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Hsieh JK, Pucci FG, Sundar SJ, Kondylis E, Sharma A, Sheikh SR, Vegh D, Moosa AN, Gupta A, Najm I, Rammo R, Bingaman W, Jehi L. Beyond seizure freedom: Dissecting long-term seizure control after surgical resection for drug-resistant epilepsy. Epilepsia 2023; 64:103-113. [PMID: 36281562 PMCID: PMC10100416 DOI: 10.1111/epi.17445] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study was undertaken to better understand the long-term palliative and disease-modifying effects of surgical resection beyond seizure freedom, including frequency reduction and both late recurrence and remission, in patients with drug-resistant epilepsy. METHODS This retrospective database-driven cohort study included all patients with >9 years of follow-up at a single high-volume epilepsy center. We included patients who underwent lobectomy, multilobar resection, or lesionectomies for drug-resistant epilepsy; we excluded patients who underwent hemispherectomies. Our main outcomes were (1) reduction in frequency of disabling seizures (at 6 months, each year up to 9 years postoperatively, and at last follow-up), (2) achievement of seizure remission (>6 months, >1 year, and longest duration), and (3) seizure freedom at last follow-up. RESULTS We included 251 patients; 234 (93.2%) achieved 6 months and 232 (92.4%) experienced 1 year of seizure freedom. Of these, the average period of seizure freedom was 10.3 years. A total of 182 (72.5%) patients were seizure-free at last follow-up (defined as >1 year without seizures), with a median 11.9 years since remission. For patients not completely seizure-free, the mean seizure frequency reduction at each time point was 76.2%, and ranged from 66.6% to 85.0%. Patients decreased their number of antiseizure medications on average by .58, and 53 (21.2%) patients were on no antiseizure medication at last follow-up. Nearly half (47.1%) of those seizure-free at last follow-up were not seizure-free immediately postoperatively. SIGNIFICANCE Patients who continue to have seizures after resection often have considerable reductions in seizure frequency, and many are able to achieve seizure freedom in a delayed manner.
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Affiliation(s)
- Jason K. Hsieh
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Francesco G. Pucci
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Swetha J. Sundar
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Efstathios Kondylis
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Akshay Sharma
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Shehryar R. Sheikh
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Deborah Vegh
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Ahsan N. Moosa
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Ajay Gupta
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Imad Najm
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Richard Rammo
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - William Bingaman
- Department of Neurosurgery, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Lara Jehi
- Charles Shor Epilepsy Center, Neurological InstituteCleveland Clinic FoundationClevelandOhioUSA
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Hermann JK, Borseth A, Pucci FG, Toth C, Hogue O, Chan HH, Machado AG, Baker KB. Changes in somatosensory evoked potentials elicited by lateral cerebellar nucleus deep brain stimulation in the naïve rodent. Neurosci Lett 2022; 786:136800. [PMID: 35842210 DOI: 10.1016/j.neulet.2022.136800] [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: 01/13/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation (DBS) of the deep cerebellar nuclei has been shown to enhance perilesional cortical excitability and promote motor rehabilitation in preclinical models of cortical ischemia and is currently being evaluated in patients with chronic, post-stroke deficits. Understanding the effects of cerebellar DBS on contralateral sensorimotor cortex may be key to developing approaches to optimize stimulation delivery and treatment outcomes. Using the naïve rat model, we characterized the effects of DBS of the lateral cerebellar nucleus (LCN) on somatosensory evoked potentials (SSEPs) and evaluated their potential use as a surrogate index of cortical excitability. SSEPs were recorded concurrently with continuous 30 Hz or 100 Hz LCN DBS and compared to the DBS OFF condition. Ratios of SSEP peak to peak amplitude during 100 Hz LCN DBS to DBS OFF at longer latency peaks were significantly>1, suggesting that cortical excitability was enhanced as a result of LCN DBS. Although changes in SSEP peak to peak amplitudes were observed, they were modest in relation to previously reported effects on motor cortical excitability. Overall, our findings suggest that LCN output influences thalamocortical somatosensory pathways, however further work is need to better understand the potential role of SSEPs in optimizing therapy.
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Affiliation(s)
- John K Hermann
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Ashley Borseth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Francesco G Pucci
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Carmen Toth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Hugh H Chan
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Andre G Machado
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States.
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Tang OY, Barrios-Anderson A, Hobbs K, Palumbo M, Bajaj AI, Pugacheva A, Leary OP, Anderson MN, Feler JR, Pucci FG, Gokaslan ZL. Letter: The Brown Student Neurosurgery & Neurology Research Conference: A Model for Student-Centric Neurosurgical Research Dissemination in the Virtual Conference Era. Neurosurgery 2022; 90:e133-e136. [PMID: 35275103 DOI: 10.1227/neu.0000000000001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adriel Barrios-Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Katherine Hobbs
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Marina Palumbo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ankush I Bajaj
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Alisa Pugacheva
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Matthew N Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Joshua R Feler
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Francesco G Pucci
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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McLaughlin NCR, Lauro PM, Patrick MT, Pucci FG, Barrios-Anderson A, Greenberg BD, Rasmussen SA, Asaad WF. Magnetic Resonance Imaging-Guided Laser Thermal Ventral Capsulotomy for Intractable Obsessive-Compulsive Disorder. Neurosurgery 2021. [DOI: 10.1093/neuros/nyab050_s132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McLaughlin NCR, Lauro PM, Patrick MT, Pucci FG, Barrios-Anderson A, Greenberg BD, Rasmussen SA, Asaad WF. Magnetic Resonance Imaging-Guided Laser Thermal Ventral Capsulotomy for Intractable Obsessive-Compulsive Disorder. Neurosurgery 2021; 88:1128-1135. [PMID: 33693795 PMCID: PMC8223246 DOI: 10.1093/neuros/nyab050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a disabling condition characterized by intrusive thoughts and repetitive behaviors. A subset of individuals have severe, treatment-resistant illness and are nonresponsive to medication or behavioral therapies. Without response to conventional therapeutic options, surgical intervention becomes an appropriate consideration. OBJECTIVE To report clinical outcomes and the safety profile of bilateral ventral anterior capsulotomy for OCD using magnetic resonance (MR)-guided laser interstitial thermal therapy (LITT) in 10 patients followed for 6 to 24 mo. METHODS A total of 10 patients underwent LITT for severe OCD; 1 patient withdrew prior to follow-up. LITT is a minimally invasive ablative technique performed with precise targeting and use of thermography under MR guidance. Lesions of the ventral anterior limb of the internal capsule by other techniques have been shown to be efficacious in prior studies. RESULTS A total of 7 of the 9 patients were considered full responders (77.8%; Yale-Brown Obsessive-Compulsive Scale change ≥35%). Adverse effects included transient apathy/amotivation postsurgery (2 patients). One patient had a small tract hemorrhage where the laser fiber traversed the cerebral cortex as well as persistent insomnia postsurgery. One individual died after a drug overdose 7 mo postsurgery, which was judged unrelated to the surgery. CONCLUSION LITT ventral capsulotomy was generally well tolerated, with promising evidence of effectiveness in the largest such series to date. Results were comparable to those after gamma knife ventral capsulotomy, as well as ventral anterior limb deep brain stimulation.
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Affiliation(s)
- Nicole C R McLaughlin
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peter M Lauro
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neuroscience, Brown University, Providence, Rhode Island, USA
| | | | - Francesco G Pucci
- Department of Neurosurgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adriel Barrios-Anderson
- Butler Hospital, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Benjamin D Greenberg
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Veterans Affairs, Providence, Rhode Island, USA
| | - Steven A Rasmussen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Wael F Asaad
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neuroscience, Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island, USA
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Moldovan K, Boxerman JL, O'Muircheartaigh J, Dean D, Eyerly-Webb S, Cosgrove GR, Pucci FG, Deoni SCL, Spader HS. Myelin water fraction changes in febrile seizures. Clin Neurol Neurosurg 2018; 175:61-67. [PMID: 30384118 DOI: 10.1016/j.clineuro.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/12/2018] [Revised: 09/27/2018] [Accepted: 10/07/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of this feasibility study was to investigate whether myelin water fraction (MWF) patterns can differentiate children presenting with febrile seizures who will go on to develop nonfebrile epilepsy from those who will not. PATIENTS AND METHODS As part of a prospective study of myelination patterns in pediatric epilepsy, seven subjects with febrile seizures underwent magnetic resonance imaging (MRI) including the following standard sequences-T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR)-and an additional experimental sequence, multicomponent-derived equilibrium single-pulse observation of T1 and T2 (mcDESPOT) to quantify MWF. For each of these subjects, MWF maps were derived and compared with an age-matched population-averaged MWF atlas. RESULTS All seven subjects (<5 years old) initially presented with febrile seizures. Of the seven, four had complex seizures and three had simple seizures. All of the children with simple febrile seizures had higher MWF compared with model-derived controls and did not develop epilepsy. All of the children with complex febrile seizures had lower MWF than their model-derived control, and two of these subjects later developed epilepsy. CONCLUSION This is the first study in which MWF maps were used to study children with febrile *seizures. This data suggests that relatively higher or stable MWF compared with normative data indicates a lower risk of nonfebrile epilepsy while relatively lower MWF may indicate a pathological condition that could lead to nonfebrile epilepsy.
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Affiliation(s)
- Krisztina Moldovan
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | | | - Doug Dean
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA.
| | - Stephanie Eyerly-Webb
- Office of Human Research, Memorial Healthcare System, 3501 Johnson Street, Hollywood, FL, 33021, USA.
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Neurosciences Center, 60 Fenwood Road, 1st Floor, Boston, MA, 02115, USA.
| | - Francesco G Pucci
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Sean C L Deoni
- Brown University Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Department of Pediatrics, 111 Brewster Street, Pawtucket, RI, 02860, USA.
| | - Heather S Spader
- Division of Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, 1150N 35th Ave, Hollywood, FL, 33021, USA.
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Wagner R, Telfeian AE, Iprenburg M, Krzok G, Gokaslan Z, Choi DB, Pucci FG, Oyelese A. Transforaminal Endoscopic Solution to a Kyphoplasty Complication: Technical Note. World Neurosurg 2016; 91:195-8. [DOI: 10.1016/j.wneu.2016.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/05/2016] [Indexed: 11/17/2022]
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Wagner R, Telfeian AE, Iprenburg M, Krzok G, Gokaslan Z, Choi DB, Pucci FG, Oyelese A. Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation. World Neurosurg 2016; 90:194-198. [PMID: 26931541 DOI: 10.1016/j.wneu.2016.02.086] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 01/28/2016] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
Transforaminal endoscopic spine surgery has emerged internationally as a minimally invasive technique that can be performed in an awake patient in the outpatient setting. Advances in high-definition endoscopic camera technologies as well as the availability of specialty graspers, reamers, drills, and other instruments that can be used down a working channel endoscope have made a myriad of spine diseases accessible to the minimally invasive spine surgeon. The major challenge inherent in the surgical treatment of thoracic disc disease is that the disc herniation is often ventral to the spinal cord. The transforaminal approach and the angled endoscopic camera are an ideal combination for creating a technical advantage to accessing thoracic disc disease.
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Affiliation(s)
- Ralf Wagner
- Ligamenta Spine Centre, Frankfurt am Main, Germany
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | | | - Guntram Krzok
- Orthopädische Praxis Waltershausen, Friedrichroda, Germany
| | - Ziya Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David B Choi
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Francesco G Pucci
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetkunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Dumitrescu ON, Pucci FG, Wong KY, Berson DM. Ectopic retinal ON bipolar cell synapses in the OFF inner plexiform layer: contacts with dopaminergic amacrine cells and melanopsin ganglion cells. J Comp Neurol 2009; 517:226-44. [PMID: 19731338 DOI: 10.1002/cne.22158] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A key principle of retinal organization is that distinct ON and OFF channels are relayed by separate populations of bipolar cells to different sublaminae of the inner plexiform layer (IPL). ON bipolar cell axons have been thought to synapse exclusively in the inner IPL (the ON sublamina) onto dendrites of ON-type amacrine and ganglion cells. However, M1 melanopsin-expressing ganglion cells and dopaminergic amacrine (DA) cells apparently violate this dogma. Both are driven by ON bipolar cells, but their dendrites stratify in the outermost IPL, within the OFF sublamina. Here, in the mouse retina, we show that some ON cone bipolar cells make ribbon synapses in the outermost OFF sublayer, where they costratify with and contact the dendrites of M1 and DA cells. Whole-cell recording and dye filling in retinal slices indicate that type 6 ON cone bipolars provide some of this ectopic ON channel input. Imaging studies in dissociated bipolar cells show that these ectopic ribbon synapses are capable of vesicular release. There is thus an accessory ON sublayer in the outer IPL.
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Affiliation(s)
- Olivia N Dumitrescu
- Department of Neuroscience, Brown University, Providence, Rhode Island 02912
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