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Calvano A, Kleinholdermann U, Heun AS, Bopp MHA, Nimsky C, Timmermann L, Pedrosa DJ. Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson's disease. Neuroimage Clin 2024; 42:103591. [PMID: 38507954 DOI: 10.1016/j.nicl.2024.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND A reduction in stride length is considered a key characteristic of gait kinematics in Parkinson's disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. OBJECTIVE This study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). METHODS Objective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. RESULTS LFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. CONCLUSION These findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Urs Kleinholdermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | | | - Miriam H A Bopp
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany.
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Calvano A, Beccaria L, Timmermann L, Bopp MHA, Gjorgjevski M, Nimsky C, Pedrosa DJ. Case report: Unilateral GPi DBS in secondary myoclonus-dystonia syndrome after acute disseminated encephalomyelitis. Front Neurol 2023; 14:1238743. [PMID: 37822522 PMCID: PMC10562570 DOI: 10.3389/fneur.2023.1238743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is an established and effective therapy for movement disorders. Here, we present a case of secondary myoclonus-dystonia syndrome following acute disseminated encephalomyelitis (ADEM) in childhood, which was alleviated by DBS. Using a patient-specific connectome analysis, we sought to characterise the fibres and circuits affected by stimulation. Case report We report a case of a 20-year-old man with progressive dystonia, myoclonic jerks, and impaired concentration following childhood ADEM. Motor assessments utilising the Unified Myoclonus Rating Scale (UMRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) revealed a greater improvement in dystonia compared to myoclonus following adjustments of DBS parameters. These adjustments were based on visualisation of electrode position and volume of tissue activated (VTA) 3 years after surgery. A patient-specific connectome analysis using the VTA as a region of interest revealed fibre tracts connecting to the cerebello-thalamo-cortical network and the superior frontal gyrus in addition to basal ganglia circuits as particularly effective. Conclusion Globus pallidus internus (GPi) DBS shows promise as a treatment for secondary myoclonus-dystonia syndromes. Personalised structural considerations, tailored to individual symptoms and clinical characteristics, can provide significant benefits. Patient-specific connectome analysis, specifically, offers insights into the structures involved and may enable a favourable treatment response.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Laura Beccaria
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
| | - Miriam H. A. Bopp
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Marko Gjorgjevski
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - David J. Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behaviour (CMBB), Marburg, Germany
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Calvano A, Timmermann L, Loehrer PA, Oehrn CR, Weber I. Binaural acoustic stimulation in patients with Parkinson's disease. Front Neurol 2023; 14:1167006. [PMID: 37213909 PMCID: PMC10196363 DOI: 10.3389/fneur.2023.1167006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023] Open
Abstract
Acoustic stimulation can improve motor symptoms in Parkinson's disease (PD) and might therefore represent a potential non-invasive treatment option. Scalp electroencephalography studies in healthy subjects indicate that specifically binaural beat stimulation (BBS) in the gamma frequency range is associated with synchronized cortical oscillations at 40 Hertz (Hz). Several studies suggest that oscillations in the gamma-frequency range (>30 Hz) serve a prokinetic function in PD. In this double-blind, randomized study, 25 PD patients were recruited. The study was conducted with (ON) and without dopaminergic medication (OFF). Each drug condition consisted of two phases (no stimulation and acoustic stimulation). The acoustic stimulation phase was divided into two blocks including BBS and conventional acoustic stimulation (CAS) as a control condition. For BBS, a modulated frequency of 35 Hz was used (left: 320 Hz; right: 355 Hz) and for CAS 340 Hz on both sides. We assessed effects on motor performance using Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and two validated commercially available portable devices (Kinesia ONE™ and Kinesia 360™) measuring motor symptoms such as dyskinesia, bradykinesia, and tremor. Repeated measures ANOVA revealed that BBS improved resting tremor on the side of the more affected limb in the OFF condition, as measured by wearables (F(2,48) = 3.61, p = 0.035). However, BBS did not exert a general positive effect on motor symptoms as assessed via MDS-UPDRS (F(2,48) = 1.00, p = 0.327). For CAS, we did not observe an improvement in specific symptoms but rather an overall beneficial effect on motor performance (MDS-UPDRS total score OFF medication: F(2,48) = 4.17, p = 0.021; wearable scores: F(2,48) = 2.46, p = 0.097). In this study, we found an improvement of resting tremor when applying BBS in the gamma frequency band OFF medication. Moreover, the positive effects of CAS underline the general positive potential for improvement of motor function by acoustically supported therapeutic approaches. However, more studies are needed to fully characterize the clinical relevance of BBS and to further optimize its ameliorating effects.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- *Correspondence: Alexander Calvano,
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Philipp Alexander Loehrer
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Carina Renate Oehrn
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Immo Weber
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Smilowska K, van Wamelen DJ, Pietrzykowski T, Calvano A, Rodriguez-Blazquez C, Martinez-Martin P, Odin P, Chaudhuri KR. Cost-Effectiveness of Device-Aided Therapies in Parkinson's Disease: A Structured Review. J Parkinsons Dis 2021; 11:475-489. [PMID: 33386813 PMCID: PMC8150660 DOI: 10.3233/jpd-202348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Despite optimal dopaminergic treatment most patients in moderate to advanced stages of Parkinson’s disease (PD) experience progressively increasing disabilities, necessitating a shift from oral medication to device-aided therapies, including deep brain stimulation (DBS), intrajejunal levodopa-carbidopa infusion (IJLI), and continuous subcutaneous apomorphine infusion (CSAI). However, these therapies are costly, limiting their implementation. Objectives: To perform a systematic review on cost-effectiveness analyses for device-aided therapies in PD. Methods: References were identified by performing a systematic search in the PubMed and Web of Science databases in accordance with the PRISMA statement. In the absence of universal cost-effectiveness definitions, the gross domestic product per capita (GDP) in the country where a study was performed was used as a cut-off for cost-effectiveness based on cost per quality adjusted life year (QALY) gained. Results: In total 30 studies were retrieved. All device-aided therapies improved quality of life compared to best medical treatment, with improvements in QALYs between 0.88 and 1.26 in the studies with long temporal horizons. For DBS, nearly all studies showed that cost per QALY was below the GDP threshold. For infusion therapies only three studies showed a cost per QALY below this threshold, with several studies with long temporal horizons showing costs below or near the GDP threshold. Conclusion: Of the device-aided therapies, DBS can be considered cost-effective, but the majority of infusion therapy studies showed that these were less cost-effective. However, long-term use of the infusion therapies appears to improve their cost-effectiveness and in addition, several strategies are underway to reduce these high costs.
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Affiliation(s)
- Katarzyna Smilowska
- Silesian Center of Neurology, Katowice, Poland.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Daniel J van Wamelen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.,Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Tomasz Pietrzykowski
- Research Center for Public Policy and Regulatory Governance, Faculty of Law and Administration, University of Silesia, Katowice, Poland
| | - Alexander Calvano
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology and Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Per Odin
- University of Lund, Faculty of Medicine, Lund, Sweden
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust, London, United Kingdom
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van Wamelen DJ, Taddei RN, Calvano A, Titova N, Leta V, Shtuchniy I, Jenner P, Martinez-Martin P, Katunina E, Chaudhuri KR. Serum Uric Acid Levels and Non-Motor Symptoms in Parkinson’s Disease. JPD 2020; 10:1003-1010. [DOI: 10.3233/jpd-201988] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Daniel J. van Wamelen
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Raquel N. Taddei
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Alexander Calvano
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Nataliya Titova
- Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Federal Medical Biological Agency, Department of Neurology, Neurosurgery and Medical Genetics, Moscow, Russia
- Federal State Budgetary Institution «Federal center of brain and neurotechnologies» of the Ministry of Health of the Russian Federation, Department of Neurodegenerative Diseases, Moscow, Russia
| | - Valentina Leta
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Igor Shtuchniy
- Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Federal Medical Biological Agency, Department of Neurology, Neurosurgery and Medical Genetics, Moscow, Russia
| | - Peter Jenner
- King’s College London, Institute of Pharmaceutical Science, Hodgkin Building, Guy’s Campus, London, United Kingdom
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Elena Katunina
- Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Federal Medical Biological Agency, Department of Neurology, Neurosurgery and Medical Genetics, Moscow, Russia
- Federal State Budgetary Institution «Federal center of brain and neurotechnologies» of the Ministry of Health of the Russian Federation, Department of Neurodegenerative Diseases, Moscow, Russia
| | - K. Ray Chaudhuri
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
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