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Eisinger RS, Cagle JN, Alcantara JD, Opri E, Cernera S, Le A, Torres Ponce EM, Lanese J, Nelson B, Lopes J, Hundley C, Ravy T, Wu SS, Foote KD, Okun MS, Gunduz A. Distinct Roles of the Human Subthalamic Nucleus and Dorsal Pallidum in Parkinson's Disease Impulsivity. Biol Psychiatry 2022; 91:370-379. [PMID: 33993998 PMCID: PMC8419208 DOI: 10.1016/j.biopsych.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Impulsivity and impulse control disorders are common in Parkinson's disease and lead to increased morbidity and reduced quality of life. Impulsivity is thought to arise from aberrant reward processing and inhibitory control, but it is unclear why deep brain stimulation of either the subthalamic nucleus (STN) or globus pallidus internus (GPi) affects levels of impulsivity. Our aim was to assess the role of the STN and GPi in impulsivity using invasive local field potential (LFP) recordings from deep brain stimulation electrodes. METHODS We measured LFPs during a simple rewarding Go/NoGo paradigm in 39 female and male human patients with Parkinson's disease manifesting variable amounts of impulsivity who were undergoing unilateral deep brain stimulation of either the STN (18 nuclei) or GPi (28 nuclei). We identified reward-specific LFP event-related potentials and correlated them to impulsivity severity. RESULTS LFPs in both structures modulated during reward-specific Go and NoGo stimulus evaluation, reward feedback, and loss feedback. Motor and limbic functions were anatomically separable in the GPi but not in the STN. Across participants, LFP reward processing responses in the STN and GPi uniquely depended on the severity of impulsivity. CONCLUSIONS This study establishes LFP correlates of impulsivity within the STN and GPi regions. We propose a model for basal ganglia reward processing that includes the bottom-up role of the GPi in reward salience and the top-down role of the STN in cognitive control.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, Gainesville, Florida.
| | - Jackson N Cagle
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Jose D Alcantara
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Enrico Opri
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Stephanie Cernera
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Anh Le
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | | | - Joseph Lanese
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Brawn Nelson
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Janine Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | | | - Tasmeah Ravy
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - Michael S Okun
- Department of Neuroscience, University of Florida, Gainesville, Florida; Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida; Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, Florida; J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
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Eisinger RS, Scott BM, Le A, Ponce EMT, Lanese J, Hundley C, Nelson B, Ravy T, Lopes J, Thompson S, Sathish S, O'Connell RL, Okun MS, Bowers D, Gunduz A. Pavlovian bias in Parkinson's disease: an objective marker of impulsivity that modulates with deep brain stimulation. Sci Rep 2020; 10:13448. [PMID: 32778775 PMCID: PMC7417529 DOI: 10.1038/s41598-020-69760-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Impulsivity is a common symptom in Parkinson's disease (PD). Adaptive behavior is influenced by prepotent action-reward and inaction-avoid loss Pavlovian biases. We aimed to assess the hypothesis that impulsivity in PD is associated with Pavlovian bias, and to assess whether dopaminergic medications and deep brain stimulation (DBS) influence Pavlovian bias. A PD DBS cohort (N = 37) completed a reward-based Go/No-Go task and bias measures were calculated. This DBS cohort completed the task under three conditions: on-med/pre-DBS, off-med/off-DBS, and on-med/on-DBS. Participants also completed self-reported measures of impulsivity. Dopaminergic medication was associated with lower action-reward bias while DBS was associated with higher action-reward bias. Impulsivity was associated with higher action-reward bias but not inaction-avoid loss bias. We furthermore replicated this association in an independent, non-DBS PD cohort (N = 88). Overall we establish an objective behavioral marker of impulsivity and show that DBS affects impulsivity by amplifying automated responding. Our results point to the importance of reward rather than punishment avoidance in driving impulsive behaviors. This work provides insight into the pathophysiological underpinnings of impulsivity and especially medication and DBS-associated impulsivity in PD.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA.
| | - Bonnie M Scott
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Anh Le
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Elena M Torres Ponce
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Joseph Lanese
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Christopher Hundley
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Brawn Nelson
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Tasmeah Ravy
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Janine Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sneha Sathish
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rebecca L O'Connell
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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