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Guo X, He S, Geng X, Yao P, Wiest C, Nie Y, Tan H, Wang S. Quantifying local field potential dynamics with amplitude and frequency stability between ON and OFF medication and stimulation in Parkinson's disease. Neurobiol Dis 2024; 197:106519. [PMID: 38685358 PMCID: PMC7616028 DOI: 10.1016/j.nbd.2024.106519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/26/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
Neural oscillations are critical to understanding the synchronisation of neural activities and their relevance to neurological disorders. For instance, the amplitude of beta oscillations in the subthalamic nucleus has gained extensive attention, as it has been found to correlate with medication status and the therapeutic effects of continuous deep brain stimulation in people with Parkinson's disease. However, the frequency stability of subthalamic nucleus beta oscillations, which has been suggested to be associated with dopaminergic information in brain states, has not been well explored. Moreover, the administration of medicine can have inverse effects on changes in frequency and amplitude. In this study, we proposed a method based on the stationary wavelet transform to quantify the amplitude and frequency stability of subthalamic nucleus beta oscillations and evaluated the method using simulation and real data for Parkinson's disease patients. The results suggest that the amplitude and frequency stability quantification has enhanced sensitivity in distinguishing pathological conditions in Parkinson's disease patients. Our quantification shows the benefit of combining frequency stability information with amplitude and provides a new potential feedback signal for adaptive deep brain stimulation.
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Affiliation(s)
- Xuanjun Guo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China; Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Shenghong He
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Xinyi Geng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Pan Yao
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; State Key Laboratory of Transducer Technology, Aerospace Information Research Institute (AIR), Chinese Academy of Sciences, 100094 Beijing, China; School of Electronic, Electrical, and Communication Engineering, University of Chinese Academy of Sciences (UCAS), 100049 Beijing, China
| | - Christoph Wiest
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Yingnan Nie
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China; Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China; Zhangjiang Fudan International Innovation Center, Shanghai, China; Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China; Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, China.
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Ubeda Matzilevich E, Daniel PL, Little S. Towards therapeutic electrophysiological neurofeedback in Parkinson's disease. Parkinsonism Relat Disord 2024; 121:106010. [PMID: 38245382 DOI: 10.1016/j.parkreldis.2024.106010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
Neurofeedback (NF) techniques support individuals to self-regulate specific features of brain activity, which has been shown to impact behavior and potentially ameliorate clinical symptoms. Electrophysiological NF (epNF) may be particularly impactful for patients with Parkinson's disease (PD), as evidence mounts to suggest a central role of pathological neural oscillations underlying symptoms in PD. Exaggerated beta oscillations (12-30 Hz) in the basal ganglia-cortical network are linked to motor symptoms (e.g., bradykinesia, rigidity), and beta is reduced by successful therapy with dopaminergic medication and Deep Brain Stimulation (DBS). PD patients also experience non-motor symptoms related to sleep, mood, motivation, and cognitive control. Although less is known about the mechanisms of non-motor symptoms in PD and how to successfully treat them, low frequency neural oscillations (1-12 Hz) in the basal ganglia-cortical network are particularly implicated in non-motor symptoms. Here, we review how cortical and subcortical epNF could be used to target motor and non-motor specific oscillations, and potentially serve as an adjunct therapy that enables PD patients to endogenously control their own pathological neural activities. Recent studies have demonstrated that epNF protocols can successfully support volitional control of cortical and subcortical beta rhythms. Importantly, this endogenous control of beta has been linked to changes in motor behavior. epNF for PD, as a casual intervention on neural signals, has the potential to increase understanding of the neurophysiology of movement, mood, and cognition and to identify new therapeutic approaches for motor and non-motor symptoms.
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Affiliation(s)
- Elena Ubeda Matzilevich
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA
| | - Pria Lauren Daniel
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA; Department of Psychology, University of California San Diego, CA, USA.
| | - Simon Little
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA
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Guo Z, Lin JP, Simeone O, Mills KR, Cvetkovic Z, McClelland VM. Cross-frequency cortex-muscle interactions are abnormal in young people with dystonia. Brain Commun 2024; 6:fcae061. [PMID: 38487552 PMCID: PMC10939448 DOI: 10.1093/braincomms/fcae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/10/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
Sensory processing and sensorimotor integration are abnormal in dystonia, including impaired modulation of beta-corticomuscular coherence. However, cortex-muscle interactions in either direction are rarely described, with reports limited predominantly to investigation of linear coupling, using corticomuscular coherence or Granger causality. Information-theoretic tools such as transfer entropy detect both linear and non-linear interactions between processes. This observational case-control study applies transfer entropy to determine intra- and cross-frequency cortex-muscle coupling in young people with dystonia/dystonic cerebral palsy. Fifteen children with dystonia/dystonic cerebral palsy and 13 controls, aged 12-18 years, performed a grasp task with their dominant hand. Mechanical perturbations were provided by an electromechanical tapper. Bipolar scalp EEG over contralateral sensorimotor cortex and surface EMG over first dorsal interosseous were recorded. Multi-scale wavelet transfer entropy was applied to decompose signals into functional frequency bands of oscillatory activity and to quantify intra- and cross-frequency coupling between brain and muscle. Statistical significance against the null hypothesis of zero transfer entropy was established, setting individual 95% confidence thresholds. The proportion of individuals in each group showing significant transfer entropy for each frequency combination/direction was compared using Fisher's exact test, correcting for multiple comparisons. Intra-frequency transfer entropy was detected in all participants bidirectionally in the beta (16-32 Hz) range and in most participants from EEG to EMG in the alpha (8-16 Hz) range. Cross-frequency transfer entropy across multiple frequency bands was largely similar between groups, but a specific coupling from low-frequency EMG to beta EEG was significantly reduced in dystonia [P = 0.0061 (corrected)]. The demonstration of bidirectional cortex-muscle communication in dystonia emphasizes the value of transfer entropy for exploring neural communications in neurological disorders. The novel finding of diminished coupling from low-frequency EMG to beta EEG in dystonia suggests impaired cortical feedback of proprioceptive information with a specific frequency signature that could be relevant to the origin of the excessive low-frequency drive to muscle.
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Affiliation(s)
- Zhenghao Guo
- Department of Engineering, King's College London, London WC2R 2LS, UK
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Jean-Pierre Lin
- Children's Neuroscience, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust (GSTT), London SE1 7EH, UK
| | - Osvaldo Simeone
- Department of Engineering, King's College London, London WC2R 2LS, UK
| | - Kerry R Mills
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 9RX, UK
| | - Zoran Cvetkovic
- Department of Engineering, King's College London, London WC2R 2LS, UK
| | - Verity M McClelland
- Children's Neuroscience, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust (GSTT), London SE1 7EH, UK
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 9RX, UK
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4
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He S, Baig F, Merla A, Torrecillos F, Perera A, Wiest C, Debarros J, Benjaber M, Hart MG, Ricciardi L, Morgante F, Hasegawa H, Samuel M, Edwards M, Denison T, Pogosyan A, Ashkan K, Pereira E, Tan H. Beta-triggered adaptive deep brain stimulation during reaching movement in Parkinson's disease. Brain 2023; 146:5015-5030. [PMID: 37433037 PMCID: PMC10690014 DOI: 10.1093/brain/awad233] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Subthalamic nucleus (STN) beta-triggered adaptive deep brain stimulation (ADBS) has been shown to provide clinical improvement comparable to conventional continuous DBS (CDBS) with less energy delivered to the brain and less stimulation induced side effects. However, several questions remain unanswered. First, there is a normal physiological reduction of STN beta band power just prior to and during voluntary movement. ADBS systems will therefore reduce or cease stimulation during movement in people with Parkinson's disease and could therefore compromise motor performance compared to CDBS. Second, beta power was smoothed and estimated over a time period of 400 ms in most previous ADBS studies, but a shorter smoothing period could have the advantage of being more sensitive to changes in beta power, which could enhance motor performance. In this study, we addressed these two questions by evaluating the effectiveness of STN beta-triggered ADBS using a standard 400 ms and a shorter 200 ms smoothing window during reaching movements. Results from 13 people with Parkinson's disease showed that reducing the smoothing window for quantifying beta did lead to shortened beta burst durations by increasing the number of beta bursts shorter than 200 ms and more frequent switching on/off of the stimulator but had no behavioural effects. Both ADBS and CDBS improved motor performance to an equivalent extent compared to no DBS. Secondary analysis revealed that there were independent effects of a decrease in beta power and an increase in gamma power in predicting faster movement speed, while a decrease in beta event related desynchronization (ERD) predicted quicker movement initiation. CDBS suppressed both beta and gamma more than ADBS, whereas beta ERD was reduced to a similar level during CDBS and ADBS compared with no DBS, which together explained the achieved similar performance improvement in reaching movements during CDBS and ADBS. In addition, ADBS significantly improved tremor compared with no DBS but was not as effective as CDBS. These results suggest that STN beta-triggered ADBS is effective in improving motor performance during reaching movements in people with Parkinson's disease, and that shortening of the smoothing window does not result in any additional behavioural benefit. When developing ADBS systems for Parkinson's disease, it might not be necessary to track very fast beta dynamics; combining beta, gamma, and information from motor decoding might be more beneficial with additional biomarkers needed for optimal treatment of tremor.
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Affiliation(s)
- Shenghong He
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Fahd Baig
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Anca Merla
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Flavie Torrecillos
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Andrea Perera
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Christoph Wiest
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Jean Debarros
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Moaad Benjaber
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Michael G Hart
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Lucia Ricciardi
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Francesca Morgante
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Harutomo Hasegawa
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Michael Samuel
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Mark Edwards
- Department of Clinical and Basic Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Erlick Pereira
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
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Rahamim N, Slovik M, Mevorach T, Linkovski O, Bergman H, Rosin B, Eitan R. Tuned to Tremor: Increased Sensitivity of Cortico-Basal Ganglia Neurons to Tremor Frequency in the MPTP Nonhuman Primate Model of Parkinson's Disease. J Neurosci 2023; 43:7712-7722. [PMID: 37833067 PMCID: PMC10634551 DOI: 10.1523/jneurosci.0529-23.2023] [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: 03/22/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Rest tremor is one of the most prominent clinical features of Parkinson's disease (PD). Here, we hypothesized that cortico-basal ganglia neurons tend to fire in a pattern that matches PD tremor frequency, suggesting a resonance phenomenon. We recorded spiking activity in the primary motor cortex (M1) and globus pallidus external segment of 2 female nonhuman primates, before and after parkinsonian state induction with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. The arm of nonhuman primates was passively rotated at seven different frequencies surrounding and overlapping PD tremor frequency. We found entrainment of the spiking activity to arm rotation and a significant sharpening of the tuning curves in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine state, with a peak response at frequencies that matched the frequency of PD tremor. These results reveal increased sensitivity of the cortico-basal ganglia network to tremor frequency and could indicate that this network acts not only as a tremor switch but is involved in setting its frequency.SIGNIFICANCE STATEMENT Tremor is a prominent clinical feature of Parkinson's disease; however, its underlying pathophysiology is still poorly understood. Using electrophysiological recordings of single cortico-basal ganglia neurons before and after the induction of a parkinsonian state, and in response to passive arm rotation, this study reports increased sensitivity to tremor frequency in Parkinson's disease. We found sharpening of the population tuning to the midrange of the tested frequencies (1-13.3 Hz) in the healthy state that further increased in the parkinsonian state. These results hint at the increased frequency-tuned sensitivity of cortico-basal ganglia neurons and suggest that they tend to resonate with the tremor.
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Affiliation(s)
- Noa Rahamim
- Edmond and Lily Safra Center for Brain Science, Hebrew University, Jerusalem, 91120, Israel
| | - Maya Slovik
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, Hadassah-Hebrew University Medical School, Jerusalem, 91120, Israel
| | - Tomer Mevorach
- Department of Psychological Medicine, Schneider Children's Medical Center in Israel, Petah Tikva, 4920235, Israel
- Psychiatric Division, Tel Aviv Sourasky Medical Center-Ichilov, Tel Aviv, 6423906, Israel
| | - Omer Linkovski
- Department of Psychology, Bar-Ilan University, Ramat Gan, 590002, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, 590002, Israel
| | - Hagai Bergman
- Edmond and Lily Safra Center for Brain Science, Hebrew University, Jerusalem, 91120, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, Hadassah-Hebrew University Medical School, Jerusalem, 91120, Israel
| | - Boris Rosin
- Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, 91120, Israel
| | - Renana Eitan
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, Hadassah-Hebrew University Medical School, Jerusalem, 91120, Israel
- Psychiatric Division, Tel Aviv Sourasky Medical Center-Ichilov, Tel Aviv, 6423906, Israel
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Alva L, Bernasconi E, Torrecillos F, Fischer P, Averna A, Bange M, Mostofi A, Pogosyan A, Ashkan K, Muthuraman M, Groppa S, Pereira EA, Tan H, Tinkhauser G. Clinical neurophysiological interrogation of motor slowing: A critical step towards tuning adaptive deep brain stimulation. Clin Neurophysiol 2023; 152:43-56. [PMID: 37285747 PMCID: PMC7615935 DOI: 10.1016/j.clinph.2023.04.013] [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: 08/23/2022] [Revised: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Subthalamic nucleus (STN) beta activity (13-30 Hz) is the most accepted biomarker for adaptive deep brain stimulation (aDBS) for Parkinson's disease (PD). We hypothesize that different frequencies within the beta range may exhibit distinct temporal dynamics and, as a consequence, different relationships to motor slowing and adaptive stimulation patterns. We aim to highlight the need for an objective method to determine the aDBS feedback signal. METHODS STN LFPs were recorded in 15 PD patients at rest and while performing a cued motor task. The impact of beta bursts on motor performance was assessed for different beta candidate frequencies: the individual frequency strongest associated with motor slowing, the individual beta peak frequency, the frequency most modulated by movement execution, as well as the entire-, low- and high beta band. How these candidate frequencies differed in their bursting dynamics and theoretical aDBS stimulation patterns was further investigated. RESULTS The individual motor slowing frequency often differs from the individual beta peak or beta-related movement-modulation frequency. Minimal deviations from a selected target frequency as feedback signal for aDBS leads to a substantial drop in the burst overlapping and in the alignment of the theoretical onset of stimulation triggers (to ∼ 75% for 1 Hz, to ∼ 40% for 3 Hz deviation). CONCLUSIONS Clinical-temporal dynamics within the beta frequency range are highly diverse and deviating from a reference biomarker frequency can result in altered adaptive stimulation patterns. SIGNIFICANCE A clinical-neurophysiological interrogation could be helpful to determine the patient-specific feedback signal for aDBS.
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Affiliation(s)
- Laura Alva
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Elena Bernasconi
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Flavie Torrecillos
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Petra Fischer
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, University Walk, BS8 1TD Bristol, United Kingdom
| | - Alberto Averna
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Manuel Bange
- Movement Disorders and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London SW17 0RE, United Kingdom
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, King's College London, SE59RS, United Kingdom
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Erlick A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London SW17 0RE, United Kingdom
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
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Radcliffe EM, Baumgartner AJ, Kern DS, Al Borno M, Ojemann S, Kramer DR, Thompson JA. Oscillatory beta dynamics inform biomarker-driven treatment optimization for Parkinson's disease. J Neurophysiol 2023; 129:1492-1504. [PMID: 37198135 DOI: 10.1152/jn.00055.2023] [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: 02/03/2023] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/19/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons and dysregulation of the basal ganglia. Cardinal motor symptoms include bradykinesia, rigidity, and tremor. Deep brain stimulation (DBS) of select subcortical nuclei is standard of care for medication-refractory PD. Conventional open-loop DBS delivers continuous stimulation with fixed parameters that do not account for a patient's dynamic activity state or medication cycle. In comparison, closed-loop DBS, or adaptive DBS (aDBS), adjusts stimulation based on biomarker feedback that correlates with clinical state. Recent work has identified several neurophysiological biomarkers in local field potential recordings from PD patients, the most promising of which are 1) elevated beta (∼13-30 Hz) power in the subthalamic nucleus (STN), 2) increased beta synchrony throughout basal ganglia-thalamocortical circuits, notably observed as coupling between the STN beta phase and cortical broadband gamma (∼50-200 Hz) amplitude, and 3) prolonged beta bursts in the STN and cortex. In this review, we highlight relevant frequency and time domain features of STN beta measured in PD patients and summarize how spectral beta power, oscillatory beta synchrony, phase-amplitude coupling, and temporal beta bursting inform PD pathology, neurosurgical targeting, and DBS therapy. We then review how STN beta dynamics inform predictive, biomarker-driven aDBS approaches for optimizing PD treatment. We therefore provide clinically useful and actionable insight that can be applied toward aDBS implementation for PD.
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Affiliation(s)
- Erin M Radcliffe
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Alexander J Baumgartner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Mazen Al Borno
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Computer Science and Engineering, University of Colorado Denver, Denver, Colorado, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Daniel R Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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8
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Rauschenberger L, Güttler C, Volkmann J, Kühn AA, Ip CW, Lofredi R. A translational perspective on pathophysiological changes of oscillatory activity in dystonia and parkinsonism. Exp Neurol 2022; 355:114140. [PMID: 35690132 DOI: 10.1016/j.expneurol.2022.114140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022]
Abstract
Intracerebral recordings from movement disorders patients undergoing deep brain stimulation have allowed the identification of pathophysiological patterns in oscillatory activity that correlate with symptom severity. Changes in oscillatory synchrony occur within and across brain areas, matching the classification of movement disorders as network disorders. However, the underlying mechanisms of oscillatory changes are difficult to assess in patients, as experimental interventions are technically limited and ethically problematic. This is why animal models play an important role in neurophysiological research of movement disorders. In this review, we highlight the contributions of translational research to the mechanistic understanding of pathological changes in oscillatory activity, with a focus on parkinsonism and dystonia, while addressing the limitations of current findings and proposing possible future directions.
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Affiliation(s)
- Lisa Rauschenberger
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Christopher Güttler
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany; NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany; DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Roxanne Lofredi
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
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Chen Y, Zhang G, Guan L, Gong C, Ma B, Hao H, Li L. Progress in the development of a fully implantable brain-computer interface: the potential of sensing-enabled neurostimulator. Natl Sci Rev 2022; 9:nwac099. [PMID: 36196114 PMCID: PMC9522391 DOI: 10.1093/nsr/nwac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/14/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022] Open
Abstract
This perspective article investigates the performance of using a sensing-enabled neurostimulator as a motor brain-computer interface.
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Affiliation(s)
- Yue Chen
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
| | - Guokun Zhang
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
| | - Linxiao Guan
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
| | - Chen Gong
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
| | - Bozhi Ma
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
| | - Hongwei Hao
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
| | - Luming Li
- National Engineering Laboratory of Neuromodulation, Tsinghua, University, China
- Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, China
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10
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Toward therapeutic electrophysiology: beta-band suppression as a biomarker in chronic local field potential recordings. NPJ Parkinsons Dis 2022; 8:44. [PMID: 35440571 PMCID: PMC9018912 DOI: 10.1038/s41531-022-00301-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/04/2022] [Indexed: 11/08/2022] Open
Abstract
Adaptive deep brain stimulation (aDBS) is a promising concept for feedback-based neurostimulation, with the potential of clinical implementation with the sensing-enabled Percept neurostimulator. We aim to characterize chronic electrophysiological activity during stimulation and to validate beta-band activity as a biomarker for bradykinesia. Subthalamic activity was recorded during stepwise stimulation amplitude increase OFF medication in 10 Parkinson's patients during rest and finger tapping. Offline analysis of wavelet-transformed beta-band activity and assessment of inter-variable relationships in linear mixed effects models were implemented. There was a stepwise suppression of low-beta activity with increasing stimulation intensity (p = 0.002). Low-beta power was negatively correlated with movement speed and predictive for velocity improvements (p < 0.001), stimulation amplitude for beta suppression (p < 0.001). Here, we characterize beta-band modulation as a chronic biomarker for motor performance. Our investigations support the use of electrophysiology in therapy optimization, providing evidence for the use of biomarker analysis for clinical aDBS.
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11
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Girges C, Vijiaratnam N, Zrinzo L, Ekanayake J, Foltynie T. Volitional Control of Brain Motor Activity and Its Therapeutic Potential. Neuromodulation 2022; 25:1187-1196. [DOI: 10.1016/j.neurom.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 12/01/2022]
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12
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Subthalamic-Cortical Network Reorganization during Parkinson's Tremor. J Neurosci 2021; 41:9844-9858. [PMID: 34702744 DOI: 10.1523/jneurosci.0854-21.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/08/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
Tremor, a common and often primary symptom of Parkinson's disease, has been modeled with distinct onset and maintenance dynamics. To identify the neurophysiologic correlates of each state, we acquired intraoperative cortical and subthalamic nucleus recordings from 10 patients (9 male, 1 female) performing a naturalistic visual-motor task. From this task, we isolated short epochs of tremor onset and sustained tremor. Comparing these epochs, we found that the subthalamic nucleus was central to tremor onset, as it drove both motor cortical activity and tremor output. Once tremor became sustained, control of tremor shifted to cortex. At the same time, changes in directed functional connectivity across sensorimotor cortex further distinguished the sustained tremor state.SIGNIFICANCE STATEMENT Tremor is a common symptom of Parkinson's disease (PD). While tremor pathophysiology is thought to involve both basal ganglia and cerebello-thalamic-cortical circuits, it is unknown how these structures functionally interact to produce tremor. In this article, we analyzed intracranial recordings from the subthalamic nucleus and sensorimotor cortex in patients with PD undergoing deep brain stimulation surgery. Using an intraoperative task, we examined tremor in two separate dynamic contexts: when tremor first emerged, and when tremor was sustained. We believe that these findings reconcile several models of Parkinson's tremor, while describing the short-timescale dynamics of subcortical-cortical interactions during tremor for the first time. These findings may describe a framework for developing proactive and responsive neurostimulation models for specifically treating tremor.
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13
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di Biase L, Tinkhauser G, Martin Moraud E, Caminiti ML, Pecoraro PM, Di Lazzaro V. Adaptive, personalized closed-loop therapy for Parkinson's disease: biochemical, neurophysiological, and wearable sensing systems. Expert Rev Neurother 2021; 21:1371-1388. [PMID: 34736368 DOI: 10.1080/14737175.2021.2000392] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Motor complication management is one of the main unmet needs in Parkinson's disease patients. AREAS COVERED Among the most promising emerging approaches for handling motor complications in Parkinson's disease, adaptive deep brain stimulation strategies operating in closed-loop have emerged as pivotal to deliver sustained, near-to-physiological inputs to dysfunctional basal ganglia-cortical circuits over time. Existing sensing systems that can provide feedback signals to close the loop include biochemical-, neurophysiological- or wearable-sensors. Biochemical sensing allows to directly monitor the pharmacokinetic and pharmacodynamic of antiparkinsonian drugs and metabolites. Neurophysiological sensing relies on neurotechnologies to sense cortical or subcortical brain activity and extract real-time correlates of symptom intensity or symptom control during DBS. A more direct representation of the symptom state, particularly the phenomenological differentiation and quantification of motor symptoms, can be realized via wearable sensor technology. EXPERT OPINION Biochemical, neurophysiologic, and wearable-based biomarkers are promising technological tools that either individually or in combination could guide adaptive therapy for Parkinson's disease motor symptoms in the future.
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Affiliation(s)
- Lazzaro di Biase
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy.,Brain Innovations Lab, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (Chuv) and University of Lausanne (Unil), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.neurorestore), Lausanne University Hospital and Swiss Federal Institute of Technology (Epfl), Lausanne, Switzerland
| | - Maria Letizia Caminiti
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Pasquale Maria Pecoraro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
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Arbuthnott GW. An Introspective Approach: A Lifetime of Parkinson's Disease Research and Not Much to Show for it Yet? Cells 2021; 10:cells10030513. [PMID: 33670933 PMCID: PMC7997292 DOI: 10.3390/cells10030513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
I feel part of a massive effort to understand what is wrong with motor systems in the brain relating to Parkinson’s disease. Today, the symptoms of the disease can be modified slightly, but dopamine neurons still die; the disease progression continues inexorably. Maybe the next research phase will bring the power of modern genetics to bear on halting, or better, preventing cell death. The arrival of accessible human neuron assemblies in organoids perhaps will provide a better access to the processes underlying neuronal demise.
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Affiliation(s)
- Gordon W Arbuthnott
- Brain Mechanisms for Behaviour Unit, Okinawa Institute of Science and Technology, Graduate University, Onna-son, Okinawa 904-0495, Japan
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