scholarly journals Median Nerve Stimulation Facilitates the Identification of Somatotopy of the Subthalamic Nucleus in Parkinson’s Disease Patients under Inhalational Anesthesia

Biomedicines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 74
Author(s):  
Yu-Chen Chen ◽  
Chang-Chih Kuo ◽  
Shin-Yuan Chen ◽  
Tsung-Ying Chen ◽  
Yan-Hong Pan ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Median Nerve ◽  
Subthalamic Nucleus ◽  
Nerve Stimulation ◽  
Electrode Placement ◽  
Beta Band ◽  
Inhalational Anesthesia ◽  
Median Nerve Stimulation ◽  
Power Spectral

Deep brain stimulation (DBS) improves Parkinson’s disease (PD) symptoms by suppressing neuropathological oscillations. These oscillations are also modulated by inhalational anesthetics used during DBS surgery in some patients, influencing electrode placement accuracy. We sought to evaluate a method that could avoid these effects. We recorded subthalamic nucleus (STN) neuronal firings in 11 PD patients undergoing DBS under inhalational anesthesia. Microelectrode recording (MER) during DBS was collected under median nerve stimulation (MNS) delivered at 5, 20, and 90 Hz frequencies and without MNS. We analyzed the spike firing rate and neuronal activity with power spectral density (PSD), and assessed correlations between the neuronal oscillation parameters and clinical motor outcomes. No patient experienced adverse effects during or after DBS surgery. PSD analysis revealed that peripheral 20 Hz MNS produced significant differences in the dorsal and ventral subthalamic nucleus (STN) between the beta band oscillation (16.9 ± 7.0% versus 13.5 ± 4.8%, respectively) and gamma band oscillation (56.0 ± 13.7% versus 66.3 ± 9.4%, respectively) (p < 0.05). Moreover, 20-Hz MNS entrained neural oscillation over the dorsal STN, which correlated positively with motor disabilities. MNS allowed localization of the sensorimotor STN and identified neural characteristics under inhalational anesthesia. This paradigm may help identify an alternative method to facilitate STN identification and DBS surgery under inhalational anesthesia.

scholarly journals Identifying and modulating distinct tremor states through peripheral nerve stimulation in Parkinsonian rest tremor

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Beatriz S. Arruda ◽  
Carolina Reis ◽  
James J. Sermon ◽  
Alek Pogosyan ◽  
Peter Brown ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Peripheral Nerve ◽  
Median Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Rest Tremor ◽  
Resting Tremor ◽  
Median Nerve Stimulation ◽  
Electrical Pulses

Abstract Background Resting tremor is one of the most common symptoms of Parkinson’s disease. Despite its high prevalence, resting tremor may not be as effectively treated with dopaminergic medication as other symptoms, and surgical treatments such as deep brain stimulation, which are effective in reducing tremor, have limited availability. Therefore, there is a clinical need for non-invasive interventions in order to provide tremor relief to a larger number of people with Parkinson’s disease. Here, we explore whether peripheral nerve stimulation can modulate resting tremor, and under what circumstances this might lead to tremor suppression. Methods We studied 10 people with Parkinson’s disease and rest tremor, to whom we delivered brief electrical pulses non-invasively to the median nerve of the most tremulous hand. Stimulation was phase-locked to limb acceleration in the axis with the biggest tremor-related excursion. Results We demonstrated that rest tremor in the hand could change from one pattern of oscillation to another in space. Median nerve stimulation was able to significantly reduce (− 36%) and amplify (117%) tremor when delivered at a certain phase. When the peripheral manifestation of tremor spontaneously changed, stimulation timing-dependent change in tremor severity could also alter during phase-locked peripheral nerve stimulation. Conclusions These results highlight that phase-locked peripheral nerve stimulation has the potential to reduce tremor. However, there can be multiple independent tremor oscillation patterns even within the same limb. Parameters of peripheral stimulation such as stimulation phase may need to be adjusted continuously in order to sustain systematic suppression of tremor amplitude.

scholarly journals Topography of emotional valence and arousal within the motor part of the subthalamic nucleus in Parkinson’s disease

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tereza Serranová ◽  
Tomáš Sieger ◽  
Filip Růžička ◽  
Eduard Bakštein ◽  
Petr Dušek ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Spatial Organization ◽  
Emotional Experience ◽  
Emotional Valence ◽  
Electrode Placement ◽  
Erotic Stimuli ◽  
Valence And Arousal ◽  
Motor Effects

AbstractClinical motor and non-motor effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) seem to depend on the stimulation site within the STN. We analysed the effects of the position of the stimulation electrode within the motor STN on subjective emotional experience, expressed as emotional valence and arousal ratings to pictures representing primary rewards and aversive fearful stimuli in 20 PD patients. Patients’ ratings from both aversive and erotic stimuli matched the mean ratings from a group of 20 control subjects at similar position within the STN. Patients with electrodes located more posteriorly reported both valence and arousal ratings from both the rewarding and aversive pictures as more extreme. Moreover, posterior electrode positions were associated with a higher occurrence of depression at a long-term follow-up. This brain–behavior relationship suggests a complex emotion topography in the motor part of the STN. Both valence and arousal representations overlapped and were uniformly arranged anterior-posteriorly in a gradient-like manner, suggesting a specific spatial organization needed for the coding of the motivational salience of the stimuli. This finding is relevant for our understanding of neuropsychiatric side effects in STN DBS and potentially for optimal electrode placement.

scholarly journals Dorsolateral subthalamic neuronal activity enhanced by median nerve stimulation characterizes Parkinson’s disease during deep brain stimulation with general anesthesia

2015 ◽  
Vol 123 (6) ◽  
pp. 1394-1400 ◽  
Author(s):  
Sheng-Tzung Tsai ◽  
Wei-Yi Chuang ◽  
Chung-Chih Kuo ◽  
Paul C. P. Chao ◽  
Tsung-Ying Chen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Median Nerve ◽  
Neuronal Activity ◽  
Nerve Stimulation ◽  
Background Activity ◽  
Neuronal Firing ◽  
General Anesthetics ◽  
Beta Band ◽  
Median Nerve Stimulation ◽  
Deep Brain

OBJECT Deep brain stimulation (DBS) surgery under general anesthesia is an alternative option for patients with Parkinson’s disease (PD). However, few studies are available that report whether neuronal firing can be accurately recorded during this condition. In this study the authors attempted to characterize the neuronal activity of the subthalamic nucleus (STN) and elucidate the influence of general anesthetics on neurons during DBS surgery in patients with PD. The benefit of median nerve stimulation (MNS) for localization of the dorsolateral subterritory of the STN, which is involved in sensorimotor function, was explored. METHODS Eight patients with PD were anesthetized with desflurane and underwent contralateral MNS at the wrist during microelectrode recording of the STN. The authors analyzed the spiking patterns and power spectral density (PSD) of the background activity along each penetration track and determined the spatial correlation to the target location, estimated mated using standard neurophysiological procedures. RESULTS The dorsolateral STN spiking pattern showed a more prominent bursting pattern without MNS and more oscillation with MNS. In terms of the neural oscillation of the background activity, beta-band oscillation dominated within the sensorimotor STN and showed significantly more PSD during MNS (p < 0.05). CONCLUSIONS Neuronal firing within the STN could be accurately identified and differentiated when patients with PD received general anesthetics. Median nerve stimulation can enhance the neural activity in beta-band oscillations, which can be used as an index to ensure optimal electrode placement via successfully tracked dorsolateral STN topography.

Very Fast Oscillations Evoked by Median Nerve Stimulation in the Human Thalamus and Subthalamic Nucleus

2004 ◽  
Vol 92 (6) ◽  
pp. 3171-3182 ◽  
Author(s):  
Ritsuko Hanajima ◽  
Robert Chen ◽  
Peter Ashby ◽  
Andres M. Lozano ◽  
William D. Hutchison ◽  
...  
Keyword(s):  
Median Nerve ◽  
Subthalamic Nucleus ◽  
Nerve Stimulation ◽  
Medial Lemniscus ◽  
Median Nerve Stimulation ◽  
Human Thalamus ◽  
Sensory Evoked Potentials ◽  
Sensory Evoked ◽  
Fast Oscillations ◽  
Low Amplitude

Very fast oscillations (VFOs; 500–1,500 Hz) are associated with sensory-evoked potentials (SEPs), but their origin is unknown. To characterize the origins of VFOs, we studied 35 patients with deep brain stimulation (DBS) electrodes [15 with thalamic and 20 with the subthalamic nucleus (STN) electrodes]. We recorded median nerve stimulation–evoked SEPs from the thalamus and STN with microelectrodes during stereotactic surgery and from the contacts of the DBS electrodes postoperatively. We also examined the firing of individual neurons in thalamus in relation to the VFOs. In the thalamus, VFOs with frequencies around 1,000 Hz were superimposed on slow potentials. Both slow and fast SEP components showed phase reversals in the somatosensory thalamus [ventralis caudalis (Vc)]. Median nerve poststimulus time histograms showed that single thalamic neurons fired at preferred times at intervals between 0.8 to 1.2 ms that were synchronous with the VFOs, although the neurons fired only once or a few times per trial. In the STN, low-amplitude SEPs with VFOs were observed at a latency similar to the thalamic SEPs. The VFOs from STN probably represent volume conduction, possibly from the medial lemniscus. We conclude that the thalamic VFOs are generated within Vc and that they induce time-locked firing in a network of neurons.

scholarly journals Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson’s disease

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Rubens Gisbert Cury ◽  
Nicola Pavese ◽  
Tipu Z. Aziz ◽  
Joachim K. Krauss ◽  
Elena Moro ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Pedunculopontine Nucleus ◽  
Globus Pallidus Internus ◽  
Electrode Placement ◽  
Optimal Programming ◽  
Cortical Regions ◽  
Oscillation Dynamics

AbstractGait issues in Parkinson’s disease (PD) are common and can be highly disabling. Although levodopa and deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus internus have been established therapies for addressing the motor symptoms of PD, their effects on gait are less predictable and not well sustained with disease progression. Given the high prevalence of gait impairment in PD and the limitations in currently approved therapies, there has been considerable interest in alternative neuromodulation targets and techniques. These have included DBS of pedunculopontine nucleus and substantia nigra pars reticulata, spinal cord stimulation, non-invasive modulation of cortical regions and, more recently, vagus nerve stimulation. However, successes and failures have also emerged with these approaches. Current gaps and controversies are related to patient selection, optimal electrode placement within the target, placebo effects and the optimal programming parameters. Additionally, recent advances in pathophysiology of oscillation dynamics have driven new models of closed-loop DBS systems that may or may not be applicable to gait issues. Our aim is to describe approaches, especially neuromodulation procedures, and emerging challenges to address PD gait issues beyond subthalamic nucleus and the globus pallidus internus stimulation.

scholarly journals Local field potentials of subthalamic nucleus contain electrophysiological footprints of motor subtypes of Parkinson’s disease

2018 ◽  
Vol 115 (36) ◽  
pp. E8567-E8576 ◽  
Author(s):  
Ilknur Telkes ◽  
Ashwin Viswanathan ◽  
Joohi Jimenez-Shahed ◽  
Aviva Abosch ◽  
Musa Ozturk ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Local Field ◽  
Local Field Potentials ◽  
Center Frequency ◽  
Field Potentials ◽  
Beta Band ◽  
High Frequency Oscillations ◽  
Cross Frequency Coupling

Although motor subtypes of Parkinson’s disease (PD), such as tremor dominant (TD) and postural instability and gait difficulty (PIGD), have been defined based on symptoms since the mid-1990s, no underlying neural correlates of these clinical subtypes have yet been identified. Very limited data exist regarding the electrophysiological abnormalities within the subthalamic nucleus (STN) that likely accompany the symptom severity or the phenotype of PD. Here, we show that activity in subbands of local field potentials (LFPs) recorded with multiple microelectrodes from subterritories of STN provide distinguishing neurophysiological information about the motor subtypes of PD. We studied 24 patients with PD and found distinct patterns between TD (n = 13) and PIGD (n = 11) groups in high-frequency oscillations (HFOs) and their nonlinear interactions with beta band in the superior and inferior regions of the STN. Particularly, in the superior region of STN, the power of the slow HFO (sHFO) (200–260 Hz) and the coupling of its amplitude with beta-band phase were significantly stronger in the TD group. The inferior region of STN exhibited fast HFOs (fHFOs) (260–450 Hz), which have a significantly higher center frequency in the PIGD group. The cross-frequency coupling between fHFOs and beta band in the inferior region of STN was significantly stronger in the PIGD group. Our results indicate that the spatiospectral dynamics of STN-LFPs can be used as an objective method to distinguish these two motor subtypes of PD. These observations might lead to the development of sensing and stimulation strategies targeting the subterritories of STN for the personalization of deep-brain stimulation (DBS).

scholarly journals The Oscillatory Effects of Rhythmic Median Nerve Stimulation

2020 ◽  
Author(s):  
Mairi S. Houlgreave ◽  
Barbara Morera Maiquez ◽  
Matthew J. Brookes ◽  
Stephen R. Jackson
Keyword(s):  
Evoked Potentials ◽  
Median Nerve ◽  
Somatosensory Cortex ◽  
Nerve Stimulation ◽  
Afferent Input ◽  
List Type ◽  
Beta Band ◽  
Median Nerve Stimulation ◽  
Sensory Evoked Potentials ◽  
Sensory Evoked

AbstractEntrainment of brain oscillations can be achieved using rhythmic non-invasive brain stimulation, and stimulation of the motor cortex at a frequency associated with sensorimotor inhibition can impair motor responses. Despite the potential therapeutic applications, these techniques do not lend themselves to use outside a clinical setting. Here, the aim was to investigate whether rhythmic median nerve stimulation (MNS) could be used to entrain oscillations related to sensorimotor inhibition. MEG data were recorded from 20 participants during 400 trials, where for each trial 10 pulses of MNS were delivered either rhythmically or arrhythmically at 12 or 20Hz. Our results demonstrate a frequency specific increase in relative amplitude in the contralateral somatosensory cortex during rhythmic but not arrhythmic stimulation. This was coupled with an increase in inter-trial phase coherence at the same frequency, suggesting that the oscillations synchronised with the pulses of MNS. While the results show that 20Hz rhythmic peripheral nerve stimulation can produce entrainment, the response to 12Hz stimulation was largely due to the presence of rhythmic sensory evoked potentials. Regardless rhythmic MNS resulted in synchronous firing of neuronal populations within the contralateral somatosensory cortex meaning these neurons were occupied in processing of the afferent input. Therefore, MNS could prove therapeutically useful in disorders associated with hyperexcitability within the sensorimotor cortices.HighlightsRhythmic median nerve stimulation at 12Hz causes rhythmic sensory evoked potentials.Rhythmic median nerve stimulation at 20Hz causes entrainment of beta-band neural oscillations.

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