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Kornilov E, Baker Erdman H, Kahana E, Fireman S, Zarchi O, Israelashvili M, Reiner J, Glik A, Weiss P, Paz R, Bergman H, Tamir I. Interleaved Propofol-Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double-Blind Randomized Controlled Trial. Mov Disord 2024; 39:694-705. [PMID: 38396358 DOI: 10.1002/mds.29746] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The gold standard anesthesia for deep brain stimulation (DBS) surgery is the "awake" approach, using local anesthesia alone. Although it offers high-quality microelectrode recordings and therapeutic-window assessment, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. General anesthesia or deep sedation is an alternative, but may reduce physiological testing reliability and lead localization accuracy. OBJECTIVES The aim is to investigate a novel anesthesia regimen of ketamine-induced conscious sedation for the physiological testing phase of DBS surgery. METHODS Parkinson's patients undergoing subthalamic DBS surgery were randomly divided into experimental and control groups. During physiological testing, the groups received 0.25 mg/kg/h ketamine infusion and normal saline, respectively. Both groups had moderate propofol sedation before and after physiological testing. The primary outcome was recording quality. Secondary outcomes included hemodynamic stability, lead accuracy, motor and cognitive outcome, patient satisfaction, and adverse events. RESULTS Thirty patients, 15 from each group, were included. Intraoperatively, the electrophysiological signature and lead localization were similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson's disease rating scale part-III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively. CONCLUSIONS Ketamine-induced conscious sedation provided high quality microelectrode recordings comparable with awake conditions. Additionally, it seems to allow superior patient satisfaction and hemodynamic stability, while maintaining similar post-operative outcomes. Therefore, it holds promise as a novel alternative anesthetic regimen for DBS. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Evgeniya Kornilov
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Halen Baker Erdman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel
| | - Eilat Kahana
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Shlomo Fireman
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Omer Zarchi
- Intraoperative Neurophysiology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | | | - Johnathan Reiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Amir Glik
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Cognitive Neurology Clinic, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Penina Weiss
- Occupational Therapy Department, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Rony Paz
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, Hebrew University, Jerusalem, Israel
| | - Idit Tamir
- Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
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Hollunder B, Ostrem JL, Sahin IA, Rajamani N, Oxenford S, Butenko K, Neudorfer C, Reinhardt P, Zvarova P, Polosan M, Akram H, Vissani M, Zhang C, Sun B, Navratil P, Reich MM, Volkmann J, Yeh FC, Baldermann JC, Dembek TA, Visser-Vandewalle V, Alho EJL, Franceschini PR, Nanda P, Finke C, Kühn AA, Dougherty DD, Richardson RM, Bergman H, DeLong MR, Mazzoni A, Romito LM, Tyagi H, Zrinzo L, Joyce EM, Chabardes S, Starr PA, Li N, Horn A. Mapping dysfunctional circuits in the frontal cortex using deep brain stimulation. Nat Neurosci 2024; 27:573-586. [PMID: 38388734 PMCID: PMC10917675 DOI: 10.1038/s41593-024-01570-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/05/2024] [Indexed: 02/24/2024]
Abstract
Frontal circuits play a critical role in motor, cognitive and affective processing, and their dysfunction may result in a variety of brain disorders. However, exactly which frontal domains mediate which (dys)functions remains largely elusive. We studied 534 deep brain stimulation electrodes implanted to treat four different brain disorders. By analyzing which connections were modulated for optimal therapeutic response across these disorders, we segregated the frontal cortex into circuits that had become dysfunctional in each of them. Dysfunctional circuits were topographically arranged from occipital to frontal, ranging from interconnections with sensorimotor cortices in dystonia, the primary motor cortex in Tourette's syndrome, the supplementary motor area in Parkinson's disease, to ventromedial prefrontal and anterior cingulate cortices in obsessive-compulsive disorder. Our findings highlight the integration of deep brain stimulation with brain connectomics as a powerful tool to explore couplings between brain structure and functional impairments in the human brain.
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Affiliation(s)
- Barbara Hollunder
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jill L Ostrem
- Movement Disorders and Neuromodulation Centre, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ilkem Aysu Sahin
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nanditha Rajamani
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simón Oxenford
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Reinhardt
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Zvarova
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mircea Polosan
- Université Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut des Neurosciences, Grenoble, France
- Department of Psychiatry, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Harith Akram
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Matteo Vissani
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Chencheng Zhang
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pavel Navratil
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin M Reich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till A Dembek
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carsten Finke
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hagai Bergman
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University, Hadassah Medical School, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Luigi M Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Himanshu Tyagi
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Eileen M Joyce
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Stephan Chabardes
- Université Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut des Neurosciences, Grenoble, France
- Department of Neurosurgery, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Johnson KA, Dosenbach NUF, Gordon EM, Welle CG, Wilkins KB, Bronte-Stewart HM, Voon V, Morishita T, Sakai Y, Merner AR, Lázaro-Muñoz G, Williamson T, Horn A, Gilron R, O'Keeffe J, Gittis AH, Neumann WJ, Little S, Provenza NR, Sheth SA, Fasano A, Holt-Becker AB, Raike RS, Moore L, Pathak YJ, Greene D, Marceglia S, Krinke L, Tan H, Bergman H, Pötter-Nerger M, Sun B, Cabrera LY, McIntyre CC, Harel N, Mayberg HS, Krystal AD, Pouratian N, Starr PA, Foote KD, Okun MS, Wong JK. Proceedings of the 11th Annual Deep Brain Stimulation Think Tank: pushing the forefront of neuromodulation with functional network mapping, biomarkers for adaptive DBS, bioethical dilemmas, AI-guided neuromodulation, and translational advancements. Front Hum Neurosci 2024; 18:1320806. [PMID: 38450221 PMCID: PMC10915873 DOI: 10.3389/fnhum.2024.1320806] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
The Deep Brain Stimulation (DBS) Think Tank XI was held on August 9-11, 2023 in Gainesville, Florida with the theme of "Pushing the Forefront of Neuromodulation". The keynote speaker was Dr. Nico Dosenbach from Washington University in St. Louis, Missouri. He presented his research recently published in Nature inn a collaboration with Dr. Evan Gordon to identify and characterize the somato-cognitive action network (SCAN), which has redefined the motor homunculus and has led to new hypotheses about the integrative networks underpinning therapeutic DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers, and researchers (from industry and academia) can freely discuss current and emerging DBS technologies, as well as logistical and ethical issues facing the field. The group estimated that globally more than 263,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: cutting-edge translational neuromodulation, cutting-edge physiology, advances in neuromodulation from Europe and Asia, neuroethical dilemmas, artificial intelligence and computational modeling, time scales in DBS for mood disorders, and advances in future neuromodulation devices.
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Affiliation(s)
- Kara A. Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Nico U. F. Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Evan M. Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cristin G. Welle
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helen M. Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuki Sakai
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Amanda R. Merner
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
- MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | | | | | - Aryn H. Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Simon Little
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Abbey B. Holt-Becker
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Lisa Moore
- Boston Scientific Neuromodulation Corporation, Valencia, CA, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Lothar Krinke
- Newronika SPA, Milan, Italy
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Hagai Bergman
- Edmond and Lily Safar Center (ELSC) for Brain Research and Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Laura Y. Cabrera
- Neuroethics, Department of Engineering Science and Mechanics, Philosophy, and Bioethics, and the Rock Ethics Institute, Pennsylvania State University, State College, PA, United States
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Neurosurgery, Duke University, Durham, NC, United States
| | - Noam Harel
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew D. Krystal
- Departments of Psychiatry and Behavioral Science and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Philip A. Starr
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly D. Foote
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
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Farquharson BJM, Collis J, Jaskani S, Bergman H, Andrews B. 17 years' experience of surgical management of thoracic outlet syndrome at a district general hospital. Ann R Coll Surg Engl 2024; 106:51-56. [PMID: 36779445 PMCID: PMC10757880 DOI: 10.1308/rcsann.2023.0002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular structures passing through the thoracic inlet. It is categorised into three subtypes: neurogenic TOS (NTOS), venous TOS (VTOS) and arterial TOS (ATOS). This study evaluates the outcomes of patients who underwent first rib resection (FRR) for TOS during a period of 17 years at a single district general hospital. METHODS Retrospective review of patient notes of individuals treated with FRR from August 2004 to August 2021. RESULTS A total of 62 FRRs were performed on 51 individual patients. Indications for FRR included 42 NTOS (68%), 6 VTOS (10%) and 14 ATOS (23%). Thirty-four patients (64%) were female and the mean age at time of surgery was 39 years (range 27 to 64 years). Eleven patients (21%) underwent bilateral FRR and seven cases of cervical ribs were observed. The mean time from initial symptoms to diagnosis was 18 months (range 2 to 60 months). Overall, outcomes after surgery were positive across all subtypes of TOS. Based on Derkash's classification, 52 patients (84%) reported excellent/good, 8 (13%) reported fair and 2 (3%) reported poor resolution of symptoms at 6 month follow-up. Complications included four (9%) pneumothorax, two (4%) wound infections, two (4%) haematoma, one (2%) haemothorax, three (5%) phrenic nerve complications and one (2%) brachial neuropraxia. CONCLUSIONS FRR for TOS can be performed safely and effectively in a district general hospital environment with excellent patient clinical outcomes.
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Affiliation(s)
| | | | | | - H Bergman
- Cambridge University Hospitals NHS Foundation Trust, UK
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Busch JL, Kaplan J, Habets JGV, Feldmann LK, Roediger J, Köhler RM, Merk T, Faust K, Schneider GH, Bergman H, Neumann WJ, Kühn AA. Single threshold adaptive deep brain stimulation in Parkinson's disease depends on parameter selection, movement state and controllability of subthalamic beta activity. Brain Stimul 2024; 17:125-133. [PMID: 38266773 DOI: 10.1016/j.brs.2024.01.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/22/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an invasive treatment option for patients with Parkinson's disease. Recently, adaptive DBS (aDBS) systems have been developed, which adjust stimulation timing and amplitude in real-time. However, it is unknown how changes in parameters, movement states and the controllability of subthalamic beta activity affect aDBS performance. OBJECTIVE To characterize how parameter choice, movement state and controllability interactively affect the electrophysiological and behavioral response to single threshold aDBS. METHODS We recorded subthalamic local field potentials in 12 patients with Parkinson's disease receiving single threshold aDBS in the acute post-operative state. We investigated changes in two aDBS parameters: the onset time and the smoothing of real-time beta power. Electrophysiological patterns and motor performance were assessed while patients were at rest and during a simple motor task. We further studied the impact of controllability on aDBS performance by comparing patients with and without beta power modulation during continuous stimulation. RESULTS Our findings reveal that changes in the onset time control the extent of beta power suppression achievable with single threshold adaptive stimulation during rest. Behavioral data indicate that only specific parameter combinations yield a beneficial effect of single threshold aDBS. During movement, action induced beta power suppression reduces the responsivity of the closed loop algorithm. We further demonstrate that controllability of beta power is a prerequisite for effective parameter dependent modulation of subthalamic beta activity. CONCLUSION Our results highlight the interaction between single threshold aDBS parameter selection, movement state and controllability in driving subthalamic beta activity and motor performance. By this means, we identify directions for the further development of closed-loop DBS algorithms.
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Affiliation(s)
- Johannes L Busch
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Kaplan
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jeroen G V Habets
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucia K Feldmann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Roediger
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Richard M Köhler
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timon Merk
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel; Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University, Hassadah Medical School, Jerusalem, Israel; Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Wolf-Julian Neumann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany.
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6
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Pal G, Corcos DM, Metman LV, Israel Z, Bergman H, Arkadir D. Cognitive Effects of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease with GBA1 Pathogenic Variants. Mov Disord 2023; 38:2155-2162. [PMID: 37916476 PMCID: PMC10990226 DOI: 10.1002/mds.29647] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
Genetic subtyping of patients with Parkinson's disease (PD) may assist in predicting the cognitive and motor outcomes of subthalamic deep brain stimulation (STN-DBS). Practical questions were recently raised with the emergence of new data regarding suboptimal cognitive outcomes after STN-DBS in individuals with PD associated with pathogenic variants in glucocerebrosidase gene (GBA1-PD). However, a variety of gaps and controversies remain. (1) Does STN-DBS truly accelerate cognitive deterioration in GBA1-PD? If so, what is the clinical significance of this acceleration? (2) How should the overall risk-to-benefit ratio of STN-DBS in GBA1-PD be established? (3) If STN-DBS has a negative effect on cognition in GBA1-PD, how can this effect be minimized? (4) Should PD patients be genetically tested before STN-DBS? (5) How should GBA1-PD patients considering STN-DBS be counseled? We aim to summarize the currently available relevant data and detail the gaps and controversies that exist pertaining to these questions. In the absence of evidence-based data, all authors strongly agree that clinicians should not categorically deny DBS to PD patients based solely on genotype (GBA1 status). We suggest that PD patients considering DBS may be offered genetic testing for GBA1, where available and feasible, so the potential risks and benefits of STN-DBS can be properly weighed by both the patient and clinician. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gian Pal
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
| | - Leo Verhagen Metman
- Parkinson’s Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zvi Israel
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel–Canada (IMRIC), The Hebrew University–Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - David Arkadir
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
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7
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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] [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: 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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8
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Levy M, Zurawel M, d’Hardemare V, Moran A, Andelman F, Manor Y, Cohen J, Meshulam M, Balash Y, Gurevich T, Fried I, Bergman H. Subthalamic nucleus physiology is correlated with deep brain stimulation motor and non-motor outcomes. Brain Commun 2023; 5:fcad268. [PMID: 38025270 PMCID: PMC10664412 DOI: 10.1093/braincomms/fcad268] [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: 10/02/2022] [Revised: 04/24/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Subthalamic nucleus deep brain stimulation is commonly indicated for symptomatic relief of idiopathic Parkinson's disease. Despite the known improvement in motor scores, affective, cognitive, voice and speech functions might deteriorate following this procedure. Recent studies have correlated motor outcomes with intraoperative microelectrode recordings. However, there are no microelectrode recording-based tools with predictive values relating to long-term outcomes of integrative motor and non-motor symptoms. We conducted a retrospective analysis of the outcomes of patients with idiopathic Parkinson's disease who had subthalamic nucleus deep brain stimulation at Tel Aviv Sourasky Medical Centre (Tel Aviv, Israel) during 2015-2016. Forty-eight patients (19 women, 29 men; mean age, 58 ± 8 years) who were implanted with a subthalamic nucleus deep brain stimulation device underwent pre- and postsurgical assessments of motor, neuropsychological, voice and speech symptoms. Significant improvements in all motor symptoms (except axial signs) and levodopa equivalent daily dose were noted in all patients. Mild improvements were observed in more posterior-related neuropsychological functions (verbal memory, visual memory and organization) while mild deterioration was observed in frontal functions (personality changes, executive functioning and verbal fluency). The concomitant decline in speech intelligibility was mild and only partial, probably in accordance with the neuropsychological verbal fluency results. Acoustic characteristics were the least affected and remained within normal values. Dimensionality reduction of motor, neuropsychological and voice scores rendered six principal components that reflect the main clinical aspects: the tremor-dominant versus the rigidity-bradykinesia-dominant motor symptoms, frontal versus posterior neuropsychological deficits and acoustic characteristics versus speech intelligibility abnormalities. Microelectrode recordings of subthalamic nucleus spiking activity were analysed off-line and correlated with the original scores and with the principal component results. Based on 198 microelectrode recording trajectories, we suggest an intraoperative subthalamic nucleus deep brain stimulation score, which is a simple sum of three microelectrode recording properties: normalized neuronal activity, the subthalamic nucleus width and the relative proportion of the subthalamic nucleus dorsolateral oscillatory region. A threshold subthalamic nucleus deep brain stimulation score >2.5 (preferentially composed of normalized root mean square >1.5, subthalamic nucleus width >3 mm and a dorsolateral oscillatory region/subthalamic nucleus width ratio >1/3) predicts better motor and non-motor long-term outcomes. The algorithm presented here optimizes intraoperative decision-making of deep brain stimulation contact localization based on microelectrode recording with the aim of improving long-term (>1 year) motor, neuropsychological and voice symptoms.
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Affiliation(s)
- Mikael Levy
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Mika Zurawel
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Vincent d’Hardemare
- Department of Neurosurgery, Hospital Foundation Rothschild, Paris 75019, France
| | - Anan Moran
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- School of Neurobiology, Biochemistry & Biophysics, George S. Wise Faculty of Life Science, Tel-Aviv University, Tel Aviv 6423906, Israel
| | - Fani Andelman
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yael Manor
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jacob Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
| | - Moshe Meshulam
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yacov Balash
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itzhak Fried
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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9
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Glowinsky S, Bergman H, Zarchi O, Fireman S, Reiner J, Tamir I. Electrophysiology-aided DBS targeting the ventral intermediate nucleus in an essential tremor patient with MRI-incompatible lead: A case report. Physiol Rep 2023; 11:e15730. [PMID: 37786936 PMCID: PMC10546088 DOI: 10.14814/phy2.15730] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 10/04/2023] Open
Abstract
Essential tremor (ET) is a common disease in the elderly population. Severe, medication-refractory ET may require surgical intervention via ablation or deep brain stimulation (DBS). Thalamic Vim (Ventral intermediate nucleus), targeted indirectly using atlas-based coordinates, is the classical target in these procedures. We present a case of an ET patient with a non-MR-compatible cardiac orphaned leads who was a candidate for DBS surgery. Due to the lead constraints of MR use, we used a head computed tomography (CT) with contrast media as the reference exam to define the AC, PC, and midline, and to register and indirectly target the Vim. For target validation, we used intraoperative electrophysiological recordings and intraoperative CT. We implanted bilateral directional leads at the target location. We used the-essential-tremor-rating-assessment-scale (TETRAS) pre and postoperatively to clinically evaluate tremor. Intraoperative micro-electrode recordings (MERs) showed individual tremor cells and a robust increase in normalized root mean square (NRMS) indicating entry to the Vim. Postoperative visualization using lead-DBS along with dramatic clinical improvements show that we were able to accurately target the Vim. Our results show that CT-only registration and planning for thalamic Vim DBS is feasible, and that MERs and intraoperative CT are useful adjuncts for Vim target validation.
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Affiliation(s)
- Stefanie Glowinsky
- The Edmond and Lily Safra Center for Brain SciencesHebrew UniversityJerusalemIsrael
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain SciencesHebrew UniversityJerusalemIsrael
- Department of Medical NeurobiologyHebrew UniversityJerusalemIsrael
- Department of NeurosurgeryHadassah Medical Center, Hebrew UniversityJerusalemIsrael
| | - Omer Zarchi
- Intraoperative Neurophysiology UnitRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
| | - Shlomo Fireman
- Department of AnesthesiologyRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
| | - Johnathan Reiner
- Department of NeurologyRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
| | - Idit Tamir
- Department of NeurosurgeryRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
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10
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Yin Z, Ma R, An Q, Xu Y, Gan Y, Zhu G, Jiang Y, Zhang N, Yang A, Meng F, Kühn AA, Bergman H, Neumann WJ, Zhang J. Pathological pallidal beta activity in Parkinson's disease is sustained during sleep and associated with sleep disturbance. Nat Commun 2023; 14:5434. [PMID: 37669927 PMCID: PMC10480217 DOI: 10.1038/s41467-023-41128-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/21/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
Parkinson's disease (PD) is associated with excessive beta activity in the basal ganglia. Brain sensing implants aim to leverage this biomarker for demand-dependent adaptive stimulation. Sleep disturbance is among the most common non-motor symptoms in PD, but its relationship with beta activity is unknown. To investigate the clinical potential of beta activity as a biomarker for sleep quality in PD, we recorded pallidal local field potentials during polysomnography in PD patients off dopaminergic medication and compared the results to dystonia patients. PD patients exhibited sustained and elevated beta activity across wakefulness, rapid eye movement (REM), and non-REM sleep, which was correlated with sleep disturbance. Simulation of adaptive stimulation revealed that sleep-related beta activity changes remain unaccounted for by current algorithms, with potential negative outcomes in sleep quality and overall quality of life for patients.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
- Exzellenzcluster - NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel Canada (IMRIC), Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Neurostimulation, Beijing, China.
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11
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Hollunder B, Ostrem JL, Sahin IA, Rajamani N, Oxenford S, Butenko K, Neudorfer C, Reinhardt P, Zvarova P, Polosan M, Akram H, Vissani M, Zhang C, Sun B, Navratil P, Reich MM, Volkmann J, Yeh FC, Baldermann JC, Dembek TA, Visser-Vandewalle V, Alho EJL, Franceschini PR, Nanda P, Finke C, Kühn AA, Dougherty DD, Richardson RM, Bergman H, DeLong MR, Mazzoni A, Romito LM, Tyagi H, Zrinzo L, Joyce EM, Chabardes S, Starr PA, Li N, Horn A. Mapping Dysfunctional Circuits in the Frontal Cortex Using Deep Brain Stimulation. medRxiv 2023:2023.03.07.23286766. [PMID: 36945497 PMCID: PMC10029043 DOI: 10.1101/2023.03.07.23286766] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Frontal circuits play a critical role in motor, cognitive, and affective processing - and their dysfunction may result in a variety of brain disorders. However, exactly which frontal domains mediate which (dys)function remains largely elusive. Here, we study 534 deep brain stimulation electrodes implanted to treat four different brain disorders. By analyzing which connections were modulated for optimal therapeutic response across these disorders, we segregate the frontal cortex into circuits that became dysfunctional in each of them. Dysfunctional circuits were topographically arranged from occipital to rostral, ranging from interconnections with sensorimotor cortices in dystonia, with the primary motor cortex in Tourette's syndrome, the supplementary motor area in Parkinson's disease, to ventromedial prefrontal and anterior cingulate cortices in obsessive-compulsive disorder. Our findings highlight the integration of deep brain stimulation with brain connectomics as a powerful tool to explore couplings between brain structure and functional impairment in the human brain.
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Affiliation(s)
- Barbara Hollunder
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jill L. Ostrem
- Movement Disorders and Neuromodulation Centre, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Ilkem Aysu Sahin
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nanditha Rajamani
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Simón Oxenford
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Reinhardt
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Zvarova
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Mircea Polosan
- Univ. Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut des Neurosciences, Grenoble, France
- Psychiatry Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, UK
| | - Matteo Vissani
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Chencheng Zhang
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pavel Navratil
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin M. Reich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till A. Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carsten Finke
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea A. Kühn
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Darin D. Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University, Hassadah Medical School, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Mahlon R. DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Luigi M. Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Himanshu Tyagi
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, UK
| | - Eileen M. Joyce
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, UK
| | - Stephan Chabardes
- Univ. Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut des Neurosciences, Grenoble, France
- Department of Neurosurgery, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Philip A. Starr
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ningfei Li
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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12
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Wolke R, Becktepe JS, Paschen S, Helmers A, Kübler‐Weller D, Youn J, Brinker D, Bergman H, Kühn AA, Fasano A, Deuschl G. The Role of Levodopa Challenge in Predicting the Outcome of Subthalamic Deep Brain Stimulation. Mov Disord Clin Pract 2023; 10:1181-1191. [PMID: 37635781 PMCID: PMC10450242 DOI: 10.1002/mdc3.13825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/14/2022] [Revised: 05/14/2023] [Accepted: 06/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective and evidence-based treatment for idiopathic Parkinson's disease (iPD). A minority of patients does not sufficiently benefit from STN-DBS. Objective The predictive validity of the levodopa challenge for individual patients is analyzed. Methods Data from patients assessed with a preoperative Levodopa-test and a follow-up examination (mean ± standard deviation: 9.15 months ±3.39) from Kiel (n = 253), Berlin (n = 78) and Toronto (n = 98) were studied. Insufficient DBS outcome was defined as an overall UPDRS-III reduction <33% compared to UPDRS-III in med-off at baseline or alternatively if the minimal clinically important improvement of 5 points was not reached. Single UPDRS-items and sub-scores were dichotomized. Following exploratory analysis, we trained supervised regression- and classification models for outcome prediction. Results Data analysis confirmed significant correlation between the absolute UPDRS-III reduction during Levodopa challenge and after stimulation. But individual improvement was inaccurately predicted with a large range of up to 30 UPDRS III points. Further analysis identified preoperative UPDRS-III/med-off-scores and preoperative Levodopa-improvement as most influential factors. The models for UPDRS-III and sub-scores improvement achieved comparably low accuracy. Conclusions With large prediction intervals, the Levodopa challenge use for patient counseling is limited, though remains important for excluding non-responders to Levodopa. Despite these deficiencies, the current practice of patient selection is highly successful and builds not only on the Levodopa challenge. However, more specific motor tasks and further paraclinical tools for prediction need to be developed.
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Affiliation(s)
- Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | | | - Steffen Paschen
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | - Ann‐Kristin Helmers
- Department of NeurosurgeryUKSH, Christian‐Albrechts University KielKielGermany
| | - Dorothee Kübler‐Weller
- Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité–UniversitätsmedizinBerlinGermany
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical CenterSchool of medicine Sungkyunkwan UniversitySeoulSouth Korea
| | - Dana Brinker
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | - Hagai Bergman
- The Edmond andLily Safra Center for Brain Sciences (ELSC)The Hebrew UniversityJerusalemIsrael
- Department of Medical Neurobiology (Physiology), Institute of Medical Research‐Israel Canada (IMRIC), Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
- Department of Neurosurgery, Hadassah Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité–UniversitätsmedizinBerlinGermany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
| | - Günther Deuschl
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
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Weill C, Gallant A, Baker Erdman H, Abu Snineh M, Linetsky E, Bergman H, Israel Z, Arkadir D. Reply to: "Subthalamic Physiology in Genetic Subtypes of Parkinson's Disease". Mov Disord 2023; 38:1114. [PMID: 37475609 DOI: 10.1002/mds.29408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Caroline Weill
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Akiva Gallant
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Halen Baker Erdman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Muneer Abu Snineh
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Eduard Linetsky
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Zvi Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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14
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Weill C, Gallant A, Baker Erdman H, Abu Snineh M, Linetsky E, Bergman H, Israel Z, Arkadir D. The Genetic Etiology of Parkinson's Disease Does Not Robustly Affect Subthalamic Physiology. Mov Disord 2023; 38:484-489. [PMID: 36621944 DOI: 10.1002/mds.29310] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/13/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND It is unknown whether Parkinson's disease (PD) genetic heterogeneity, leading to phenotypic and pathological variability, is also associated with variability in the unique PD electrophysiological signature. Such variability might have practical implications for adaptive deep brain stimulation (DBS). OBJECTIVE The aim of our work was to study the electrophysiological activity in the subthalamic nucleus (STN) of patients with PD with pathogenic variants in different disease-causing genes. METHODS Electrophysiological data from participants with negative genetic tests were compared with those from GBA, LRRK2, and PRKN-PD. RESULTS We analyzed data from 93 STN trajectories (GBA-PD: 28, LRRK2-PD: 22, PARK-PD: 10, idiopathic PD: 33) of 52 individuals who underwent DBS surgery. Characteristics of β oscillatory activity in the dorsolateral motor part of the STN were similar for patients with negative genetic tests and for patients with different forms of monogenic PD. CONCLUSIONS The genetic heterogeneity in PD is not associated with electrophysiological differences. Therefore, similar adaptive DBS algorithms would be applicable to genetically heterogeneous patient populations. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Caroline Weill
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Akiva Gallant
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Halen Baker Erdman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Muneer Abu Snineh
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Eduard Linetsky
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Zvi Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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15
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Kalita S, Bergman H, Dubey KD, Shaik S. How Can Static and Oscillating Electric Fields Serve in Decomposing Alzheimer's and Other Senile Plaques? J Am Chem Soc 2023; 145:3543-3553. [PMID: 36735972 PMCID: PMC9936589 DOI: 10.1021/jacs.2c12305] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Alzheimer's disease is one of the most common neurodegenerative conditions, which are ascribed to extracellular accumulation of β-amyloid peptides into plaques. This phenomenon seems to typify other related neurodegenerative diseases. The present study uses classical molecular-dynamics simulations to decipher the aggregation-disintegration behavior of β-amyloid peptide plaques in the presence of static and oscillating oriented external electric fields (OEEFs). A long-term disintegration of such plaques is highly desirable since this may improve the prospects of therapeutic treatments of Alzheimer's disease and of other neurodegenerative diseases typified by senile plaques. Our study illustrates the spontaneous aggregation of the β-amyloid, its prevention and breakdown when OEEF is applied, and the fate of the broken aggregate when the OEEF is removed. Notably, we demonstrate that the usage of an oscillating OEEF on β-amyloid aggregates appears to lead to an irreversible disintegration. Insight is provided into the root causes of the various modes of aggregation, as well as into the different fates of OEEF-induced disintegration in oscillating vs static fields. Finally, our simulation results are compared to the well-established TTFields and the Deep Brain Stimulation (DBS) therapies, which are currently used options for treatments of Alzheimer's disease and other related neurodegenerative diseases.
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Affiliation(s)
- Surajit Kalita
- Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 9190401, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), The Hebrew University of Jerusalem, Hadassah Medical Faculty, Jerusalem, Israel 91120
| | - Kshatresh Dutta Dubey
- Department of Chemistry, School of Natural Sciences, Shiv Nadar Institution of Eminence, Greater Noida, Uttar Pradesh 201314, India
| | - Sason Shaik
- Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 9190401, Israel
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16
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Katabi S, Adler A, Deffains M, Bergman H. Dichotomous activity and function of neurons with low- and high-frequency discharge in the external globus pallidus of non-human primates. Cell Rep 2023; 42:111898. [PMID: 36596302 DOI: 10.1016/j.celrep.2022.111898] [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: 02/14/2022] [Revised: 07/30/2022] [Accepted: 12/07/2022] [Indexed: 01/03/2023] Open
Abstract
To date, there is a consensus that there are at least two neuronal populations in the non-human primate (NHP) external globus pallidus (GPe): low-frequency discharge (LFD) and high-frequency discharge (HFD) neurons. Nevertheless, almost all NHP physiological studies have neglected the functional importance of LFD neurons. This study examined the discharge features of these two GPe neuronal subpopulations recorded in four NHPs engaged in a classical conditioning task with cues predicting reward, neutral and aversive outcomes. The results show that LFD neurons tended to burst, encoded the salience of behavioral cues, and exhibited correlated spiking activity. By contrast, the HFD neurons tended to pause, encoded cue valence, and exhibited uncorrelated spiking activity. Overall, these findings point to the dichotomic organization of the NHP GPe, which is likely to be critical to the implementation of normal basal ganglia functions and computations.
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Affiliation(s)
- Shiran Katabi
- Department of Medical Neuroscience, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, 91120 Jerusalem, Israel.
| | - Avital Adler
- Department of Medical Neuroscience, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, 91120 Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem 91904, Israel
| | - Marc Deffains
- University of Bordeaux, UMR 5293, IMN, 33000 Bordeaux, France; CNRS, UMR 5293, IMN, 33000 Bordeaux, France
| | - Hagai Bergman
- Department of Medical Neuroscience, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, 91120 Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem 91904, Israel; Department of Neurosurgery, Hadassah Medical Center, Jerusalem 91120, Israel
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17
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Shamir RR, Joskowicz L, Bergman H. Editorial: Image-based planning of electric neurological treatments. Front Hum Neurosci 2023; 16:1089818. [PMID: 36704092 PMCID: PMC9872135 DOI: 10.3389/fnhum.2022.1089818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Reuben R. Shamir
- Novocure Ltd., Haifa, Israel,*Correspondence: Reuben R. Shamir ✉
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel,Department Medical Neurobiology, Institute for Medical Research, IMRIC, Hebrew University School of Medicine, Jerusalem, Israel
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18
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Mizrahi-Kliger AD, Kaplan A, Israel Z, Bergman H. Entrainment to sleep spindles reflects dissociable patterns of connectivity between cortex and basal ganglia. Cell Rep 2022; 40:111367. [PMID: 36130495 DOI: 10.1016/j.celrep.2022.111367] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/20/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Sleep spindles are crucial for learning in the cortex and basal ganglia (BG) because they facilitate the reactivation of previously active neuronal ensembles. Studying field potentials (FPs) and spiking in the cortex and BG during sleep in non-human primates following pre-sleep learning, we show that FP sleep spindles are widespread in the BG and are similar to cortical spindles in morphology, spectral content, and response to the pre-sleep task. Further, BG spindles are concordant with electroencephalogram (EEG) spindles and associated with increased cortico-BG correlation. However, spindles across the BG differ markedly in their entrainment of local spiking. The spiking activity of striatal projection neurons exhibits consistent phase locking to striatal and EEG spindles, producing phase windows of peaked cross-region spindling. In contrast, firing in other BG nuclei is not entrained to either local or EEG sleep spindles. These results suggest corticostriatal synapses as the main hub for offline cortico-BG communication.
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Affiliation(s)
- Aviv D Mizrahi-Kliger
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, 9112001 Jerusalem, Israel.
| | - Alexander Kaplan
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, 9112001 Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, 9190401 Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, 9112001 Jerusalem, Israel
| | - Hagai Bergman
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, 9112001 Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, 9190401 Jerusalem, Israel; Department of Neurosurgery, Hadassah University Hospital, 9112001 Jerusalem, Israel
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Ma W, Li M, Wu J, Zhang Z, Jia F, Zhang M, Bergman H, Li X, Ling Z, Xu X. Multiple step saccades in simply reactive saccades could serve as a complementary biomarker for the early diagnosis of Parkinson’s disease. Front Aging Neurosci 2022; 14:912967. [PMID: 35966789 PMCID: PMC9363762 DOI: 10.3389/fnagi.2022.912967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective It has been argued that the incidence of multiple step saccades (MSS) in voluntary saccades could serve as a complementary biomarker for diagnosing Parkinson’s disease (PD). However, voluntary saccadic tasks are usually difficult for elderly subjects to complete. Therefore, task difficulties restrict the application of MSS measurements for the diagnosis of PD. The primary objective of the present study is to assess whether the incidence of MSS in simply reactive saccades could serve as a complementary biomarker for the early diagnosis of PD. Materials and methods There were four groups of human subjects: PD patients, mild cognitive impairment (MCI) patients, elderly healthy controls (EHCs), and young healthy controls (YHCs). There were four monkeys with subclinical hemi-PD induced by injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) through the unilateral internal carotid artery and three healthy control monkeys. The behavioral task was a visually guided reactive saccade. Results In a human study, the incidence of MSS was significantly higher in PD than in YHC, EHC, and MCI groups. In addition, receiver operating characteristic (ROC) analysis could discriminate PD from the EHC and MCI groups, with areas under the ROC curve (AUCs) of 0.76 and 0.69, respectively. In a monkey study, while typical PD symptoms were absent, subclinical hemi-PD monkeys showed a significantly higher incidence of MSS than control monkeys when the dose of MPTP was greater than 0.4 mg/kg. Conclusion The incidence of MSS in simply reactive saccades could be a complementary biomarker for the early diagnosis of PD.
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Affiliation(s)
- Wenbo Ma
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Division of Psychology, Beijing Normal University, Beijing, China
| | - Min Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Division of Psychology, Beijing Normal University, Beijing, China
| | - Junru Wu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Division of Psychology, Beijing Normal University, Beijing, China
| | - Zhihao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Division of Psychology, Beijing Normal University, Beijing, China
| | - Fangfang Jia
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Division of Psychology, Beijing Normal University, Beijing, China
| | - Mingsha Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Division of Psychology, Beijing Normal University, Beijing, China
| | - Hagai Bergman
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Xuemei Li
- Department of Cadre Medical Service, The First Clinical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xuemei Li,
| | - Zhipei Ling
- Senior Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Zhipei Ling,
| | - Xin Xu
- Senior Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Xin Xu,
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Oz O, Matityahu L, Mizrahi-Kliger A, Kaplan A, Berkowitz N, Tiroshi L, Bergman H, Goldberg JA. Non-uniform distribution of dendritic nonlinearities differentially engages thalamostriatal and corticostriatal inputs onto cholinergic interneurons. eLife 2022; 11:76039. [PMID: 35815934 PMCID: PMC9302969 DOI: 10.7554/elife.76039] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/09/2022] [Indexed: 11/13/2022] Open
Abstract
The tonic activity of striatal cholinergic interneurons (CINs) is modified differentially by their afferent inputs. Although their unitary synaptic currents are identical, in most CINs cortical inputs onto distal dendrites only weakly entrain them, whereas proximal thalamic inputs trigger abrupt pauses in discharge in response to salient external stimuli. To test whether the dendritic expression of the active conductances that drive autonomous discharge contribute to the CINs’ capacity to dissociate cortical from thalamic inputs, we used an optogenetics-based method to quantify dendritic excitability in mouse CINs. We found that the persistent sodium (NaP) current gave rise to dendritic boosting, and that the hyperpolarization-activated cyclic nucleotide-gated (HCN) current gave rise to a subhertz membrane resonance. This resonance may underlie our novel finding of an association between CIN pauses and internally-generated slow wave events in sleeping non-human primates. Moreover, our method indicated that dendritic NaP and HCN currents were preferentially expressed in proximal dendrites. We validated the non-uniform distribution of NaP currents: pharmacologically; with two-photon imaging of dendritic back-propagating action potentials; and by demonstrating boosting of thalamic, but not cortical, inputs by NaP currents. Thus, the localization of active dendritic conductances in CIN dendrites mirrors the spatial distribution of afferent terminals and may promote their differential responses to thalamic vs. cortical inputs.
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Affiliation(s)
- Osnat Oz
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Matityahu
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviv Mizrahi-Kliger
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexander Kaplan
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Berkowitz
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Tiroshi
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua A Goldberg
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
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Erdman HB, Kornilov E, Kahana E, Zarchi O, Reiner J, Socher A, Strauss I, Firman S, Israel Z, Bergman H, Tamir I. Asleep DBS under ketamine sedation: Proof of concept. Neurobiol Dis 2022; 170:105747. [PMID: 35550159 DOI: 10.1016/j.nbd.2022.105747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to optimize brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS borders and subdomains based on electrophysiological properties like firing rates and patterns, intra-operative evaluation of therapeutic window, and improvement of lead placement accuracy. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties and interference with clinical testing, resulting in potential impact on surgical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. OBJECTIVE This open-label study investigates the use of low-dose ketamine for conscious sedation during microelectrode recordings and lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. METHODS Three anesthetic regimens were retrospectively compared in 38 surgeries (74 MER trajectories, 5962 recording sites) across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). RESULTS All anesthesia regimens achieved satisfactory MER. Detection of STN borders and subdomains by expert electrophysiologist was similar between the groups. Electrophysiological signature of the STN under ketamine was not inferior to either control group. All patients completed stimulation testing. CONCLUSIONS This study supports a low-dose ketamine anesthesia regimen for DBS which allows microelectrode recordings and stimulation testing that are not inferior to those conducted under awake and propofol-awake regimens and may optimize patient experience. A prospective double-blind study that would also compare patients' satisfaction level and clinical outcome should be performed to confirm these findings.
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Affiliation(s)
- Halen Baker Erdman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel.
| | - Evgeniya Kornilov
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel; Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Eilat Kahana
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Omer Zarchi
- Intraoperative Neurophysiology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Johnathan Reiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Achinoam Socher
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shimon Firman
- Department of Anesthesiology, Critical Care Medicine, and Pain Management, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel; Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, Hebrew University, Jerusalem, Israel
| | - Idit Tamir
- Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
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Wong JK, Deuschl G, Wolke R, Bergman H, Muthuraman M, Groppa S, Sheth SA, Bronte-Stewart HM, Wilkins KB, Petrucci MN, Lambert E, Kehnemouyi Y, Starr PA, Little S, Anso J, Gilron R, Poree L, Kalamangalam GP, Worrell GA, Miller KJ, Schiff ND, Butson CR, Henderson JM, Judy JW, Ramirez-Zamora A, Foote KD, Silburn PA, Li L, Oyama G, Kamo H, Sekimoto S, Hattori N, Giordano JJ, DiEuliis D, Shook JR, Doughtery DD, Widge AS, Mayberg HS, Cha J, Choi K, Heisig S, Obatusin M, Opri E, Kaufman SB, Shirvalkar P, Rozell CJ, Alagapan S, Raike RS, Bokil H, Green D, Okun MS. Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury. Front Hum Neurosci 2022; 16:813387. [PMID: 35308605 PMCID: PMC8931265 DOI: 10.3389/fnhum.2022.813387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
DBS Think Tank IX was held on August 25-27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging deep brain stimulation (DBS) technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury.
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Affiliation(s)
- Joshua K. Wong
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Robin Wolke
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Section of Movement Disorders and Neurostimulation, Focus Program Translational Neuroscience, Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Biomedical Statistics and Multimodal Signal Processing Unit, Section of Movement Disorders and Neurostimulation, Focus Program Translational Neuroscience, Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sameer A. Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Helen M. Bronte-Stewart
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Kevin B. Wilkins
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Matthew N. Petrucci
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Emilia Lambert
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Yasmine Kehnemouyi
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Philip A. Starr
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Simon Little
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Juan Anso
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Ro’ee Gilron
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Lawrence Poree
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, United States
| | - Giridhar P. Kalamangalam
- Department of Neurology, Wilder Center for Epilepsy Research, University of Florida, Gainesville, FL, United States
| | | | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, NY, United States
| | - Nicholas D. Schiff
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, United States
| | - Christopher R. Butson
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jaimie M. Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Jack W. Judy
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kelly D. Foote
- Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Peter A. Silburn
- Queensland Brain Institute, University of Queensland and Saint Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Genko Oyama
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hikaru Kamo
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Satoko Sekimoto
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - James J. Giordano
- Neuroethics Studies Program, Department of Neurology, Georgetown University Medical Center, Washington, DC, United States
| | - Diane DiEuliis
- US Department of Defense Fort Lesley J. McNair, National Defense University, Washington, DC, United States
| | - John R. Shook
- Department of Philosophy and Science Education, University of Buffalo, Buffalo, NY, United States
| | - Darin D. Doughtery
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alik S. Widge
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Helen S. Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jungho Cha
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kisueng Choi
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen Heisig
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mosadolu Obatusin
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Enrico Opri
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Scott B. Kaufman
- Department of Psychology, Columbia University, New York, NY, United States
| | - Prasad Shirvalkar
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
- Department of Anesthesiology (Pain Management) and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher J. Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sankaraleengam Alagapan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Hemant Bokil
- Boston Scientific Neuromodulation Corporation, Valencia, CA, United States
| | - David Green
- NeuroPace, Inc., Mountain View, CA, United States
| | - Michael S. Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Henschke N, Bergman H, Hungerford D, Cunliffe NA, Grais RF, Kang G, Parashar UD, Wang SA, Neuzil KM. The efficacy and safety of rotavirus vaccines in countries in Africa and Asia with high child mortality. Vaccine 2022; 40:1707-1711. [PMID: 35184924 PMCID: PMC8914343 DOI: 10.1016/j.vaccine.2022.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/05/2021] [Revised: 12/17/2021] [Accepted: 02/01/2022] [Indexed: 12/25/2022]
Abstract
Rotavirus remains a leading cause of diarrhoeal morbidity and mortality in young children and rotavirus vaccines are critical for reducing global disease burden. This report addresses the performance of rotavirus vaccines in countries with high child mortality. We performed a sensitivity analysis as part of a systematic review on rotavirus vaccines to inform development of World Health Organization vaccine recommendations. The efficacy of four prequalified vaccines against severe rotavirus gastroenteritis was similar across high mortality settings in Asia and Africa. Within the first year following vaccination, vaccine efficacy for the four vaccines ranged from 48% to 57% while in the second year, efficacy ranged from 29% to 54%. The four vaccines showed no increase in intussusception risk in these settings. All four vaccines appear to prevent significant numbers of severe rotavirus gastroenteritis episodes with no measurable increase in intussusception risk in high mortality settings in Africa and Asia.
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Affiliation(s)
| | | | - D Hungerford
- The Centre for Global Vaccine Research, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom
| | - N A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom
| | | | - G Kang
- Christian Medical College, Vellore, India
| | - U D Parashar
- Centers for Disease Control and Prevention, Atlanta, USA
| | - S A Wang
- World Health Organization, Geneva, Switzerland
| | - K M Neuzil
- University of Maryland School of Medicine, Baltimore, USA
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24
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Mizrahi-Kliger AD, Feldmann LK, Kühn AA, Bergman H. Etiologies of insomnia in Parkinson's disease - Lessons from human studies and animal models. Exp Neurol 2022; 350:113976. [PMID: 35026228 DOI: 10.1016/j.expneurol.2022.113976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 08/19/2021] [Revised: 10/27/2021] [Accepted: 01/06/2022] [Indexed: 12/28/2022]
Abstract
Sleep disorders are integral to Parkinson's disease (PD). Insomnia, an inability to maintain stable sleep, affects most patients and is widely rated as one of the most debilitating facets of this disease. PD insomnia is often perceived as a multifactorial entity - a consequence of several of the disease symptoms, comorbidities and therapeutic strategies. Yet, this view evolved against a backdrop of a relative scarcity of works trying to directly dissect the underlying neural correlates and mechanisms in animal models. The last years have seen the emergence of a wealth of new evidence regarding the neural underpinnings of insomnia in PD. Here, we review early and recent reports from patients and animal models evaluating the etiology of PD insomnia. We start by outlining the phenomenology of PD insomnia and continue to analyze the evidence supporting insomnia as emanating from four distinct subdivisions of etiologies - the symptoms and comorbidities of the disease, the medical therapy, the degeneration of non-dopaminergic cell groups and subsequent alterations in circadian rhythms, and the degeneration of dopaminergic neurons in the brainstem and its resulting effect on the basal ganglia. Finally, we review emerging neuromodulation-based therapeutic avenues for PD insomnia.
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Affiliation(s)
- Aviv D Mizrahi-Kliger
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
| | - Lucia K Feldmann
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
| | - Hagai Bergman
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem 91904, Israel; Department of Neurosurgery, Hadassah University Hospital, Jerusalem 91120, Israel
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25
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Iskhakova L, Rappel P, Deffains M, Fonar G, Marmor O, Paz R, Israel Z, Eitan R, Bergman H. Modulation of dopamine tone induces frequency shifts in cortico-basal ganglia beta oscillations. Nat Commun 2021; 12:7026. [PMID: 34857767 PMCID: PMC8640051 DOI: 10.1038/s41467-021-27375-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/24/2020] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
Βeta oscillatory activity (human: 13-35 Hz; primate: 8-24 Hz) is pervasive within the cortex and basal ganglia. Studies in Parkinson's disease patients and animal models suggest that beta-power increases with dopamine depletion. However, the exact relationship between oscillatory power, frequency and dopamine tone remains unclear. We recorded neural activity in the cortex and basal ganglia of healthy non-human primates while acutely and chronically up- and down-modulating dopamine levels. We assessed changes in beta oscillations in patients with Parkinson's following acute and chronic changes in dopamine tone. Here we show beta oscillation frequency is strongly coupled with dopamine tone in both monkeys and humans. Power, coherence between single-units and local field potentials (LFP), spike-LFP phase-locking, and phase-amplitude coupling are not systematically regulated by dopamine levels. These results demonstrate that beta frequency is a key property of pathological oscillations in cortical and basal ganglia networks.
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Affiliation(s)
- L Iskhakova
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel.
| | - P Rappel
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Deffains
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France
- CNRS, UMR 5293, IMN, Bordeaux, France
| | - G Fonar
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - O Marmor
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Paz
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Z Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - R Eitan
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
- Jerusalem Mental Health Center, Hebrew University Medical School, Jerusalem, Israel
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - H Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
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26
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Sand D, Arkadir D, Abu Snineh M, Marmor O, Israel Z, Bergman H, Hassin-Baer S, Israeli-Korn S, Peremen Z, Geva AB, Eitan R. Deep Brain Stimulation Can Differentiate Subregions of the Human Subthalamic Nucleus Area by EEG Biomarkers. Front Syst Neurosci 2021; 15:747681. [PMID: 34744647 PMCID: PMC8565520 DOI: 10.3389/fnsys.2021.747681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Precise lead localization is crucial for an optimal clinical outcome of subthalamic nucleus (STN) deep brain stimulation (DBS) treatment in patients with Parkinson's disease (PD). Currently, anatomical measures, as well as invasive intraoperative electrophysiological recordings, are used to locate DBS electrodes. The objective of this study was to find an alternative electrophysiology tool for STN DBS lead localization. Methods: Sixty-one postoperative electrophysiology recording sessions were obtained from 17 DBS-treated patients with PD. An intraoperative physiological method automatically detected STN borders and subregions. Postoperative EEG cortical activity was measured, while STN low frequency stimulation (LFS) was applied to different areas inside and outside the STN. Machine learning models were used to differentiate stimulation locations, based on EEG analysis of engineered features. Results: A machine learning algorithm identified the top 25 evoked response potentials (ERPs), engineered features that can differentiate inside and outside STN stimulation locations as well as within STN stimulation locations. Evoked responses in the medial and ipsilateral fronto-central areas were found to be most significant for predicting the location of STN stimulation. Two-class linear support vector machine (SVM) predicted the inside (dorso-lateral region, DLR, and ventro-medial region, VMR) vs. outside [zona incerta, ZI, STN stimulation classification with an accuracy of 0.98 and 0.82 for ZI vs. VMR and ZI vs. DLR, respectively, and an accuracy of 0.77 for the within STN (DLR vs. VMR)]. Multiclass linear SVM predicted all areas with an accuracy of 0.82 for the outside and within STN stimulation locations (ZI vs. DLR vs. VMR). Conclusions: Electroencephalogram biomarkers can use low-frequency STN stimulation to localize STN DBS electrodes to ZI, DLR, and VMR STN subregions. These models can be used for both intraoperative electrode localization and postoperative stimulation programming sessions, and have a potential to improve STN DBS clinical outcomes.
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Affiliation(s)
- Daniel Sand
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel.,Edmond and Lily Safra Center for Brain Research, Hebrew University of Jerusalem, Jerusalem, Israel.,Elminda Ltd., Herzliya, Israel
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Muneer Abu Snineh
- Department of Neurology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Odeya Marmor
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zvi Israel
- Brain Division, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel.,Edmond and Lily Safra Center for Brain Research, Hebrew University of Jerusalem, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Hassin-Baer
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simon Israeli-Korn
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Amir B Geva
- Department of Electrical and Computer Engineering, Ben Gurion University, Beer-Sheva, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel.,Brain Division, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Neuropsychiatry Unit, Jerusalem Mental Health Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Liu X, Xu Y, Bergman H, Li S, Wang W. A systematic review of Twiddler's syndrome: a hardware-related complication of deep brain stimulation. Neurosurg Rev 2021; 45:951-963. [PMID: 34491478 DOI: 10.1007/s10143-021-01636-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
Twiddler's syndrome (TS) is a hardware-related complication of deep brain stimulation which has not been well documented and is probably underreported. The objective of this study is to comprehensively describe TS by systematically reviewing the related literature. The methods include selecting the eligible studies based on the inclusion and exclusion criteria. Data about studies and TS were collected. A descriptive statistical analysis of the extracted data was performed. We found 18 eligible studies describing 23 patients with TS. The mean age of the 23 patients was 61.4 ± 15.9 years (range, 16-79 years.). The percentage of TS in the female population was 91.3% (females: 21/23). The incidence of postoperative TS was 1.4% (6 out of 437) per patient and 1.1% (8 out of 709) per extension wire. The mean time to clinical presentation was 9.9 ± 10.3 months (range, 0.5-36 months). Nineteen of the twenty-three patients presented with a rebound of previous symptoms. Twelve of the twenty-three patients had high impedance at the postoperative checkup of the DBS system. A plain X-ray indicated twisted extension wires in almost all these patients. All patients meeting the definition of postoperative device-related TS underwent revision surgery. TS is more prevalent in females. Based on the typical clinical symptoms (rebound of the previous symptoms, high impedance, and X-ray demonstration), the differential diagnosis can often be straightforward. TS should thus be taken into consideration when attempting to explain or rule out hardware malfunction. The timely recognition and proper revision of TS can prevent further serious damage.
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Affiliation(s)
- Xiaowei Liu
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Yangyang Xu
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel.,Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Siyu Li
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China
| | - Wei Wang
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China.
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28
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Farquharson BJ, Sivarajah V, Mahdi S, Bergman H, Jeyarajah S. Where is the nerve? Review of operation note documentation practice for inguinal hernia repair. Ann R Coll Surg Engl 2021; 103:651-655. [PMID: 34412537 DOI: 10.1308/rcsann.2021.0024] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice may inform postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in their operation notes. METHODS We carried out a retrospective review of operation notes at a single district general hospital. We analysed operation notes for documentation of identification and intraoperative management (preservation or sacrifice) of the inguinal nerves (iliohypogastric, ilioinguinal, genital branch of genitofemoral nerve). We collected data on the baseline characteristics of the patients, hernia characteristics and primary operating surgeons for subgroup analysis. RESULTS A total of 100 patients were included in the analysis. Identification of any inguinal nerves (generic 'nerve') was documented in 17% of operation notes. Documentation in the operation notes of named individual nerves was limited. No documentation of intraoperative management of inguinal nerves was found in 83% of operation notes. Preservation of the inguinal nerves (generic 'nerve') was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades. CONCLUSION This study reveals a lack of appreciation of the importance of documenting identification and management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.
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Affiliation(s)
| | | | - S Mahdi
- East and North Hertfordshire NHS Trust, UK
| | - H Bergman
- East and North Hertfordshire NHS Trust, UK
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29
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Guang J, Baker H, Ben-Yishay Nizri O, Firman S, Werner-Reiss U, Kapuller V, Israel Z, Bergman H. Toward asleep DBS: cortico-basal ganglia spectral and coherence activity during interleaved propofol/ketamine sedation mimics NREM/REM sleep activity. NPJ Parkinsons Dis 2021; 7:67. [PMID: 34341348 PMCID: PMC8329235 DOI: 10.1038/s41531-021-00211-9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022]
Abstract
Deep brain stimulation (DBS) is currently a standard procedure for advanced Parkinson's disease. Many centers employ awake physiological navigation and stimulation assessment to optimize DBS localization and outcome. To enable DBS under sedation, asleep DBS, we characterized the cortico-basal ganglia neuronal network of two nonhuman primates under propofol, ketamine, and interleaved propofol-ketamine (IPK) sedation. Further, we compared these sedation states in the healthy and Parkinsonian condition to those of healthy sleep. Ketamine increases high-frequency power and synchronization while propofol increases low-frequency power and synchronization in polysomnography and neuronal activity recordings. Thus, ketamine does not mask the low-frequency oscillations used for physiological navigation toward the basal ganglia DBS targets. The brain spectral state under ketamine and propofol mimicked rapid eye movement (REM) and Non-REM (NREM) sleep activity, respectively, and the IPK protocol resembles the NREM-REM sleep cycle. These promising results are a meaningful step toward asleep DBS with nondistorted physiological navigation.
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Affiliation(s)
- Jing Guang
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Halen Baker
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Shimon Firman
- Department of Anesthesiology, Critical Care Medicine, and Pain Management, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri Werner-Reiss
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vadim Kapuller
- Department of Pediatric Surgery, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.,Asuta-Ashdod University Medical Center, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Bergman
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Neurosurgery, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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30
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Sand D, Rappel P, Marmor O, Bick AS, Arkadir D, Lu BL, Bergman H, Israel Z, Eitan R. Machine learning-based personalized subthalamic biomarkers predict ON-OFF levodopa states in Parkinson patients. J Neural Eng 2021; 18. [PMID: 33906182 DOI: 10.1088/1741-2552/abfc1d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/29/2020] [Accepted: 04/27/2021] [Indexed: 01/20/2023]
Abstract
Objective.Adaptive deep brain stimulation (aDBS) based on subthalamic nucleus (STN) electrophysiology has recently been proposed to improve clinical outcomes of DBS for Parkinson's disease (PD) patients. Many current models for aDBS are based on one or two electrophysiological features of STN activity, such as beta or gamma activity. Although these models have shown interesting results, we hypothesized that an aDBS model that includes many STN activity parameters will yield better clinical results. The objective of this study was to investigate the most appropriate STN neurophysiological biomarkers, detectable over long periods of time, that can predict OFF and ON levodopa states in PD patients.Approach.Long-term local field potentials (LFPs) were recorded from eight STNs (four PD patients) during 92 recording sessions (44 OFF and 48 ON levodopa states), over a period of 3-12 months. Electrophysiological analysis included the power of frequency bands, band power ratio and burst features. A total of 140 engineered features was extracted for 20 040 epochs (each epoch lasting 5 s). Based on these engineered features, machine learning (ML) models classified LFPs as OFF vs ON levodopa states.Main results.Beta and gamma band activity alone poorly predicts OFF vs ON levodopa states, with an accuracy of 0.66 and 0.64, respectively. Group ML analysis slightly improved prediction rates, but personalized ML analysis, based on individualized engineered electrophysiological features, were markedly better, predicting OFF vs ON levodopa states with an accuracy of 0.8 for support vector machine learning models.Significance.We showed that individual patients have unique sets of STN neurophysiological biomarkers that can be detected over long periods of time. ML models revealed that personally classified engineered features most accurately predict OFF vs ON levodopa states. Future development of aDBS for PD patients might include personalized ML algorithms.
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Affiliation(s)
- Daniel Sand
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Pnina Rappel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Odeya Marmor
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Atira S Bick
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Arkadir
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bao-Liang Lu
- Center for Brain-like Computing and Machine Intelligence, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Zvi Israel
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Jerusalem Mental Health Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
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31
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Peles O, Werner-Reiss U, Bergman H, Israel Z, Vaadia E. Phase-Specific Microstimulation Differentially Modulates Beta Oscillations and Affects Behavior. Cell Rep 2021; 30:2555-2566.e3. [PMID: 32101735 DOI: 10.1016/j.celrep.2020.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 04/15/2019] [Revised: 11/13/2019] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Abstract
It is widely accepted that Beta-band oscillations play a role in sensorimotor behavior. To further explore this role, we developed a hybrid platform to combine neural operant conditioning and phase-specific intracortical microstimulation (ICMS). We trained monkeys, implanted with 96 electrode arrays in the motor cortex, to volitionally enhance local field potential (LFP) Beta-band (20-30 Hz) activity at selected sites using a brain-machine interface. We find that Beta oscillations of LFP and single-unit spiking activity increase dramatically with brain-machine interface training and that pre-movement Beta power is anti-correlated with task performance. We also find that phase-specific ICMS modulates the power and phase of oscillations, shifting local networks between oscillatory and non-oscillatory states. Furthermore, ICMS induces phase-dependent effects in animal reaction times and success rates. These findings contribute to unraveling the functional role of cortical oscillations and to the future development of clinical tools for ameliorating abnormal neuronal activities in brain disease.
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Affiliation(s)
- Oren Peles
- Department of Medical Neurobiology, Institute of Medical Research-Israel Canada, The Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; Edmond and Lily Safra Centre for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel.
| | - Uri Werner-Reiss
- Department of Medical Neurobiology, Institute of Medical Research-Israel Canada, The Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; Edmond and Lily Safra Centre for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Institute of Medical Research-Israel Canada, The Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; Edmond and Lily Safra Centre for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem 9112102, Israel
| | - Eilon Vaadia
- Department of Medical Neurobiology, Institute of Medical Research-Israel Canada, The Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; Edmond and Lily Safra Centre for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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32
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Sui Y, Tian Y, Ko WKD, Wang Z, Jia F, Horn A, De Ridder D, Choi KS, Bari AA, Wang S, Hamani C, Baker KB, Machado AG, Aziz TZ, Fonoff ET, Kühn AA, Bergman H, Sanger T, Liu H, Haber SN, Li L. Deep Brain Stimulation Initiative: Toward Innovative Technology, New Disease Indications, and Approaches to Current and Future Clinical Challenges in Neuromodulation Therapy. Front Neurol 2021; 11:597451. [PMID: 33584498 PMCID: PMC7876228 DOI: 10.3389/fneur.2020.597451] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Deep brain stimulation (DBS) is one of the most important clinical therapies for neurological disorders. DBS also has great potential to become a great tool for clinical neuroscience research. Recently, the National Engineering Laboratory for Neuromodulation at Tsinghua University held an international Deep Brain Stimulation Initiative workshop to discuss the cutting-edge technological achievements and clinical applications of DBS. We specifically addressed new clinical approaches and challenges in DBS for movement disorders (Parkinson's disease and dystonia), clinical application toward neurorehabilitation for stroke, and the progress and challenges toward DBS for neuropsychiatric disorders. This review highlighted key developments in (1) neuroimaging, with advancements in 3-Tesla magnetic resonance imaging DBS compatibility for exploration of brain network mechanisms; (2) novel DBS recording capabilities for uncovering disease pathophysiology; and (3) overcoming global healthcare burdens with online-based DBS programming technology for connecting patient communities. The successful event marks a milestone for global collaborative opportunities in clinical development of neuromodulation to treat major neurological disorders.
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Affiliation(s)
- Yanan Sui
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Ye Tian
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Wai Kin Daniel Ko
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Zhiyan Wang
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Fumin Jia
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Andreas Horn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ki Sueng Choi
- Department of Psychiatry and Behavioural Science, Emory University, Atlanta, GA, United States.,Department of Radiology, Mount Sinai School of Medicine, New York, NY, United States.,Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G Machado
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio-Libanês and Hospital Albert Einstein, São Paulo, Brazil
| | - Andrea A Kühn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada (IMRIC), Faculty of Medicine, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University and Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Terence Sanger
- University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Hesheng Liu
- Department of Neuroscience, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States.,McLean Hospital and Harvard Medical School, Belmont, MA, United States
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
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Menchón JM, Real E, Alonso P, Aparicio MA, Segalas C, Plans G, Luyten L, Brunfaut E, Matthijs L, Raymakers S, Bervoets C, Higueras A, Katati M, Guerrero J, Hurtado M, Prieto M, Stieglitz LH, Löffelholz G, Walther S, Pollo C, Zurowski B, Tronnier V, Kordon A, Gambini O, Ranieri R, Franzini A, Messina G, Radu-Djurfeldt D, Schechtmann G, Chen LL, Eitan R, Israel Z, Bergman H, Brelje T, Brionne TC, Conseil A, Gielen F, Schuepbach M, Nuttin B, Gabriëls L. A prospective international multi-center study on safety and efficacy of deep brain stimulation for resistant obsessive-compulsive disorder. Mol Psychiatry 2021; 26:1234-1247. [PMID: 31664175 PMCID: PMC7985042 DOI: 10.1038/s41380-019-0562-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/30/2019] [Accepted: 10/12/2019] [Indexed: 02/07/2023]
Abstract
Deep brain stimulation (DBS) has been proposed for severe, chronic, treatment-refractory obsessive-compulsive disorder (OCD) patients. Although serious adverse events can occur, only a few studies report on the safety profile of DBS for psychiatric disorders. In a prospective, open-label, interventional multi-center study, we examined the safety and efficacy of electrical stimulation in 30 patients with DBS electrodes bilaterally implanted in the anterior limb of the internal capsule. Safety, efficacy, and functionality assessments were performed at 3, 6, and 12 months post implant. An independent Clinical Events Committee classified and coded all adverse events (AEs) according to EN ISO14155:2011. All patients experienced AEs (195 in total), with the majority of these being mild (52% of all AEs) or moderate (37%). Median time to resolution was 22 days for all AEs and the etiology with the highest AE incidence was 'programming/stimulation' (in 26 patients), followed by 'New illness, injury, condition' (13 patients) and 'pre-existing condition, worsening or exacerbation' (11 patients). Sixteen patients reported a total of 36 serious AEs (eight of them in one single patient), mainly transient anxiety and affective symptoms worsening (20 SAEs). Regarding efficacy measures, Y-BOCS reduction was 42% at 12 months and the responder rate was 60%. Improvements in GAF, CGI, and EuroQol-5D index scores were also observed. In sum, although some severe AEs occurred, most AEs were mild or moderate, transient and related to programming/stimulation and tended to resolve by adjustment of stimulation. In a severely treatment-resistant population, this open-label study supports that the potential benefits outweigh the potential risks of DBS.
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Affiliation(s)
- José M. Menchón
- grid.5841.80000 0004 1937 0247Bellvitge University Hospital-IDIBELL, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Eva Real
- grid.5841.80000 0004 1937 0247Bellvitge University Hospital-IDIBELL, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Pino Alonso
- grid.5841.80000 0004 1937 0247Bellvitge University Hospital-IDIBELL, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Marco Alberto Aparicio
- grid.5841.80000 0004 1937 0247Bellvitge University Hospital-IDIBELL, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Cinto Segalas
- grid.5841.80000 0004 1937 0247Bellvitge University Hospital-IDIBELL, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Gerard Plans
- grid.5841.80000 0004 1937 0247Bellvitge University Hospital-IDIBELL, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Laura Luyten
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
| | - Els Brunfaut
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
| | - Laurean Matthijs
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
| | - Simon Raymakers
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
| | - Chris Bervoets
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
| | - Antonio Higueras
- grid.411380.f0000 0000 8771 3783Hospital Virgen de las Nieves, Granada, Spain
| | - Majed Katati
- grid.411380.f0000 0000 8771 3783Hospital Virgen de las Nieves, Granada, Spain
| | - José Guerrero
- grid.411380.f0000 0000 8771 3783Hospital Virgen de las Nieves, Granada, Spain
| | - Mariena Hurtado
- grid.411380.f0000 0000 8771 3783Hospital Virgen de las Nieves, Granada, Spain
| | - Mercedes Prieto
- grid.411380.f0000 0000 8771 3783Hospital Virgen de las Nieves, Granada, Spain
| | | | - Georg Löffelholz
- grid.411656.10000 0004 0479 0855Inselspital Bern, Bern, Switzerland
| | - Sebastian Walther
- grid.411656.10000 0004 0479 0855Inselspital Bern, Bern, Switzerland ,grid.412559.e0000 0001 0694 3235Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - Claudio Pollo
- grid.411656.10000 0004 0479 0855Inselspital Bern, Bern, Switzerland
| | - Bartosz Zurowski
- grid.412468.d0000 0004 0646 2097Universitätsklinik Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Volker Tronnier
- grid.412468.d0000 0004 0646 2097Universitätsklinik Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Andreas Kordon
- grid.5963.9Oberbergklinik Schwarzwald, Hornberg, and Universitätsklinikum Freiburg, Klinik für Psychiatrie und Psychotherapie, Freiburg, Germany
| | - Orsola Gambini
- grid.415093.aDepartment of Health Sciences, University of Milano, San Paolo Hospital Milano, Milano, Italy
| | - Rebecca Ranieri
- grid.415093.aDepartment of Health Sciences, University of Milano, San Paolo Hospital Milano, Milano, Italy
| | - Angelo Franzini
- Fondazione IRCCS Istituto Naz Neurologico C.Besta, Milano, Italy
| | - Giuseppe Messina
- Fondazione IRCCS Istituto Naz Neurologico C.Besta, Milano, Italy
| | - Diana Radu-Djurfeldt
- grid.24381.3c0000 0000 9241 5705Psykiatri Sydvast, OCD-departement, Karolinska University Hospital-region in Huddinge, Stockholm, Sweden
| | - Gaston Schechtmann
- grid.24381.3c0000 0000 9241 5705Department of Neurosurgery, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Long-Long Chen
- grid.24381.3c0000 0000 9241 5705Department of Neurosurgery, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Renana Eitan
- grid.17788.310000 0001 2221 2926Psychiatry Department, Hadassah-University Hospital, Jerusalem, Israel
| | - Zvi Israel
- grid.17788.310000 0001 2221 2926Psychiatry Department, Hadassah-University Hospital, Jerusalem, Israel
| | - Hagai Bergman
- grid.17788.310000 0001 2221 2926Psychiatry Department, Hadassah-University Hospital, Jerusalem, Israel
| | - Tim Brelje
- grid.419673.e0000 0000 9545 2456Medtronic, Minneapolis, USA
| | - Thomas C. Brionne
- grid.471158.e0000 0004 0384 6386Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Aurélie Conseil
- grid.471158.e0000 0004 0384 6386Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Frans Gielen
- grid.419671.c0000 0004 1771 1765Medtronic Bakken Research Center, Maastricht, The Netherlands
| | | | - Bart Nuttin
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
| | - Loes Gabriëls
- grid.5596.f0000 0001 0668 7884KU Leuven and/or UZ Leuven and/or UPC KU Leuven, Leuven, Belgium
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Benady A, Zadik S, Eimerl D, Heymann S, Bergman H, Israel Z, Raz A. Sedative drugs modulate the neuronal activity in the subthalamic nucleus of parkinsonian patients. Sci Rep 2020; 10:14536. [PMID: 32884017 PMCID: PMC7471283 DOI: 10.1038/s41598-020-71358-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
Microelectrode recording (MER) is often used to identify electrode location which is critical for the success of deep brain stimulation (DBS) treatment of Parkinson’s disease. The usage of anesthesia and its’ impact on MER quality and electrode placement is controversial. We recorded neuronal activity at a single depth inside the Subthalamic Nucleus (STN) before, during, and after remifentanil infusion. The root mean square (RMS) of the 250–6000 Hz band-passed signal was used to evaluate the regional spiking activity, the power spectrum to evaluate the oscillatory activity and the coherence to evaluate synchrony between two microelectrodes. We compare those to new frequency domain (spectral) analysis of previously obtained data during propofol sedation. Results showed Remifentanil decreased the normalized RMS by 9% (P < 0.001), a smaller decrease compared to propofol. Regarding the beta range oscillatory activity, remifentanil depressed oscillations (drop from 25 to 5% of oscillatory electrodes), while propofol did not (increase from 33.3 to 41.7% of oscillatory electrodes). In the cases of simultaneously recorded oscillatory electrodes, propofol did not change the synchronization while remifentanil depressed it. In conclusion, remifentanil interferes with the identification of the dorsolateral oscillatory region, whereas propofol interferes with RMS identification of the STN borders. Thus, both have undesired effect during the MER procedure. Trial registration: NCT00355927 and NCT00588926.
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Affiliation(s)
- Amit Benady
- St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel.,Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Sean Zadik
- St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel
| | - Dan Eimerl
- Department of Anesthesia, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sami Heymann
- Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University - Hadassah Medical Scholl, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Center affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Rambam Health Care Campus, Technion - Israel Institute of Technology, 8 HaAliya HaShniya St., 3109601, Haifa, Israel.
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35
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Valsky D, Heiman Grosberg S, Israel Z, Boraud T, Bergman H, Deffains M. What is the true discharge rate and pattern of the striatal projection neurons in Parkinson's disease and Dystonia? eLife 2020; 9:e57445. [PMID: 32812870 PMCID: PMC7462612 DOI: 10.7554/elife.57445] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Abstract
Dopamine and striatal dysfunctions play a key role in the pathophysiology of Parkinson's disease (PD) and Dystonia, but our understanding of the changes in the discharge rate and pattern of striatal projection neurons (SPNs) remains limited. Here, we recorded and examined multi-unit signals from the striatum of PD and dystonic patients undergoing deep brain stimulation surgeries. Contrary to earlier human findings, we found no drastic changes in the spontaneous discharge of the well-isolated and stationary SPNs of the PD patients compared to the dystonic patients or to the normal levels of striatal activity reported in healthy animals. Moreover, cluster analysis using SPN discharge properties did not characterize two well-separated SPN subpopulations, indicating no SPN subpopulation-specific (D1 or D2 SPNs) discharge alterations in the pathological state. Our results imply that small to moderate changes in spontaneous SPN discharge related to PD and Dystonia are likely amplified by basal ganglia downstream structures.
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Affiliation(s)
- Dan Valsky
- Department of Medical Neurobiology, Institute of Medical Research Israel - Canada (IMRIC), The Hebrew University - Hadassah Medical SchoolJerusalemIsrael
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew UniversityJerusalemIsrael
| | - Shai Heiman Grosberg
- Department of Medical Neurobiology, Institute of Medical Research Israel - Canada (IMRIC), The Hebrew University - Hadassah Medical SchoolJerusalemIsrael
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University HospitalJerusalemIsrael
| | - Thomas Boraud
- University of Bordeaux, UMR 5293, IMNBordeauxFrance
- CNRS, UMR 5293, IMNBordeauxFrance
- CHU de Bordeaux, IMN CliniqueBordeauxFrance
| | - Hagai Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel - Canada (IMRIC), The Hebrew University - Hadassah Medical SchoolJerusalemIsrael
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew UniversityJerusalemIsrael
- Department of Neurosurgery, Hadassah University HospitalJerusalemIsrael
| | - Marc Deffains
- University of Bordeaux, UMR 5293, IMNBordeauxFrance
- CNRS, UMR 5293, IMNBordeauxFrance
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36
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Asch N, Herschman Y, Maoz R, Auerbach-Asch CR, Valsky D, Abu-Snineh M, Arkadir D, Linetsky E, Eitan R, Marmor O, Bergman H, Israel Z. Independently together: subthalamic theta and beta opposite roles in predicting Parkinson's tremor. Brain Commun 2020; 2:fcaa074. [PMID: 33585815 PMCID: PMC7869429 DOI: 10.1093/braincomms/fcaa074] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 01/20/2023] Open
Abstract
Tremor is a core feature of Parkinson’s disease and the most easily recognized Parkinsonian sign. Nonetheless, its pathophysiology remains poorly understood. Here, we show that multispectral spiking activity in the posterior-dorso-lateral oscillatory (motor) region of the subthalamic nucleus distinguishes resting tremor from the other Parkinsonian motor signs and strongly correlates with its severity. We evaluated microelectrode-spiking activity from the subthalamic dorsolateral oscillatory region of 70 Parkinson’s disease patients who underwent deep brain stimulation surgery (114 subthalamic nuclei, 166 electrode trajectories). We then investigated the relationship between patients’ clinical Unified Parkinson’s Disease Rating Scale score and their peak theta (4–7 Hz) and beta (13–30 Hz) powers. We found a positive correlation between resting tremor and theta activity (r = 0.41, P < 0.01) and a non-significant negative correlation with beta activity (r = −0.2, P = 0.5). Hypothesizing that the two neuronal frequencies mask each other’s relationship with resting tremor, we created a non-linear model of their proportional spectral powers and investigated its relationship with resting tremor. As hypothesized, patients’ proportional scores correlated better than either theta or beta alone (r = 0.54, P < 0.001). However, theta and beta oscillations were frequently temporally correlated (38/70 patients manifested significant positive temporal correlations and 1/70 exhibited significant negative correlation between the two frequency bands). When comparing theta and beta temporal relationship (r θ β) to patients’ resting tremor scores, we found a significant negative correlation between the two (r = −0.38, P < 0.01). Patients manifesting a positive correlation between the two bands (i.e. theta and beta were likely to appear simultaneously) were found to have lower resting tremor scores than those with near-zero correlation values (i.e. theta and beta were likely to appear separately). We therefore created a new model incorporating patients’ proportional theta–beta power and r θ βscores to obtain an improved neural correlate of resting tremor (r = 0.62, P < 0.001). We then used the Akaike and Bayesian information criteria for model selection and found the multispectral model, incorporating theta–beta proportional power and their correlation, to be the best fitting model, with 0.96 and 0.89 probabilities, respectively. Here we found that as theta increases, beta decreases and the two appear separately—resting tremor is worsened. Our results therefore show that theta and beta convey information about resting tremor in opposite ways. Furthermore, the finding that theta and beta coactivity is negatively correlated with resting tremor suggests that theta–beta non-linear scale may be a valuable biomarker for Parkinson’s resting tremor in future adaptive deep brain stimulation techniques.
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Affiliation(s)
- Nir Asch
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Israel
| | - Yehuda Herschman
- Functional Neurosurgery Unit, Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rotem Maoz
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Israel
| | - Carmel R Auerbach-Asch
- Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Israel
| | - Dan Valsky
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Israel
| | | | - David Arkadir
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
| | - Eduard Linetsky
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Research and Training Unit, Jerusalem Mental Health Center, Kfar Shaul Eitanim Hospital, Jerusalem, Israel
| | - Odeya Marmor
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Israel
| | - Zvi Israel
- Functional Neurosurgery Unit, Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Kaplan A, Mizrahi-Kliger AD, Israel Z, Adler A, Bergman H. Dissociable roles of ventral pallidum neurons in the basal ganglia reinforcement learning network. Nat Neurosci 2020; 23:556-564. [PMID: 32231338 DOI: 10.1038/s41593-020-0605-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Abstract
Reinforcement learning models treat the basal ganglia (BG) as an actor-critic network. The ventral pallidum (VP) is a major component of the BG limbic system. However, its precise functional roles within the BG circuitry, particularly in comparison to the adjacent external segment of the globus pallidus (GPe), remain unexplored. We recorded the spiking activity of VP neurons, GPe cells (actor) and striatal cholinergic interneurons (critic) while monkeys performed a classical conditioning task. Here, we report that VP neurons can be classified into two distinct populations. The persistent population displayed sustained activation following visual cue presentation, was correlated with monkeys' behavior and showed uncorrelated spiking activity. The transient population displayed phasic synchronized responses that were correlated with the rate of learning and the reinforcement learning model's prediction error. Our results suggest that the VP is physiologically different from the GPe and identify the transient VP neurons as a BG critic.
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Affiliation(s)
- Alexander Kaplan
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel. .,Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Aviv D Mizrahi-Kliger
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Avital Adler
- Skirball Institute, Department of Neuroscience and Physiology, Department of Anesthesiology, New York University School of Medicine, New York, NY, USA
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel.,Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
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38
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Marmor O, Rappel P, Valsky D, Bick AS, Arkadir D, Linetsky E, Peled O, Tamir I, Bergman H, Israel Z, Eitan R. Movement context modulates neuronal activity in motor and limbic-associative domains of the human parkinsonian subthalamic nucleus. Neurobiol Dis 2020; 136:104716. [DOI: 10.1016/j.nbd.2019.104716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/08/2019] [Accepted: 12/13/2019] [Indexed: 11/16/2022] Open
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Valsky D, Blackwell KT, Tamir I, Eitan R, Bergman H, Israel Z. Real-time machine learning classification of pallidal borders during deep brain stimulation surgery. J Neural Eng 2020; 17:016021. [PMID: 31675740 DOI: 10.1088/1741-2552/ab53ac] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) in patients with Parkinson's disease and dystonia improves motor symptoms and quality of life. Traditionally, pallidal borders have been demarcated by electrophysiological microelectrode recordings (MERs) during DBS surgery. However, detection of pallidal borders can be challenging due to the variability of the firing characteristics of neurons encountered along the trajectory. MER can also be time-consuming and therefore costly. Here we show the feasibility of real-time machine learning classification of striato-pallidal borders to assist neurosurgeons during DBS surgery. APPROACH An electrophysiological dataset from 116 trajectories of 42 patients consisting of 11 774 MER segments of background spiking activity in five classes of disease was used to train the classification algorithm. The five classes included awake Parkinson's disease patients, as well as awake and lightly anesthetized genetic and non-genetic dystonia patients. A machine learning algorithm was designed to provide prediction of the striato-pallidal borders, based on hidden Markov models (HMMs) and the L1-distance measure in normalized root mean square (NRMS) and power spectra of the MER. We tested its performance prospectively against the judgment of three electrophysiologists in the operating rooms of three hospitals using newly collected data. MAIN RESULTS The awake and the light anesthesia dystonia classes could be merged. Using MER NRMS and spectra, the machine learning algorithm was on par with the performance of the three electrophysiologists across the striatum-GPe, GPe-GPi, and GPi-exit transitions for all disease classes. SIGNIFICANCE Machine learning algorithms enable real-time GPi navigation systems to potentially shorten the duration of electrophysiological mapping of pallidal borders, while ensuring correct pallidal border detection.
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Affiliation(s)
- Dan Valsky
- The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University, Jerusalem, Israel. Author to whom any correspondence should be addressed
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Shamir RR, Duchin Y, Kim J, Patriat R, Marmor O, Bergman H, Vitek JL, Sapiro G, Bick A, Eliahou R, Eitan R, Israel Z, Harel N. Microelectrode Recordings Validate the Clinical Visualization of Subthalamic-Nucleus Based on 7T Magnetic Resonance Imaging and Machine Learning for Deep Brain Stimulation Surgery. Neurosurgery 2020; 84:749-757. [PMID: 29800386 DOI: 10.1093/neuros/nyy212] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/13/2017] [Accepted: 04/26/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a proven and effective therapy for the management of the motor symptoms of Parkinson's disease (PD). While accurate positioning of the stimulating electrode is critical for success of this therapy, precise identification of the STN based on imaging can be challenging. We developed a method to accurately visualize the STN on a standard clinical magnetic resonance imaging (MRI). The method incorporates a database of 7-Tesla (T) MRIs of PD patients together with machine-learning methods (hereafter 7 T-ML). OBJECTIVE To validate the clinical application accuracy of the 7 T-ML method by comparing it with identification of the STN based on intraoperative microelectrode recordings. METHODS Sixteen PD patients who underwent microelectrode-recordings guided STN DBS were included in this study (30 implanted leads and electrode trajectories). The length of the STN along the electrode trajectory and the position of its contacts to dorsal, inside, or ventral to the STN were compared using microelectrode-recordings and the 7 T-ML method computed based on the patient's clinical 3T MRI. RESULTS All 30 electrode trajectories that intersected the STN based on microelectrode-recordings, also intersected it when visualized with the 7 T-ML method. STN trajectory average length was 6.2 ± 0.7 mm based on microelectrode recordings and 5.8 ± 0.9 mm for the 7 T-ML method. We observed a 93% agreement regarding contact location between the microelectrode-recordings and the 7 T-ML method. CONCLUSION The 7 T-ML method is highly consistent with microelectrode-recordings data. This method provides a reliable and accurate patient-specific prediction for targeting the STN.
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Affiliation(s)
| | - Yuval Duchin
- Surgical Information Sciences, Minneapolis, Minnesota.,Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minnesota
| | - Jinyoung Kim
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
| | - Remi Patriat
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minnesota
| | - Odeya Marmor
- Department of Neurobiology, Institute of Medical Research-Israel Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Hagai Bergman
- Department of Neurobiology, Institute of Medical Research-Israel Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina.,Departments of Biomedical Engineering, Computer Science, and Mathematics, Duke University, Durham, North Carolina
| | - Atira Bick
- Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - Ruth Eliahou
- Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Department of Neurobiology, Institute of Medical Research-Israel Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Noam Harel
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minnesota
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Snineh MA, Hajyahya A, Linetsky E, Eitan R, Bergman H, Israel Z, Arkadir D. A Real-Life Search for the Optimal Set of Conversion Factors to Levodopa-Equivalent-Dose in Parkinson's Disease Patients on Polytherapy. J Parkinsons Dis 2019; 10:173-178. [PMID: 31868682 DOI: 10.3233/jpd-191769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A wide variety of conversion factors for a levodopa-equivalent-dose (LED) have been proposed for each Parkinson's disease (PD) medication. The currently-used set of conversion factors is based on studies that relied on subjective experience or theoretical assumptions. This set was never validated in patients receiving polytherapy. OBJECTIVES To use real-life data to identify an optimal set of conversion factors independent of prior assumptions regarding clinical efficacy of different medications. METHODS Retrospective analysis of data from 206 cognitively-preserved patients with advanced PD receiving polytherapy before deep brain stimulation (DBS) surgery. A nonlinear automated problem solver was used to find a set of conversion factors that, when applied, minimized the coefficient of variation of LEDs in a relatively homogenous cohort of patients. RESULTS Independent and model-free evaluation of a wide range of possible sets of conversion factors to LED suggested a set of normalized conversion factors for immediate release levodopa (1.00), controlled release levodopa (0.88), and amantadine (1.23). A minimal clinical benefit of entacapone was observed for patients with motor fluctuations. Our analysis could not detect conversion factors for dopamine agonists and MAO-B inhibitors, possibly because their clinical contribution when added to levodopa is limited. CONCLUSIONS Independent from previous studies and prior assumptions we show that the currently-used LED conversion factors for immediate release levodopa, controlled release levodopa and amantadine are largely correct and that dopamine agonists, MAO-B inhibitors and entacapone, given in addition to levodopa, have little additional clinical value for PD patients with motor fluctuations.
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Affiliation(s)
- Muneer Abu Snineh
- Department of Neurology, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - Amal Hajyahya
- School of Pharmacy, Faculty of Medicine, the Hebrew University, Jerusalem, Israel
| | - Eduard Linetsky
- Department of Neurology, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel-Canada, the Hebrew University - Hadassah Medical School and the Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel.,Jerusalem Mental Health Center, Hebrew University Medical School, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel-Canada, the Hebrew University - Hadassah Medical School and the Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
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42
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Rappel P, Grosberg S, Arkadir D, Linetsky E, Abu Snineh M, Bick AS, Tamir I, Valsky D, Marmor O, Abo Foul Y, Peled O, Gilad M, Daudi C, Ben‐Naim S, Bergman H, Israel Z, Eitan R. Theta‐alpha Oscillations Characterize Emotional Subregion in the Human Ventral Subthalamic Nucleus. Mov Disord 2019; 35:337-343. [DOI: 10.1002/mds.27910] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/22/2019] [Accepted: 09/27/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pnina Rappel
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
- The Edmond and Lily Safra Center for Brain Research the Hebrew University Jerusalem Israel
| | - Shai Grosberg
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
| | - David Arkadir
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Eduard Linetsky
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Muneer Abu Snineh
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Atira S. Bick
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Idit Tamir
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
- The Center for Functional and Restorative Neurosurgery Hadassah‐Hebrew University Medical Center Jerusalem Israel
- Department of Neurosurgery University of California San Francisco San Francisco California USA
| | - Dan Valsky
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
- The Edmond and Lily Safra Center for Brain Research the Hebrew University Jerusalem Israel
| | - Odeya Marmor
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
- The Edmond and Lily Safra Center for Brain Research the Hebrew University Jerusalem Israel
| | - Yasmin Abo Foul
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Or Peled
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Moran Gilad
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Chen Daudi
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Shiri Ben‐Naim
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
- The Edmond and Lily Safra Center for Brain Research the Hebrew University Jerusalem Israel
- The Center for Functional and Restorative Neurosurgery Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Zvi Israel
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
- The Center for Functional and Restorative Neurosurgery Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology) Institute of Medical Research–Israel‐Canada, the Hebrew University‐Hadassah Medical School Jerusalem Israel
- The Brain Division Hadassah–Hebrew University Medical Center Jerusalem Israel
- Jerusalem Mental Health Center Hebrew University Medical School Jerusalem Israel
- Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Department of Psychiatry Harvard Medical School Boston Massachusetts USA
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Buckley BS, Henschke N, Bergman H, Skidmore B, Klemm EJ, Villanueva G, Garritty C, Paul M. Impact of vaccination on antibiotic usage: a systematic review and meta-analysis. Clin Microbiol Infect 2019; 25:1213-1225. [PMID: 31284031 DOI: 10.1016/j.cmi.2019.06.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 04/26/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vaccines may reduce antibiotic use and the development of resistance. OBJECTIVES To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use. DATA SOURCES Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry. STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) and observational studies published from January 1998 to March 2018. PARTICIPANTS Any population. INTERVENTIONS Vaccines versus placebo, no vaccine or another vaccine. METHODS Titles, abstracts and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE. RESULTS In all, 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high-certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (one RCT; n = 4253; rate reduction 28·1%; 95% CI 16·0-38·4); moderate-certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (three RCTs; n = 610; ratio of means 0·62; 95% CI 0·54-0·70) and probably reduce community antibiotic use in children aged 3-15 years (one RCT; n = 10 985 person-seasons; risk ratio 0·69, 95% CI 0·58-0·83); and moderate-certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (two RCTs; n = 47 945; rate ratio 0·93, 95% CI 0·87-0·99) and reduces illness episodes requiring antibiotics in children aged 12-35 months (one RCT; n = 264; rate ratio 0·85, 95% CI 0·75-0·97). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding. CONCLUSIONS The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base. PROSPERO REGISTRATION CRD42018103881.
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Affiliation(s)
- B S Buckley
- Department of Surgery, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines; Cochrane Response, Cochrane, London, UK
| | - N Henschke
- Cochrane Response, Cochrane, London, UK.
| | - H Bergman
- Cochrane Response, Cochrane, London, UK
| | - B Skidmore
- Independent Information Specialist, Ottawa, ON, Canada
| | | | | | - C Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Eitan R, Arkadir D, Linetsky E, Bick AS, Gilad M, Freedman S, Bergman H, Israel Z. [DEEP BRAIN STIMULATION FOR OBSESSIVE COMPULSIVE DISORDER: CASE REPORT OF THE FIRST OCD PATIENT IN ISRAEL]. Harefuah 2019; 158:418-422. [PMID: 31339238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Treatment-resistant obsessive-compulsive disorder (OCD) is considered a severe psychiatric disorder that causes severe functional decline. In the past, these patients were treated by selective ablation of neuronal pathways related to the pathophysiology of OCD. Deep brain stimulation is an effective and safe treatment alternative that enables reversible changes in neural circuits and reduces OCD symptoms. In this paper we present the outcome of a treatment-resistant OCD patient who underwent deep brain stimulation procedure for the first time in Israel. The patient has achieved a significant decline in OCD symptoms as well as improvement in personal and social functioning. The discussion focuses on methods to implement deep brain stimulation for OCD patients in Israel.
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Affiliation(s)
- Renana Eitan
- Research and Training Unit, Jerusalem Mental Health Center, Kfar Shaul-Eitamin Hospital, Jerusalem, Israel
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Arkadir
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eduard Linetsky
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Atira S Bick
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Moran Gilad
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sara Freedman
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Hagai Bergman
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
- The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Zvi Israel
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Deffains M, Bergman H. Parkinsonism-related β oscillations in the primate basal ganglia networks – Recent advances and clinical implications. Parkinsonism Relat Disord 2019; 59:2-8. [DOI: 10.1016/j.parkreldis.2018.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Deffains M, Iskhakova L, Katabi S, Israel Z, Bergman H. Longer β oscillatory episodes reliably identify pathological subthalamic activity in Parkinsonism. Mov Disord 2018; 33:1609-1618. [PMID: 30145811 DOI: 10.1002/mds.27418] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 12/14/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The efficacy of deep brain stimulation (DBS) - primarily of the subthalamic nucleus (STN) - for advanced Parkinson's disease (PD) is commonly attributed to the suppression of pathological synchronous β oscillations along the cortico-thalamo-basal ganglia network. Conventional continuous high-frequency DBS indiscriminately influences pathological and normal neural activity. The DBS protocol would therefore be more effective if stimulation was only applied when necessary (closed-loop adaptive DBS). OBJECTIVES AND METHODS Our study aimed to identify a reliable biomarker of the pathological neuronal activity in parkinsonism that could be used as a trigger for adaptive DBS. To this end, we examined the oscillatory features of paired spiking activities recorded in three distinct nodes of the basal ganglia network of 2 African green monkeys before and after induction of parkinsonism (by MPTP intoxication). RESULTS Parkinsonism-related basal ganglia β oscillations consisted of synchronized time-limited episodes, rather than a continuous stretch, of β oscillatory activity. Episodic basal ganglia β oscillatory activity, although prolonged in parkinsonism, was not necessarily pathological given that short β episodes could also be detected in the healthy state. Importantly, prolongation of the basal ganglia β episodes was more pronounced than their intensification in the parkinsonian state-especially in the STN. Hence, deletion of longer β episodes was more effective than deletion of stronger β episodes in reducing parkinsonian STN synchronized oscillatory activity. CONCLUSIONS Prolonged STN β episodes are pathological in parkinsonism and can be used as optimal trigger for future adaptive DBS applications. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marc Deffains
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Liliya Iskhakova
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Shiran Katabi
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel.,Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
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47
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Abstract
The scores of 93 male students on Rod-and-frame Test (RFT), Embedded-figures Test (EFT) and on 3 reference tests for each of 4 intellectual factors were correlated and factor analyzed. The hypothesis that 2 of J. P. Guilford's factors, Convergent Production of Figural Transformations and Cognition of Figural Systems, would explain the performance in RFT, whereas figural transformations alone would explain performance in EFT was rejected (p < 0.000). Instead, RFT defined a separate factor and EFT also loaded figural systems. RFT and EFT had quite different factor patterns and shared only 4 to 16% common variance.
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48
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Rappel P, Marmor O, Bick AS, Arkadir D, Linetsky E, Castrioto A, Tamir I, Freedman SA, Mevorach T, Gilad M, Bergman H, Israel Z, Eitan R. Subthalamic theta activity: a novel human subcortical biomarker for obsessive compulsive disorder. Transl Psychiatry 2018; 8:118. [PMID: 29915200 PMCID: PMC6006433 DOI: 10.1038/s41398-018-0165-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/22/2018] [Indexed: 11/24/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a common and serious psychiatric disorder. Although subthalamic nucleus deep brain stimulation (DBS) has been studied as a treatment for OCD patients the underlying mechanism of this treatment and the optimal method of stimulation are unknown. To study the neural basis of subthalamic nucleus DBS in OCD patients we used a novel, implantable DBS system with long-term local field potential sensing capability. We focus our analysis on two patients with OCD who experienced severe treatment-resistant symptoms and were implanted with subthalamic nucleus DBS systems. We studied them for a year at rest and during provocation of OCD symptoms (46 recording sessions) and compared them to four Parkinson's disease (PD) patients implanted with subthalamic nucleus DBS systems (69 recording sessions). We show that the dorsal (motor) area of the subthalamic nucleus in OCD patients displays a beta (25-35 Hz) oscillatory activity similar to PD patients whereas the ventral (limbic-cognitive) area of the subthalamic nucleus displays distinct theta (6.5-8 Hz) oscillatory activity only in OCD patients. The subthalamic nucleus theta oscillatory activity decreases with provocation of OCD symptoms and is inversely correlated with symptoms severity over time. We conclude that beta oscillations at the dorsal subthalamic nucleus in OCD patients challenge their pathophysiologic association with movement disorders. Furthermore, theta oscillations at the ventral subthalamic nucleus in OCD patients suggest a new physiological target for OCD therapy as well as a promising input signal for future emotional-cognitive closed-loop DBS.
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Affiliation(s)
- Pnina Rappel
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0004 1937 0538grid.9619.7The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Odeya Marmor
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0004 1937 0538grid.9619.7The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Atira S Bick
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - David Arkadir
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Eduard Linetsky
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Anna Castrioto
- 0000 0004 0429 3736grid.462307.4Grenoble Institute of Neuroscience, Grenoble, France
| | - Idit Tamir
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel ,0000 0001 2221 2926grid.17788.31The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel ,0000 0001 2297 6811grid.266102.1Department of Neurosurgery, University of California San Francisco, San Francisco, CA USA
| | - Sara A. Freedman
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel ,0000 0004 1937 0503grid.22098.31School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Tomer Mevorach
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Moran Gilad
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0004 1937 0538grid.9619.7The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel ,0000 0001 2221 2926grid.17788.31The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel. .,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. .,Department of Psychiatry, Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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49
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Thompson JA, Oukal S, Bergman H, Ojemann S, Hebb AO, Hanrahan S, Israel Z, Abosch A. Semi-automated application for estimating subthalamic nucleus boundaries and optimal target selection for deep brain stimulation implantation surgery. J Neurosurg 2018:1-10. [PMID: 29775152 DOI: 10.3171/2017.12.jns171964] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/09/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDeep brain stimulation (DBS) of the subthalamic nucleus (STN) has become standard care for the surgical treatment of Parkinson's disease (PD). Reliable interpretation of microelectrode recording (MER) data, used to guide DBS implantation surgery, requires expert electrophysiological evaluation. Recent efforts have endeavored to use electrophysiological signals for automatic detection of relevant brain structures and optimal implant target location.The authors conducted an observational case-control study to evaluate a software package implemented on an electrophysiological recording system to provide online objective estimates for entry into and exit from the STN. In addition, they evaluated the accuracy of the software in selecting electrode track and depth for DBS implantation into STN, which relied on detecting changes in spectrum activity.METHODSData were retrospectively collected from 105 MER-guided STN-DBS surgeries (4 experienced neurosurgeons; 3 sites), in which estimates for entry into and exit from the STN, DBS track selection, and implant depth were compared post hoc between those determined by the software and those determined by the implanting neurosurgeon/neurophysiologist during surgery.RESULTSThis multicenter study revealed submillimetric agreement between surgeon/neurophysiologist and software for entry into and exit out of the STN as well as optimal DBS implant depth.CONCLUSIONSThe results of this study demonstrate that the software can reliably and accurately estimate entry into and exit from the STN and select the track corresponding to ultimate DBS implantation.
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Affiliation(s)
- John A Thompson
- 1Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Hagai Bergman
- 2Department of Medical Neurobiology, The Hebrew University-Hadassah Medical School.,3Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Steven Ojemann
- 1Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam O Hebb
- 4Colorado Neurological Institute, Englewood, Colorado; and
| | - Sara Hanrahan
- 4Colorado Neurological Institute, Englewood, Colorado; and
| | - Zvi Israel
- 3Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Aviva Abosch
- 1Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
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50
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Abstract
Slow oscillations of neuronal activity alternating between firing and silence are a hallmark of slow-wave sleep (SWS). These oscillations reflect the default activity present in all mammalian species, and are ubiquitous to anesthesia, brain slice preparations, and neuronal cultures. In all these cases, neuronal firing is highly synchronous within local circuits, suggesting that oscillation-synchronization coupling may be a governing principle of sleep physiology regardless of anatomical connectivity. To investigate whether this principle applies to overall brain organization, we recorded the activity of individual neurons from basal ganglia (BG) structures and the thalamocortical (TC) network over 70 full nights of natural sleep in two vervet monkeys. During SWS, BG neurons manifested slow oscillations (∼0.5 Hz) in firing rate that were as prominent as in the TC network. However, in sharp contrast to any neural substrate explored thus far, the slow oscillations in all BG structures were completely desynchronized between individual neurons. Furthermore, whereas in the TC network single-cell spiking was locked to slow oscillations in the local field potential (LFP), the BG LFP exhibited only weak slow oscillatory activity and failed to entrain nearby cells. We thus show that synchrony is not inherent to slow oscillations, and propose that the BG desynchronization of slow oscillations could stem from its unique anatomy and functional connectivity. Finally, we posit that BG slow-oscillation desynchronization may further the reemergence of slow-oscillation traveling waves from multiple independent origins in the frontal cortex, thus significantly contributing to normal SWS.
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Affiliation(s)
- Aviv D Mizrahi-Kliger
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, 9112001 Jerusalem, Israel;
| | - Alexander Kaplan
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, 9190401 Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, 9112001 Jerusalem, Israel
| | - Hagai Bergman
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, 9112001 Jerusalem, Israel
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, 9190401 Jerusalem, Israel
- Department of Neurosurgery, Hadassah University Hospital, 9112001 Jerusalem, Israel
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