Closed-Loop Deep Brain Stimulation Is Superior in Ameliorating Parkinsonism
Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strateg...
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| Published in | Neuron (Cambridge, Mass.) Vol. 72; no. 2; pp. 370 - 384 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
20.10.2011
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0896-6273 1097-4199 1097-4199 |
| DOI | 10.1016/j.neuron.2011.08.023 |
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| Abstract | Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strategy for PD in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) primate model of PD. Application of pallidal closed-loop stimulation leads to dissociation between changes in basal ganglia (BG) discharge rates and patterns, providing insights into PD pathophysiology. Furthermore, cortico-pallidal closed-loop stimulation has a significantly greater effect on akinesia and on cortical and pallidal discharge patterns than standard open-loop DBS and matched control stimulation paradigms. Thus, closed-loop DBS paradigms, by modulating pathological oscillatory activity rather than the discharge rate of the BG-cortical networks, may afford more effective management of advanced PD. Such strategies have the potential to be effective in additional brain disorders in which a pathological neuronal discharge pattern can be recognized.
► Novel DBS based on neuronal activity (closed-loop, CL-DBS) is superior to standard DBS ► Corticopallidal CL-DBS yields greater alleviation of parkinsonian akinesia ► Corticopallidal CL-DBS yields greater reduction of oscillatory neuronal discharge ► Pallidopallidal CL-DBS leads to dissociation between discharge rate and patterns |
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| AbstractList | Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strategy for PD in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) primate model of PD. Application of pallidal closed-loop stimulation leads to dissociation between changes in basal ganglia (BG) discharge rates and patterns, providing insights into PD pathophysiology. Furthermore, cortico-pallidal closed-loop stimulation has a significantly greater effect on akinesia and on cortical and pallidal discharge patterns than standard open-loop DBS and matched control stimulation paradigms. Thus, closed-loop DBS paradigms, by modulating pathological oscillatory activity rather than the discharge rate of the BG-cortical networks, may afford more effective management of advanced PD. Such strategies have the potential to be effective in additional brain disorders in which a pathological neuronal discharge pattern can be recognized. Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strategy for PD in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) primate model of PD. Application of pallidal closed-loop stimulation leads to dissociation between changes in basal ganglia (BG) discharge rates and patterns, providing insights into PD pathophysiology. Furthermore, cortico-pallidal closed-loop stimulation has a significantly greater effect on akinesia and on cortical and pallidal discharge patterns than standard open-loop DBS and matched control stimulation paradigms. Thus, closed-loop DBS paradigms, by modulating pathological oscillatory activity rather than the discharge rate of the BG-cortical networks, may afford more effective management of advanced PD. Such strategies have the potential to be effective in additional brain disorders in which a pathological neuronal discharge pattern can be recognized. ► Novel DBS based on neuronal activity (closed-loop, CL-DBS) is superior to standard DBS ► Corticopallidal CL-DBS yields greater alleviation of parkinsonian akinesia ► Corticopallidal CL-DBS yields greater reduction of oscillatory neuronal discharge ► Pallidopallidal CL-DBS leads to dissociation between discharge rate and patterns Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strategy for PD in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) primate model of PD. Application of pallidal closed-loop stimulation leads to dissociation between changes in basal ganglia (BG) discharge rates and patterns, providing insights into PD pathophysiology. Furthermore, cortico-pallidal closed-loop stimulation has a significantly greater effect on akinesia and on cortical and pallidal discharge patterns than standard open-loop DBS and matched control stimulation paradigms. Thus, closed-loop DBS paradigms, by modulating pathological oscillatory activity rather than the discharge rate of the BG-cortical networks, may afford more effective management of advanced PD. Such strategies have the potential to be effective in additional brain disorders in which a pathological neuronal discharge pattern can be recognized.Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strategy for PD in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) primate model of PD. Application of pallidal closed-loop stimulation leads to dissociation between changes in basal ganglia (BG) discharge rates and patterns, providing insights into PD pathophysiology. Furthermore, cortico-pallidal closed-loop stimulation has a significantly greater effect on akinesia and on cortical and pallidal discharge patterns than standard open-loop DBS and matched control stimulation paradigms. Thus, closed-loop DBS paradigms, by modulating pathological oscillatory activity rather than the discharge rate of the BG-cortical networks, may afford more effective management of advanced PD. Such strategies have the potential to be effective in additional brain disorders in which a pathological neuronal discharge pattern can be recognized. |
| Author | Mitelman, Rea Rosin, Boris Israel, Zvi Bergman, Hagai Haber, Suzanne N. Vaadia, Eilon Slovik, Maya Rivlin-Etzion, Michal |
| Author_xml | – sequence: 1 givenname: Boris surname: Rosin fullname: Rosin, Boris email: boris.rosin@mail.huji.ac.il organization: Department of Medical Neurobiology (Physiology), The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel – sequence: 2 givenname: Maya surname: Slovik fullname: Slovik, Maya organization: Department of Medical Neurobiology (Physiology), The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel – sequence: 3 givenname: Rea surname: Mitelman fullname: Mitelman, Rea organization: Department of Medical Neurobiology (Physiology), The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel – sequence: 4 givenname: Michal surname: Rivlin-Etzion fullname: Rivlin-Etzion, Michal organization: Department of Medical Neurobiology (Physiology), The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel – sequence: 5 givenname: Suzanne N. surname: Haber fullname: Haber, Suzanne N. organization: Department of Pharmacology and Physiology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA – sequence: 6 givenname: Zvi surname: Israel fullname: Israel, Zvi organization: Center for Functional & Restorative Neurosurgery, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel – sequence: 7 givenname: Eilon surname: Vaadia fullname: Vaadia, Eilon organization: Department of Medical Neurobiology (Physiology), The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel – sequence: 8 givenname: Hagai surname: Bergman fullname: Bergman, Hagai organization: Department of Medical Neurobiology (Physiology), The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical Association School of Medicine and Hadassah University Hospital, Jerusalem 91120, Israel |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22017994$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Animals Basal Ganglia - physiopathology Cercopithecus aethiops Deep Brain Stimulation - methods Electrodes Globus Pallidus - physiopathology Monkeys & apes MPTP Poisoning - chemically induced MPTP Poisoning - physiopathology MPTP Poisoning - therapy Neurons - physiology Neurosciences Parkinson Disease, Secondary - chemically induced Parkinson Disease, Secondary - physiopathology Parkinson Disease, Secondary - therapy Parkinson's disease Primates Treatment Outcome |
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| Title | Closed-Loop Deep Brain Stimulation Is Superior in Ameliorating Parkinsonism |
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