Edge detections of MER Signals of STN with DBS micro electrode local field potential acquisitions in Parkinson`s

Deep brain stimulation of the subthalamic nucleus (STN) is a highly effective treatment for motor symptoms of Parkinson’s disease. Sub thalamic nucleus deep brain stimulation (STN-DBS) is a therapeutic surgical procedure for reducing the symptoms Parkinson’s and restoring and increasing the motor functioning. However, precise intraoperative edge or perimeter detection of STN remains a procedural challenge. In this study, we present the micro electrode signals recordings (MER) of STNs and local field potentials (LFPs) were acquired from deep brain stimulation macro electrodes during trajectory towards STN, in Parkinson patients. The frequency versus intensity atlas of field potential activity was obtained and further than investigated in distinct sub band’s, to explore whether field potentials activity can be employed for STN edge detection. STN perimeter detections by means of L F Ps were evaluated to edge predictions by way of the functional stereotactic DBS neurosurgeon, based on micro electrode derived, single unit recordings (M E R – S N A of S T Ns). The findings show variation amongst M E R – S N A and macro electrode L F P-signals gathering through MER-system pertaining to the d o r s a l S T N b o r d e r of -1.00±0.85mm plus -0.42±1.08 mm in the and frequencies, correspondingly. For these sub band`s, root mean square of the voids was found to be 1.27milli meters and 1.07milli meters. The Assessment of other sub band`s didn`t set a limit for differentiating the posterior (c a u d a l) point of sub-thalamic nuclei. We may infer that In conclusion, macro electrode signal acquisitions of STNs derived L F P gatherings might offer an unconventional methodology in the direction of m e r – s n a, for detecting the aimed target subthalamic nucleus borders during DBS-surgery.

Chronic High-frequency Stimulation of the Subthalamic Nucleus Induces a Sustained Inhibition of Serotonergic System via Loss of Cell Phenotype

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a standard treatment in Parkinson’s disease (PD). However, in a considerable number of patients debilitating psychiatric side-effects occur. Recent research has revealed that external stimuli can alter the neurotransmitters’ homeostasis in neurons, which is known as “neurotransmitter respecification”. Herein, we addressed if neurotransmitter respecification could be a mechanism by which DBS suppresses the serotonergic function in the dorsal raphe nucleus (DRN) leading to mood changes. We infused transgenic 5-HT-Cre (ePet-cre) mice with AAV viruses to achieve targeted expression of eYFP and the genetically encoded calcium indicator GCaMP6s in the DRN prior to methyl-4phenyl-1,2,3,6-tetrahydropyridine (MPTP) treatment. Mice received bilateral DBS electrodes in the STN and an optic fiber in the DRN for Ca2+ photometry. MPTP treated mice demonstrated behavioral and histological PD phenotype, whereas all STN-DBS animals exhibited an increased immobility time in the forced swim test, reduced Ca2+ activity, and loss of TPH2 expression in the DRN. Given the prominent role of Ca2+ transients in mediating neurotransmitter respecification, these results suggest a chronic loss of serotonergic phenotype in the DRN following STN-DBS. These findings indicate that loss of 5-HT cell phenotype may underlie the unwanted depressive symptoms following STN-DBS.

The motor inhibitory network in patients with asymmetrical Parkinson’s disease: An fMRI study

Recent imaging studies with the stop-signal task in healthy individuals indicate that the subthalamic nucleus, the pre-supplementary motor area and the inferior frontal gyrus are key components of the right hemisphere “inhibitory network”. Limited information is available regarding neural substrates of inhibitory processing in patients with asymmetric Parkinson’s disease. The aim of the current fMRI study was to identify the neural changes underlying deficient inhibitory processing on the stop-signal task in patients with predominantly left-sided Parkinson’s disease. Fourteen patients and 23 healthy controls performed a stop-signal task with the left and right hands. Behaviorally, patients showed delayed response inhibition with either hand compared to controls. We found small imaging differences for the right hand, however for the more affected left hand when behavior was successfully inhibited we found reduced activation of the inferior frontal gyrus bilaterally and the insula. Using the stop-signal delay as regressor, contralateral underactivation in the right dorsolateral prefrontal cortex, inferior frontal and anterior putamen were found in patients. This finding indicates dysfunction of the right inhibitory network in left-sided Parkinson’s disease. Functional connectivity analysis of the left subthalamic nucleus showed a significant increase of connectivity with bilateral insula. In contrast, the right subthalamic nucleus showed increased connectivity with visuomotor and sensorimotor regions of the cerebellum. We conclude that altered inhibitory control in left-sided Parkinson’s disease is associated with reduced activation in regions dedicated to inhibition in healthy controls, which requires engagement of additional regions, not observed in controls, to successfully stop ongoing actions.

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

Gait 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.

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

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.