Network modulation by the subthalamic nucleus in the treatment of Parkinson's disease

Trošt, Maja; Su, Sherwin L.; Su, Pen‐Hua; Yen, Ruoh‐Fang; Tseng, Ham‐Min; Barnes, Anna; Ma, Yilong; Eidelberg, David

doi:10.1016/j.neuroimage.2005.12.024

Cited by 153 publications

(170 citation statements)

References 48 publications

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“…These studies have resulted in general guidelines on the selection of stimulation parameters, as well as clinical algorithms for programming the devices. Imaging studies have developed correlations between stimulation parameters and markers of brain activity (Hershey et al, 2003;Haslinger et al, 2005;Phillips et al, 2006;Trost et al, 2006), and identified the location of therapeutic DBS electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). Modeling studies have characterized the theoretical effects of DBS electric fields on the underlying neural tissue (McIntyre et al, 2004b;Miocinovic et al, 2006b).…”

Section: Discussionmentioning

confidence: 99%

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. We have developed a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals are to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consists of three fundamental components: 1) a 3D anatomical model of the subcortical nuclei and DBS electrode position in the brain, each derived from magnetic resonance imaging (MRI); 2) a finite element model of the DBS electrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; 3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson's disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta / fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides the opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS.

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Section: Discussionmentioning

confidence: 99%

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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“…However, it is important to note that although treatment-mediated changes in PDRP expression correlate significantly with improvement in UPDRS ratings, the metabolic and clinical disease descriptors are not interchangeable. Indeed, intersubject differences in these measures generally have less than 50% of their variability in common, as observed in correlations between PDRP scores and motor UPDRS ratings obtained at baseline or during therapy (e.g., Feigin et al, 2002;Lozza et al, 2004;Trošt et al, 2006). Thus, it is likely that the objective imaging-based network measure may provide unique information about disease severity or the Test-retest reliability of Parkinson's disease-related brain network Y Ma et al treatment response that is not captured by the simpler and more accessible clinical rating scales.…”

Section: Discussionmentioning

confidence: 99%

“…This method has proved useful in imaging studies of neurodegenerative disorders in which a focal pathology affects the activity of broadly distributed neural systems (Eidelberg et al, 2000;Eckert and Eidelberg, 2005). Moreover, this form of network analysis can be applied prospectively to quantify pattern expression in individual subjects on a single scan basis (Trošt et al, 2002(Trošt et al, , 2006Spetsieris et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Abnormal Metabolic Network Activity in Parkinson'S Disease: Test—Retest Reproducibility

Tang

Spetsieris

et al. 2007

J Cereb Blood Flow Metab

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282

385

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Parkinson's disease (PD) is associated with an abnormal pattern of regional brain function. The expression of this PD-related covariance pattern (PDRP) has been used to assess disease progression and the response to treatment. In this study, we validated the PDRP network as a measure of parkinsonism by prospectively computing its expression (PDRP scores) in 15 O-water (H 2 15 O) and 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans from PD patients and healthy volunteers. The reliability of this measure was also assessed within subjects using a test-retest design in mildly affected and advanced PD patients scanned at baseline and during treatment with levodopa or deep brain stimulation (DBS). We found that PDRP expression was significantly elevated in PD patients (P < 0.001) relative to controls in a prospective analysis of brain scans obtained with either H 2 15 O or FDG PET. A significant correlation (R 2 = 0.61; P < 0.001) was evident between PDRP scores computed from H 2 15 O and FDG images in PD subjects scanned with both tracers. Test-retest reproducibility was very high (intraclass correlation coefficient (ICC) > 0.92) for PDRP scores measured both within PET session and between sessions separated by up to 2 months. This high reproducibility was observed in both early stage and advanced PD patients scanned at baseline and during treatment. The within-subject variability of this measure was less than 10% for both unmedicated and treated conditions. These findings suggest that the PDRP network is a reproducible and stable descriptor of regional functional abnormalities in parkinsonism. The quantification of PDRP expression in PD patients can serve as a potential biomarker in PET intervention studies for this disorder.

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“…16 Moreover, substantial amelioration of motor features and improvement of neurophysiological and PET metabolic markers have been documented after surgery (ie, pallidotomy, subthalamotomy, and deep brain stimulation). 17,18 …”

Section: Pathophysiology Of Key Motor Features: the Classic Modelmentioning

confidence: 99%

Initial clinical manifestations of Parkinson's disease: features and pathophysiological mechanisms

Rodriguez-Oroz

Jahanshahi

Krack

et al. 2009

The Lancet Neurology

744

500

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A dopaminergic defi ciency in patients with Parkinson's disease (PD) causes abnormalities of movement, behaviour, learning, and emotions. The main motor features (ie, tremor, rigidity, and akinesia) are associated with a defi ciency of dopamine in the posterior putamen and the motor circuit. Hypokinesia and bradykinesia might have a dual anatomo-functional basis: hypokinesia mediated by brainstem mechanisms and bradykinesia by cortical mechanisms. The classic pathophysiological model for PD (ie, hyperactivity in the globus pallidus pars interna and substantia nigra pars reticulata) does not explain rigidity and tremor, which might be caused by changes in primary motor cortex activity. Executive functions (ie, planning and problem solving) are also impaired in early PD, but are usually not clinically noticed. These impairments are associated with dopamine defi ciency in the caudate nucleus and with dysfunction of the associative and other non-motor circuits. Apathy, anxiety, and depression are the main psychiatric manifestations in untreated PD, which might be caused by ventral striatum dopaminergic defi cit and depletion of serotonin and norepinephrine. In this Review we discuss the motor, cognitive, and psychiatric manifestations associated with the dopaminergic defi ciency in the early phase of the parkinsonian state and the diff erent circuits implicated, and we propose distinct mechanisms to explain the wide clinical range of PD symptoms at the time of diagnosis.

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Network modulation by the subthalamic nucleus in the treatment of Parkinson's disease

Cited by 153 publications

References 48 publications

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Abnormal Metabolic Network Activity in Parkinson'S Disease: Test—Retest Reproducibility

Initial clinical manifestations of Parkinson's disease: features and pathophysiological mechanisms

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