Effects of subthalamic nucleus stimulation on motor cortex plasticity in Parkinson disease

Kim, Sang Jin; Udupa, Kaviraja; Ni, Zhen; Moro, Elena; Gunraj, Carolyn; Mazzella, Filomena; Lozano, Andrés M.; Hodaie, Mojgan; Lang, Anthony E.; Chen, Robert

doi:10.1212/wnl.0000000000001806

Cited by 46 publications

(45 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because the STN is thought to have separate functional subregions [37], we hypothesize that the volume and locus of activated STN tissue may interact with the effect of DBS frequency. Besides that, there are studies suggesting that DBS leads to neural plasticity in motor cortex and in modulating corticobasal circuits [38, 39]. Then, it is possible that frequency of stimulation may also interact with the effect of neural plasticity leading to different outcomes on verbal fluency.…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation Frequency of the Subthalamic Nucleus Affects Phonemic and Action Fluency in Parkinson’s Disease

Fagundes

Rieder

Cruz

et al. 2016

Parkinson's Disease

View full text Add to dashboard Cite

Introduction. Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) has been linked to a decline in verbal fluency. The decline can be attributed to surgical effects, but the relative contributions of the stimulation parameters are not well understood. This study aimed to investigate the impact of the frequency of STN-DBS on the performance of verbal fluency tasks in patients with PD. Methods. Twenty individuals with PD who received bilateral STN-DBS were evaluated. Their performances of verbal fluency tasks (semantic, phonemic, action, and unconstrained fluencies) upon receiving low-frequency (60 Hz) and high-frequency (130 Hz) STN-DBS were assessed. Results. The performances of phonemic and action fluencies were significantly different between low- and high-frequency STN-DBS. Patients showed a decrease in these verbal fluencies for high-frequency STN-DBS. Conclusion. Low-frequency STN-DBS may be less harmful to the verbal fluency of PD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation Frequency of the Subthalamic Nucleus Affects Phonemic and Action Fluency in Parkinson’s Disease

Fagundes

Rieder

Cruz

et al. 2016

Parkinson's Disease

View full text Add to dashboard Cite

show abstract

“…This effect may be amplified by the lower resistance of the burr hole if the transcra-nial electrode is closer than approximately 2 cm (Datta et al, 2010). Another concern could be the still unknown combined biological effects of tDCS with intracranial stimulation since both tDCS and DBS (Kim et al, 2015; Udupa et al, 2016) can induce cortical plasticity alterations.…”

Section: The Application Of Low Intensity Tes In Human Studies: Aementioning

confidence: 99%

Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines

Antal

Alekseichuk

Bikson

et al. 2017

Clinical Neurophysiology

931

728

View full text Add to dashboard Cite

Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1–2 mA and during tACS at higher peak-to-peak intensities above 2 mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity ‘conventional’ TES defined as <4 mA, up to 60 min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3–13 A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10 mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6–7, 2016 and were refined thereafter by email correspondence.

show abstract

“…Moreover, higher degree of plasticity in dystonia patients on GPi DBS may be a marker for resistance to the re-emergence of dystonia when the stimulator is turned off (Ruge et al, 2011a). In advanced PD patients with dyskinesia treated with chronic dopaminergic medications, deficient PAS was not corrected with dopaminergic medications (Morgante et al, 2006) but was restored with STN DBS together with medications (Kim et al, 2015), suggesting that there may be synergistic effects between DBS and medications. Repeated applications of STN DBS and TMS timed to coincide with periods of increased motor cortical excitability from STN DBS (at ~3 and 23 ms) also led to long-term potentiation-like plasticity in the motor cortex (Udupa et al, 2016) (Figure 4).…”

Section: Tms-dbs and Dbs-tmsmentioning

confidence: 99%

Contribution of transcranial magnetic stimulation to assessment of brain connectivity and networks

Hallett

Iorio

Rossini

et al. 2017

Clinical Neurophysiology

Self Cite

132

View full text Add to dashboard Cite

The goal of this review is to show how transcranial magnetic stimulation (TMS) techniques can make a contribution to the study of brain networks. Brain networks are fundamental in understanding how the brain operates. Effects on remote areas can be directly observed or identified after a period of stimulation, and each section of this review will discuss one method. EEG analyzed following TMS is called TMS-evoked potentials (TEPs). A conditioning TMS can influence the effect of a test TMS given over the motor cortex. A disynaptic connection can be tested also by assessing the effect of a pre-conditioning stimulus on the conditioning-test pair. Basal ganglia-cortical relationships can be assessed using electrodes placed in the process of deep brain stimulation therapy. Cerebellar-cortical relationships can be determined using TMS over the cerebellum. Remote effects of TMS on the brain can be found as well using neuroimaging, including both positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). The methods complement each other since they give different views of brain networks, and it is often valuable to use more than one technique to achieve converging evidence. The final product of this type of work is to show how information is processed and transmitted in the brain.

show abstract

Effects of subthalamic nucleus stimulation on motor cortex plasticity in Parkinson disease

Abstract: Our findings suggest that STN-DBS together with dopaminergic medications restore LTP-like plasticity in motor cortex in PD. Restoration of cortical plasticity may be one of the mechanisms of how STN-DBS produces clinical benefit.

Cited by 46 publications

References 40 publications

Deep Brain Stimulation Frequency of the Subthalamic Nucleus Affects Phonemic and Action Fluency in Parkinson’s Disease

Deep Brain Stimulation Frequency of the Subthalamic Nucleus Affects Phonemic and Action Fluency in Parkinson’s Disease

Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines

Contribution of transcranial magnetic stimulation to assessment of brain connectivity and networks

Contact Info

Product

Resources

About