417-425. [PMID: 31923896 DOI: 10.3171/2019.11.jns191982] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to explore the contralesional homotopic functional plasticity in the brain of patients with unilateral temporal glioma. METHODS Demographic, neurocognitive, and resting-state functional MRI data were collected from 17 patients with temporal glioma (10 in the right lobe and 7 in the left lobe), along with 14 age- and sex-matched healthy controls. The amplitude of low-frequency fluctuation (ALFF) of the contralesional homotopic region and 2 control regions was examined. The region-of-interest-based analysis was used to determine the altered functional connectivity (FC) of the contralesional homotopic region, showing significantly different intrinsic regional brain activity between patients and controls. Partial correlation analysis was conducted to determine the association between the altered neural activity and behavioral characteristics. RESULTS Compared with controls, patients with right temporal glioma exhibited significantly increased ALFF in the contralesional homotopic hippocampus and parahippocampal region. In addition, the intrinsic regional activity in these regions was negatively correlated with the visuospatial score (r = -0.718, p = 0.045). Whole-brain FC analysis revealed significantly increased FC between the left hippocampus and parahippocampal regions and the left inferior temporal gyrus, and decreased FC between the left hippocampus and parahippocampal regions and the left inferior frontal gyrus. No significant changes were found in the 2 control regions. CONCLUSIONS Contralesional homotopic regions are instrumental in the process of neural plasticity and functional compensation observed in patients with unilateral temporal glioma. The observed findings might be used to help preoperative evaluation or rehabilitation of postsurgical patients.
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Affiliation(s)
- Dongming Liu
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Jiu Chen
- 2Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Fourth Clinical College of Nanjing Medical University, Nanjing, Jiangsu
- 3Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu; and
| | - Xinhua Hu
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
- 3Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu; and
| | - Guanjie Hu
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Yong Liu
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Kun Yang
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Chaoyong Xiao
- 3Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu; and
- 4Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanjie Zou
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
- 3Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu; and
| | - Hongyi Liu
- 1Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
- 3Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu; and
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30
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Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clin Neurophysiol 2020; 131:474-528. [PMID: 31901449 DOI: 10.1016/j.clinph.2019.11.002] [Citation(s) in RCA: 872] [Impact Index Per Article: 218.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/21/2019] [Accepted: 11/02/2019] [Indexed: 02/08/2023]
Abstract
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jérôme Brunelin
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Saša R Filipović
- Department of Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Christian Grefkes
- Department of Neurology, Cologne University Hospital, Cologne, Germany; Institute of Neurosciences and Medicine (INM3), Jülich Research Centre, Jülich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair in Clinical Neuroengineering, Swiss Federal Institute of Technology (EPFL) Valais and Clinique Romande de Réadaptation, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Letizia Leocani
- Department of Neurorehabilitation and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alain Londero
- Department of Otorhinolaryngology - Head and Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Jean-Paul Nguyen
- Multidisciplinary Pain Center, Clinique Bretéché, ELSAN, Nantes, France; Multidisciplinary Pain, Palliative and Supportive Care Center, UIC22-CAT2-EA3826, University Hospital, CHU Nord-Laënnec, Nantes, France
| | - Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Bern, Switzerland; Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Emmanuel Poulet
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Si-BIN Lab Human Physiology Section, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Hanna Sahlsten
- ENT Clinic, Mehiläinen and University of Turku, Turku, Finland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - David Szekely
- Department of Psychiatry, Princess Grace Hospital, Monaco
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Weissbach A, Udupa K, Ni Z, Gunraj C, Rinchon C, Baarbe J, Fasano A, Munhoz RP, Lang A, Tadic V, Brüggemann N, Münchau A, Bäumer T, Chen R. Single-pulse subthalamic deep brain stimulation reduces premotor-motor facilitation in Parkinson's disease. Parkinsonism Relat Disord 2019; 66:224-227. [DOI: 10.1016/j.parkreldis.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/26/2022]
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Dubbioso R, Manganelli F, Siebner HR, Di Lazzaro V. Fast Intracortical Sensory-Motor Integration: A Window Into the Pathophysiology of Parkinson's Disease. Front Hum Neurosci 2019; 13:111. [PMID: 31024277 PMCID: PMC6463734 DOI: 10.3389/fnhum.2019.00111] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/13/2019] [Indexed: 01/09/2023] Open
Abstract
Parkinson's Disease (PD) is a prototypical basal ganglia disorder. Nigrostriatal dopaminergic denervation leads to progressive dysfunction of the cortico-basal ganglia-thalamo-cortical sensorimotor loops, causing the classical motor symptoms. Although the basal ganglia do not receive direct sensory input, they are important for sensorimotor integration. Therefore, the basal ganglia dysfunction in PD may profoundly affect sensory-motor interaction in the cortex. Cortical sensorimotor integration can be probed with transcranial magnetic stimulation (TMS) using a well-established conditioning-test paradigm, called short-latency afferent inhibition (SAI). SAI probes the fast-inhibitory effect of a conditioning peripheral electrical stimulus on the motor response evoked by a TMS test pulse given to the contralateral primary motor cortex (M1). Since SAI occurs at latencies that match the peaks of early cortical somatosensory potentials, the cortical circuitry generating SAI may play an important role in rapid online adjustments of cortical motor output to changes in somatosensory inputs. Here we review the existing studies that have used SAI to examine how PD affects fast cortical sensory-motor integration. Studies of SAI in PD have yielded variable results, showing reduced, normal or even enhanced levels of SAI. This variability may be attributed to the fact that the strength of SAI is influenced by several factors, such as differences in dopaminergic treatment or the clinical phenotype of PD. Inter-individual differences in the expression of SAI has been shown to scale with individual motor impairment as revealed by UPDRS motor score and thus, may reflect the magnitude of dopaminergic neurodegeneration. The magnitude of SAI has also been linked to cognitive dysfunction, and it has been suggested that SAI also reflects cholinergic denervation at the cortical level. Together, the results indicate that SAI is a useful marker of disease-related alterations in fast cortical sensory-motor integration driven by subcortical changes in the dopaminergic and cholinergic system. Since a multitude of neurobiological factors contribute to the magnitude of inhibition, any mechanistic interpretation of SAI changes in PD needs to consider the group characteristics in terms of phenotypical spectrum, disease stage, and medication.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Rome, Italy
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Optogenetic Stimulation of the M2 Cortex Reverts Motor Dysfunction in a Mouse Model of Parkinson's Disease. J Neurosci 2019; 39:3234-3248. [PMID: 30782975 DOI: 10.1523/jneurosci.2277-18.2019] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/21/2022] Open
Abstract
Neuromodulation of deep brain structures (deep brain stimulation) is the current surgical procedure for treatment of Parkinson's disease (PD). Less studied is the stimulation of cortical motor areas to treat PD symptoms, although also known to alleviate motor disturbances in PD. We were able to show that optogenetic activation of secondary (M2) motor cortex improves motor functions in dopamine-depleted male mice. The stimulated M2 cortex harbors glutamatergic pyramidal neurons that project to subcortical structures, critically involved in motor control, and makes synaptic contacts with dopaminergic neurons. Strikingly, optogenetic activation of M2 neurons or axons into the dorsomedial striatum increases striatal levels of dopamine and evokes locomotor activity. We found that dopamine neurotransmission sensitizes the locomotor behavior elicited by activation of M2 neurons. Furthermore, combination of intranigral infusion of glutamatergic antagonists and circuit specific optogenetic stimulation revealed that behavioral response depended on the activity of M2 neurons projecting to SNc. Interestingly, repeated M2 stimulation combined with l-DOPA treatment produced an unanticipated improvement in working memory performance, which was absent in control mice under l-DOPA treatment only. Therefore, the M2-basal ganglia circuit is critical for the assembly of the motor and cognitive function, and this study demonstrates a therapeutic mechanism for cortical stimulation in PD that involves recruitment of long-range glutamatergic projection neurons.SIGNIFICANCE STATEMENT Some patients with Parkinson's disease are offered treatment through surgery, which consists of delivering electrical current to regions deep within the brain. This study shows that stimulation of an area located on the brain surface, known as the secondary motor cortex, can also reverse movement disorders in mice. Authors have used a brain stimulation technique called optogenetics, which allowed targeting a specific type of surface neuron that communicates with the deep part of the brain involved in movement control. The study also shows that a combination of this stimulation with drug treatment might be useful to treat memory impairment, a kind of cognitive problem in Parkinson's disease.
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Kohl S, Hannah R, Rocchi L, Nord CL, Rothwell J, Voon V. Cortical Paired Associative Stimulation Influences Response Inhibition: Cortico-cortical and Cortico-subcortical Networks. Biol Psychiatry 2019; 85:355-363. [PMID: 29724490 PMCID: PMC7004814 DOI: 10.1016/j.biopsych.2018.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The ability to stop a suboptimal response is integral to decision making and is commonly impaired across psychiatric disorders. Cortical paired associative stimulation (cPAS) is a form of transcranial magnetic stimulation in which paired pulses can induce plasticity at cortical synapses. Here we used cPAS protocols to target cortico-cortical and cortico-subcortical networks by using different intervals between the paired pulses in an attempt to modify response inhibition. METHODS A total of 25 healthy volunteers underwent four cPAS sessions in random order 1 week apart: right inferior frontal cortex (IFC) stimulation preceding right presupplementary motor area (pre-SMA) stimulation by 10 or 4 ms and pre-SMA stimulation preceding IFC stimulation by 10 or 4 ms. Subjects were tested on the stop signal task along with the delay discounting task as control at baseline (randomized across sessions and cPAS protocol) and after each cPAS session. RESULTS The stop signal reaction time showed a main effect of cPAS condition when controlling for age (F3,57 = 4.05, p = .01). Younger subjects had greater impairments in response inhibition when the pre-SMA pulse preceded the IFC pulse by 10 ms. In older individuals, response inhibition improved when the IFC pulse preceded the pre-SMA pulse by 4 ms. There were no effects on delay discounting. CONCLUSIONS cPAS modified response inhibition through age-dependent long-term potentiation and depression-like plasticity mechanisms via putative cortico-cortical and cortico-subcortical networks. We show for the first time the capacity for cPAS to modify a cognitive process highly relevant to psychiatric disorders.
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Affiliation(s)
- Sina Kohl
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Lorenzo Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Camilla L Nord
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough National Health Service Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom.
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Terranova C, Rizzo V, Cacciola A, Chillemi G, Calamuneri A, Milardi D, Quartarone A. Is There a Future for Non-invasive Brain Stimulation as a Therapeutic Tool? Front Neurol 2019; 9:1146. [PMID: 30733704 PMCID: PMC6353822 DOI: 10.3389/fneur.2018.01146] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/11/2018] [Indexed: 01/11/2023] Open
Abstract
Several techniques and protocols of non-invasive transcranial brain stimulation (NIBS), including transcranial magnetic and electrical stimuli, have been developed in the past decades. These techniques can induce long lasting changes in cortical excitability by promoting synaptic plasticity and thus may represent a therapeutic option in neuropsychiatric disorders. On the other hand, despite these techniques have become popular, the fragility and variability of the after effects are the major challenges that non-invasive transcranial brain stimulation currentlyfaces. Several factors may account for such a variability such as biological variations, measurement reproducibility, and the neuronal state of the stimulated area. One possible strategy, to reduce this variability is to monitor the neuronal state in real time using EEG and trigger TMS pulses only at pre-defined state. In addition, another strategy under study is to use the spaced application of multiple NIBS protocols within a session to improve the reliability and extend the duration of NIBS effects. Further studies, although time consuming, are required for improving the so far limited effect sizes of NIBS protocols for treatment of neurological or psychiatric disorders.
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Affiliation(s)
- Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberto Cacciola
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | | | | | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.,IRCCS Centro Neurolesi 'Bonino Pulejo', Messina, Italy
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Mancini C, Modugno N, Santilli M, Pavone L, Grillea G, Morace R, Mirabella G. Unilateral Stimulation of Subthalamic Nucleus Does Not Affect Inhibitory Control. Front Neurol 2019; 9:1149. [PMID: 30666229 PMCID: PMC6330317 DOI: 10.3389/fneur.2018.01149] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/11/2018] [Indexed: 01/06/2023] Open
Abstract
Despite the relevance of inhibitory control in shaping our behavior its neural substrates are still hotly debated. In this regard, it has been suggested that inhibitory control relies upon a right-lateralized network which involves the right subthalamic nucleus (STN). To assess the role of STN, we took advantage of a relatively rare model, i.e., advanced Parkinson's patients who received unilateral deep-brain stimulation (DBS) of the STN either of the left (n = 10) or of the right (n = 10) hemisphere. We gave them a stop-signal reaching task, and we compared patients' performance in two experimental conditions, DBS-ON and DBS-OFF. In addition, we also tested 22 age-matched healthy participants. As expected, we found that inhibitory control is impaired in Parkinson's patients with respect to healthy participants. However, neither reactive nor proactive inhibition is improved when either the right or the left DBS is active. We interpreted these findings in light of the fact that previous studies, exploiting exactly the same task, have shown that only bilateral STN DBS restores a near-normal inhibitory control. Thus, although null results have to be interpreted with caution, our current findings confirm that the right STN does not play a key role in suppressing pending actions. However, on the ground of previous studies, it is very likely that this subcortical structure is part of the brain network subserving inhibition but to implement this executive function both subthalamic nuclei must be simultaneously active. Our findings are of significance to other researchers studying the effects of STN DBS on key executive functions, such as impulsivity and inhibition and they are also of clinical relevance for determining the therapeutic benefits of STN DBS as they suggest that, at least as far as inhibitory control is concerned, it is better to implant DBS bilaterally than unilaterally.
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Affiliation(s)
- Christian Mancini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | | | | | | | | | | | - Giovanni Mirabella
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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Abstract
We review the motor cortical and basal ganglia involvement in two important movement disorders: Parkinson's disease (PD) and dystonia. Single and paired pulse transcranial magnetic stimulation studies showed altered excitability and cortical circuits in PD with decreased silent period, short interval intracortical inhibition, intracortical facilitation, long afferent inhibition, interhemispheric inhibition, and cerebellar inhibition, and increased long interval intracortical inhibition and short interval intracortical facilitation. In dystonia, there is decreased silent period, short interval intracortical inhibition, long afferent inhibition, interhemispheric inhibition, and increased intracortical facilitation. Plasticity induction protocols revealed deficient plasticity in PD and normal and exaggerated plasticity in dystonia. In the basal ganglia, there is increased β (14-30Hz) rhythm in PD and characteristic 5-18Hz band synchronization in dystonia. These motor cortical circuits, cortical plasticity, and oscillation profiles of the basal ganglia are altered with medications and deep brain stimulation treatment. There is considerable variability in these measures related to interindividual variations, different disease characteristics, and methodological considerations. Nevertheless, these pathophysiologic studies have expanded our knowledge of cortical excitability, plasticity, and oscillations in PD and dystonia, improved our understanding of disease pathophysiology, and helped to develop new treatments for these conditions.
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Affiliation(s)
- Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Peng X, Hickman JL, Bowles SG, Donegan DC, Welle CG. Innovations in electrical stimulation harness neural plasticity to restore motor function. BIOELECTRONICS IN MEDICINE 2018; 1:251-263. [PMID: 33859830 DOI: 10.2217/bem-2019-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Novel technology and innovative stimulation paradigms allow for unprecedented spatiotemporal precision and closed-loop implementation of neurostimulation systems. In turn, precise, closed-loop neurostimulation appears to preferentially drive neural plasticity in motor networks, promoting neural repair. Recent clinical studies demonstrate that electrical stimulation can drive neural plasticity in damaged motor circuits, leading to meaningful improvement in users. Future advances in these areas hold promise for the treatment of a wide range of motor systems disorders.
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Affiliation(s)
- Xiaoyu Peng
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Jordan L Hickman
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Spencer G Bowles
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Dane C Donegan
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045.,ETH Zurich, Department Health Science and Technology, Institute for Neuroscience. Schorenstrasse 16, 8603 Schwerzenbach, Switzerland
| | - Cristin G Welle
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
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Ni Z, Udupa K, Hallett M, Chen R. Effects of deep brain stimulation on the primary motor cortex: Insights from transcranial magnetic stimulation studies. Clin Neurophysiol 2018; 130:558-567. [PMID: 30527386 DOI: 10.1016/j.clinph.2018.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 01/01/2023]
Abstract
Deep brain stimulation (DBS) implanted in different basal ganglia nuclei regulates the dysfunctional neuronal circuits and improves symptoms in movement disorders. However, the understanding of the neurophysiological mechanism of DBS is at an early stage. Transcranial magnetic stimulation (TMS) can be used safely in movement disorder patients with DBS, and can shed light on how DBS works. DBS at a therapeutic setting normalizes the abnormal motor cortical excitability measured with motor evoked potentials (MEP) produced by primary motor cortical TMS. Abnormal intracortical circuits in the motor cortex tested with paired-pulse TMS paradigm also show normalization with DBS. These changes are accompanied with improvements in symptoms after chronic DBS. Single-pulse DBS produces cortical evoked potentials recorded by electroencephalography at specific latencies and modulates motor cortical excitability at certain time intervals measured with MEP. Combination of basal ganglia DBS with motor cortical TMS at stimulus intervals consistent with the latency of cortical evoked potentials delivered in a repetitive mode produces plastic changes in the primary motor cortex. TMS can be used to examine the effects of open and closed loop DBS. Patterned DBS and TMS delivered in a repetitive mode may be developed as a new therapeutic method for movement disorder patients.
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Affiliation(s)
- Zhen Ni
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.
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Distinct cortical responses evoked by electrical stimulation of the thalamic ventral intermediate nucleus and of the subthalamic nucleus. NEUROIMAGE-CLINICAL 2018; 20:1246-1254. [PMID: 30420259 PMCID: PMC6308824 DOI: 10.1016/j.nicl.2018.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/27/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022]
Abstract
Objective To investigate the spatial and temporal pattern of cortical responses evoked by deep brain stimulation (DBS) of the subthalamic nucleus (STN) and ventral intermediate nucleus of the thalamus (VIM). Methods We investigated 7 patients suffering from Essential tremor (ET) and 7 patients with Parkinson's Disease (PD) following the implantation of DBS electrodes (VIM for ET patients, STN for PD patients). Magnetoencephalography (MEG) was used to record cortical responses evoked by electric stimuli that were applied via the DBS electrode in trains of 5 Hz. Dipole fitting was applied to reconstruct the origin of evoked responses. Results Both VIM and STN DBS led to short latency cortical responses at about 1 ms. The pattern of medium and long latency cortical responses following VIM DBS consisted of peaks at 13, 40, 77, and 116 ms. The associated equivalent dipoles were localized within the central sulcus, 3 patients showed an additional response in the cerebellum at 56 ms. STN DBS evoked cortical responses peaking at 4 ms, 11 ms, and 27 ms, respectively. While most dipoles were localized in the pre- or postcentral gyrus, the distribution was less homogenous compared to VIM stimulation and partially included prefrontal brain areas. Conclusion MEG enables localization of cortical responses evoked by DBS of the VIM and the STN, especially in the sensorimotor cortex. Short latency responses of 1 ms suggest cortical modulation which bypasses synaptic transmission, i.e. antidromic activation of corticofugal fiber pathways. Cortical responses evoked by VIM or STN DBS can be precisely described using MEG. Both STN and VIM DBS primarily evoke cortical responses within the sensorimotor region. Short latency responses of 1 ms both observed in VIM and STN DBS suggest antidromic activation of corticofugal fibers.
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Tan J, Iyer KK, Tang AD, Jamil A, Martins RN, Sohrabi HR, Nitsche MA, Hinder MR, Fujiyama H. Modulating functional connectivity with non-invasive brain stimulation for the investigation and alleviation of age-associated declines in response inhibition: A narrative review. Neuroimage 2018; 185:490-512. [PMID: 30342977 DOI: 10.1016/j.neuroimage.2018.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
Response inhibition, the ability to withhold a dominant and prepotent response following a change in circumstance or sensory stimuli, declines with advancing age. While non-invasive brain stimulation (NiBS) has shown promise in alleviating some cognitive and motor functions in healthy older individuals, NiBS research focusing on response inhibition has mostly been conducted on younger adults. These extant studies have primarily focused on modulating the activity of distinct neural regions known to be critical for response inhibition, including the right inferior frontal gyrus (rIFG) and the pre-supplementary motor area (pre-SMA). However, given that changes in structural and functional connectivity have been associated with healthy aging, this review proposes that NiBS protocols aimed at modulating the functional connectivity between the rIFG and pre-SMA may be the most efficacious approach to investigate-and perhaps even alleviate-age-related deficits in inhibitory control.
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Affiliation(s)
- Jane Tan
- Action and Cognition Laboratory, School of Psychology and Exercise Science, Murdoch University, Perth, Australia
| | - Kartik K Iyer
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Alexander D Tang
- Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Australia
| | - Asif Jamil
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia; Department of Biomedical Sciences, Macquarie University, New South Wales, Australia; The School of Psychiatry and Clinical Neurosciences, University of Western Australia, Western Australia, Australia
| | - Hamid R Sohrabi
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia; Department of Biomedical Sciences, Macquarie University, New South Wales, Australia; The School of Psychiatry and Clinical Neurosciences, University of Western Australia, Western Australia, Australia
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Mark R Hinder
- Sensorimotor Neuroscience and Ageing Research Laboratory, School of Medicine (Division of Psychology), University of Tasmania, Hobart, Australia
| | - Hakuei Fujiyama
- Action and Cognition Laboratory, School of Psychology and Exercise Science, Murdoch University, Perth, Australia.
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Cortical Potentials Evoked by Subthalamic Stimulation Demonstrate a Short Latency Hyperdirect Pathway in Humans. J Neurosci 2018; 38:9129-9141. [PMID: 30201770 DOI: 10.1523/jneurosci.1327-18.2018] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022] Open
Abstract
A monosynaptic projection from the cortex to the subthalamic nucleus is thought to have an important role in basal ganglia function and in the mechanism of therapeutic subthalamic deep-brain stimulation, but in humans the evidence for its existence is limited. We sought physiological confirmation of the cortico-subthalamic hyperdirect pathway using invasive recording techniques in patients with Parkinson's disease (9 men, 1 woman). We measured sensorimotor cortical evoked potentials using a temporary subdural strip electrode in response to low-frequency deep-brain stimulation in patients undergoing awake subthalamic or pallidal lead implantations. Evoked potentials were grouped into very short latency (<2 ms), short latency (2-10 ms), and long latency (10-100 ms) from the onset of the stimulus pulse. Subthalamic and pallidal stimulation resulted in very short-latency evoked potentials at 1.5 ms in the primary motor cortex accompanied by EMG-evoked potentials consistent with corticospinal tract activation. Subthalamic, but not pallidal stimulation, resulted in three short-latency evoked potentials at 2.8, 5.8, and 7.7 ms in a widespread cortical distribution, consistent with antidromic activation of the hyperdirect pathway. Long-latency potentials were evoked by both targets, with subthalamic responses lagging pallidal responses by 10-20 ms, consistent with orthodromic activation of the thalamocortical pathway. The amplitude of the first short-latency evoked potential was predictive of the chronic therapeutic stimulation contact.SIGNIFICANCE STATEMENT This is the first physiological demonstration of the corticosubthalamic hyperdirect pathway and its topography at high spatial resolution in humans. We studied cortical potentials evoked by deep-brain stimulation in patients with Parkinson's disease undergoing awake lead implantation surgery. Subthalamic stimulation resulted in multiple short-latency responses consistent with activation of hyperdirect pathway, whereas no such response was present during pallidal stimulation. We contrast these findings with very short latency, direct corticospinal tract activations, and long-latency responses evoked through polysynaptic orthodromic projections. These findings underscore the importance of incorporating the hyperdirect pathway into models of human basal ganglia function.
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Muthuraman M, Koirala N, Ciolac D, Pintea B, Glaser M, Groppa S, Tamás G, Groppa S. Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease. Front Neurol 2018; 9:711. [PMID: 30210436 PMCID: PMC6119713 DOI: 10.3389/fneur.2018.00711] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stanislav Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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45
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Huh Y, Jung D, Seo T, Sun S, Kim SH, Rhim H, Chung S, Kim CH, Kwon Y, Bikson M, Chung YA, Kim JJ, Cho J. Brain stimulation patterns emulating endogenous thalamocortical input to parvalbumin-expressing interneurons reduce nociception in mice. Brain Stimul 2018; 11:1151-1160. [PMID: 29784588 DOI: 10.1016/j.brs.2018.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The bursting pattern of thalamocortical (TC) pathway dampens nociception. Whether brain stimulation mimicking endogenous patterns can engage similar sensory gating processes in the cortex and reduce nociceptive behaviors remains uninvestigated. OBJECTIVE We investigated the role of cortical parvalbumin expressing (PV) interneurons within the TC circuit in gating nociception and their selective response to TC burst patterns. We then tested if transcranial magnetic stimulation (TMS) patterned on endogenous nociceptive TC bursting modulate nociceptive behaviors. METHODS The switching of TC neurons between tonic (single spike) and burst (high frequency spikes) firing modes may be a critical component in modulating nociceptive signals. Deep brain electrical stimulation of TC neurons and immunohistochemistry were used to examine the differential influence of each firing mode on cortical PV interneuron activity. Optogenetic stimulation of cortical PV interneurons assessed a direct role in nociceptive modulation. A new TMS protocol mimicking thalamic burst firing patterns, contrasted with conventional continuous and intermittent theta burst protocols, tested if TMS patterned on endogenous TC activity reduces nociceptive behaviors in mice. RESULTS Immunohistochemical evidence confirmed that burst, but not tonic, deep brain stimulation of TC neurons increased the activity of PV interneurons in the cortex. Both optogenetic activation of PV interneurons and TMS protocol mimicking thalamic burst reduced nociceptive behaviors. CONCLUSIONS Our findings suggest that burst firing of TC neurons recruits PV interneurons in the cortex to reduce nociceptive behaviors and that neuromodulation mimicking thalamic burst firing may be useful for modulating nociception.
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Affiliation(s)
- Yeowool Huh
- Translational Brain Research Center, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea; Dept. of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do, South Korea
| | - Dahee Jung
- Translational Brain Research Center, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea; Dept. of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do, South Korea; Department of Neuroscience, University of Science and Technology, Daejeon, South Korea
| | - Taeyoon Seo
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea
| | - Sukkyu Sun
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea
| | - Su Hyun Kim
- Department of Neuroscience, University of Science and Technology, Daejeon, South Korea; Center for Neuroscience, Korea Institute of Science and Technology, Seoul, South Korea
| | - Hyewhon Rhim
- Center for Neuroscience, Korea Institute of Science and Technology, Seoul, South Korea
| | - Sooyoung Chung
- Department of Neuroscience, University of Science and Technology, Daejeon, South Korea; Center for Neuroscience, Korea Institute of Science and Technology, Seoul, South Korea
| | - Chong-Hyun Kim
- Department of Neuroscience, University of Science and Technology, Daejeon, South Korea; Center for Neuroscience, Korea Institute of Science and Technology, Seoul, South Korea
| | - Youngwoo Kwon
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, NY, USA
| | - Yong-An Chung
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jeansok J Kim
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jeiwon Cho
- Translational Brain Research Center, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea; Dept. of Medical Science, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do, South Korea.
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46
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Hu B, Shi Q, Guo Y, Diao X, Guo H, Zhang J, Yu L, Dai H, Chen L. The oscillatory boundary conditions of different frequency bands in Parkinson's disease. J Theor Biol 2018; 451:67-79. [PMID: 29727632 DOI: 10.1016/j.jtbi.2018.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/10/2018] [Accepted: 04/30/2018] [Indexed: 12/16/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that is common in the elderly population. The most important pathological change in PD is the degeneration and death of dopaminergic neurons in the substantia nigra of the midbrain, which results in a decrease in the dopamine (DA) content of the striatum. The exact cause of this pathological change is still unknown. Numerous studies have shown that the evolution of PD is associated with abnormal oscillatory activities in the basal ganglia, with different oscillation frequency ranges, such as the typical beta band (13-30 Hz), the alpha band (8-12 Hz), the theta band (4-7 Hz) and the delta band (1-3 Hz). Although some studies have implied that abnormal interactions between the subthalamic nucleus (STN) and globus pallidus (GP) neurons may be a key factor required to induce these oscillations, the relative mechanism is still unclear. The effects of other nerve nuclei in the basal ganglia, such as the striatum, on these oscillations are still unknown. The thalamus and cortex both have close input and output relationships with the basal ganglia, and many previous studies have indicated that they may also exert effects on Parkinson's disease oscillation, but the mechanisms involved are unclear. In this paper, we built a corticothalamic-basal ganglia (CTBG) mean firing-rate model to explore the onset mechanisms of these different oscillation phenomena. We found that, in addition to the STN-GP network, Parkinson's disease oscillations may also be induced by changing the coupling strength and delays in other pathways. Different frequency bands appear in the oscillating region, and various boundary conditions are depicted in parameter diagrams. The onset mechanism is well explained both by the model and by the numerical simulation results. Therefore, this model provides a unifying framework for studying the mechanism of Parkinson's disease oscillations, and we hope that the results obtained in this work can inspire future experimental studies.
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Affiliation(s)
- Bing Hu
- Institute of Applied Mathematics, Department of Mathematics and Statistics, College of Science, Huazhong Agricultural University, Wuhan 430070, China; Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China.
| | - Qianqian Shi
- College of Informatics, Huazhong Agricultural University, Wuhan 430070, China
| | - Yu Guo
- Institute of Applied Mathematics, Department of Mathematics and Statistics, College of Science, Huazhong Agricultural University, Wuhan 430070, China
| | - Xiyezi Diao
- Institute of Applied Mathematics, Department of Mathematics and Statistics, College of Science, Huazhong Agricultural University, Wuhan 430070, China
| | - Heng Guo
- Institute of Applied Mathematics, Department of Mathematics and Statistics, College of Science, Huazhong Agricultural University, Wuhan 430070, China
| | - Jinsong Zhang
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Liang Yu
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Hao Dai
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Luonan Chen
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China; Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming 650223, China.
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Targeted neural network interventions for auditory hallucinations: Can TMS inform DBS? Schizophr Res 2018; 195:455-462. [PMID: 28969932 PMCID: PMC8141945 DOI: 10.1016/j.schres.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
Abstract
The debilitating and refractory nature of auditory hallucinations (AH) in schizophrenia and other psychiatric disorders has stimulated investigations into neuromodulatory interventions that target the aberrant neural networks associated with them. Internal or invasive forms of brain stimulation such as deep brain stimulation (DBS) are currently being explored for treatment-refractory schizophrenia. The process of developing and implementing DBS is limited by symptom clustering within psychiatric constructs as well as a scarcity of causal tools with which to predict response, refine targeting or guide clinical decisions. Transcranial magnetic stimulation (TMS), an external or non-invasive form of brain stimulation, has shown some promise as a therapeutic intervention for AH but remains relatively underutilized as an investigational probe of clinically relevant neural networks. In this editorial, we propose that TMS has the potential to inform DBS by adding individualized causal evidence to an evaluation processes otherwise devoid of it in patients. Although there are significant limitations and safety concerns regarding DBS, the combination of TMS with computational modeling of neuroimaging and neurophysiological data could provide critical insights into more robust and adaptable network modulation.
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48
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Kumaravelu K, Oza CS, Behrend CE, Grill WM. Model-based deconstruction of cortical evoked potentials generated by subthalamic nucleus deep brain stimulation. J Neurophysiol 2018; 120:662-680. [PMID: 29694280 DOI: 10.1152/jn.00862.2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease is associated with altered neural activity in the motor cortex. Chronic high-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in suppressing parkinsonian motor symptoms and modulates cortical activity. However, the anatomical pathways responsible for STN DBS-mediated cortical modulation remain unclear. Cortical evoked potentials (cEP) generated by STN DBS reflect the response of cortex to subcortical stimulation, and the goal of this study was to determine the neural origin of STN DBS-generated cEP using a two-step approach. First, we recorded cEP over ipsilateral primary motor cortex during different frequencies of STN DBS in awake healthy and unilateral 6-OHDA-lesioned parkinsonian rats. Second, we used a detailed, biophysically based model of the thalamocortical network to deconstruct the neural origin of the recorded cEP. The in vivo cEP included short (R1)-, intermediate (R2)-, and long-latency (R3) responses. Model-based cortical responses to simulated STN DBS matched remarkably well the in vivo responses. The short-latency response was generated by antidromic activation of layer 5 pyramidal neurons, whereas recurrent activation of layer 5 pyramidal neurons via excitatory axon collaterals reproduced the intermediate-latency response. The long-latency response was generated by polysynaptic activation of layer 2/3 pyramidal neurons via the cortico-thalamic-cortical pathway. Antidromic activation of the hyperdirect pathway and subsequent intracortical and cortico-thalamo-cortical synaptic interactions were sufficient to generate cortical potential evoked by STN DBS, and orthodromic activation through basal ganglia-thalamus-cortex pathways was not required. These results demonstrate the utility of cEP to determine the neural elements activated by STN DBS that might modulate cortical activity and contribute to the suppression of parkinsonian symptoms. NEW & NOTEWORTHY Subthalamic nucleus (STN) deep brain stimulation (DBS) is increasingly used to treat Parkinson's disease (PD). Cortical potentials evoked by STN DBS in patients with PD exhibit consistent short-latency (1-3 ms), intermediate-latency (5-15 ms), and long-latency (18-25 ms) responses. The short-latency response occurs as a result of antidromic activation of the hyperdirect pathway comprising corticosubthalamic axons. However, the neural origins of intermediate- and long-latency responses remain elusive, and the dominant view is that these are produced through the orthodromic pathway (basal ganglia-thalamus-cortex). By combining in vivo electrophysiology with computational modeling, we demonstrate that antidromic activation of the cortico-thalamic-cortical pathway is sufficient to generate the intermediate- and long-latency cortical responses to STN DBS.
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Affiliation(s)
- Karthik Kumaravelu
- Department of Biomedical Engineering, Duke University , Durham, North Carolina
| | - Chintan S Oza
- Department of Biomedical Engineering, Duke University , Durham, North Carolina
| | - Christina E Behrend
- Department of Biomedical Engineering, Duke University , Durham, North Carolina.,School of Medicine, Duke University , Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University , Durham, North Carolina.,Department of Electrical and Computer Engineering, Duke University , Durham, North Carolina.,Department of Neurobiology, Duke University , Durham, North Carolina.,Department of Neurosurgery, Duke University , Durham, North Carolina
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49
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Ni Z, Kim SJ, Phielipp N, Ghosh S, Udupa K, Gunraj CA, Saha U, Hodaie M, Kalia SK, Lozano AM, Lee DJ, Moro E, Fasano A, Hallett M, Lang AE, Chen R. Pallidal deep brain stimulation modulates cortical excitability and plasticity. Ann Neurol 2018; 83:352-362. [DOI: 10.1002/ana.25156] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Zhen Ni
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Sang Jin Kim
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Nicolas Phielipp
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Soumya Ghosh
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Kaviraja Udupa
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Carolyn A. Gunraj
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Utpal Saha
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Darrin J. Lee
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Elena Moro
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Neurology Department; University Hospital Center Grenoble, Grenoble Alpes University, National Institute of Health and Medical Research; U1214 Grenoble France
| | - Alfonso Fasano
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; Toronto Ontario Canada
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health; Bethesda MD
| | - Anthony E. Lang
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; Toronto Ontario Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; Toronto Ontario Canada
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50
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Mogilner AY. Neuromodulation and Neuronal Plasticity. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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