Chronic deep brain stimulation normalizes scalp EEG activity in isolated dystonia

Miocinovic, Svjetlana; Miller, Andrew M.; Swann, Nicole C.; Ostrem, Jill L.; Starr, Philip A.

doi:10.1016/j.clinph.2017.11.011

Cited by 27 publications

(21 citation statements)

References 57 publications

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“…Another study showed that increased low-frequency activity in the cortex is normalized after applying DBS. 40 These findings indicate that the application of high-frequency GPi DBS modulates the abnormally increased low-frequency activity. For these reasons, a paradigm for aDBS in dystonia based on the level of low-frequency oscillations seems plausible (Fig.…”

Section: Neural Oscillations In Isolated (Primary) Dystoniamentioning

confidence: 86%

Toward adaptive deep brain stimulation for dystonia

Piña-Fuentes

Beudel

Little

et al. 2018

Neurosurgical Focus

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The presence of abnormal neural oscillations within the cortico-basal ganglia-thalamo-cortical (CBGTC) network has emerged as one of the current principal theories to explain the pathophysiology of movement disorders. In theory, these oscillations can be used as biomarkers and thereby serve as a feedback signal to control the delivery of deep brain stimulation (DBS). This new form of DBS, dependent on different characteristics of pathological oscillations, is called adaptive DBS (aDBS), and it has already been applied in patients with Parkinson’s disease. In this review, the authors summarize the scientific research to date on pathological oscillations in dystonia and address potential biomarkers that might be used as a feedback signal for controlling aDBS in patients with dystonia.

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Section: Neural Oscillations In Isolated (Primary) Dystoniamentioning

confidence: 86%

Toward adaptive deep brain stimulation for dystonia

Piña-Fuentes

Beudel

Little

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Electrophysiological evaluations have further suggested that the loss of intracortical inhibition, increased cortical excitability in a cortico‐subcortical network, and abnormal sensorimotor integration play a causal role in the pathophysiology of dystonia . Importantly, GPi‐DBS stimulation can attenuate this cortical hypersynchrony and this effect has been shown to be dependent on the stimulation amplitude . However, the extent to which these DBS‐related effects rely on the structural integrity of the underlying cortical circuits remains unknown.…”

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confidence: 99%

Cortical network fingerprints predict deep brain stimulation outcome in dystonia

et al. 2019

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Background Deep brain stimulation (DBS) is an effective evidence‐based therapy for dystonia. However, no unequivocal predictors of therapy responses exist. We investigated whether patients optimally responding to DBS present distinct brain network organization and structural patterns. Methods From a German multicenter cohort of 82 dystonia patients with segmental and generalized dystonia who received DBS implantation in the globus pallidus internus, we classified patients based on the clinical response 3 years after DBS. Patients were assigned to the superior‐outcome group or moderate‐outcome group, depending on whether they had above or below 70% motor improvement, respectively. Fifty‐one patients met MRI‐quality and treatment response requirements (mean age, 51.3 ± 13.2 years; 25 female) and were included in further analysis. From preoperative MRI we assessed cortical thickness and structural covariance, which were then fed into network analysis using graph theory. We designed a support vector machine to classify subjects for the clinical response based on individual gray‐matter fingerprints. Results The moderate‐outcome group showed cortical atrophy mainly in the sensorimotor and visuomotor areas and disturbed network topology in these regions. The structural integrity of the cortical mantle explained about 45% of the DBS stimulation amplitude for optimal response in individual subjects. Classification analyses achieved up to 88% of accuracy using individual gray‐matter atrophy patterns to predict DBS outcomes. Conclusions The analysis of cortical integrity, informed by group‐level network properties, could be developed into independent predictors to identify dystonia patients who benefit from DBS. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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“…However, the latter aspect should be verified in larger cohort studies to identify potential differences between dystonia subtypes and specific medication effects on both beta and low-frequency activity as subgroup analyses were not feasible because of the small sample size in the present study. Importantly, our findings should be considered in the context of additional mechanisms such as delayed long-term DBS-induced plastic changes 17,18,29 and electrophysiological changes on the cortical level, where DBS-reduced higher cortical alpha band (8-13Hz) power and coherence 30 and higher pallidal LFP alpha power was associated with increased cortico-pallidal coherence. 31 Finally, there is evidence for a disruption of structural 32 and functional connectivity 33 with the cerebellum that extends the complexity of unified framework for the pathogenesis of dystonic symptoms.…”

Section: Discussionmentioning

confidence: 81%

“…Overall, 3 to 12 Hz peaks occurred in 168 of 240 analyzed individual recordings. Beta peaks (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Hz) could be detected in every patient, but not at all timepoints (range 2-16 of 30 recordings per patient), adding up to a total of 94 of 240 analyzed recordings, with overall lower amplitude. No other distinct peaks were revealed in higher frequency bands.…”

Section: Resultsmentioning

confidence: 95%

Pallidal low‐frequency activity in dystonia after cessation of long‐term deep brain stimulation

et al. 2019

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Objective This study investigates the association between pallidal low‐frequency activity and motor sign severity in dystonia after chronic deep brain stimulation for several months. Methods Local field potentials were recorded in 9 dystonia patients at 5 timepoints (T1–T5) during an OFF‐stimulation period of 5 to 7 hours in parallel with clinical assessment using Burke‐Fahn‐Marsden Dystonia Rating Scale. A linear mixed effects model was used to investigate the potential association of motor signs with local field potential activity in the low frequency (3–12 Hz) and beta range (13–30 Hz). Results A significant association of Burke‐Fahn‐Marsden Dystonia Rating Scale scores with low‐frequency activity (3–12 Hz; b = 4.4; standard error = 1.5, degrees of freedom = 43, P = 0.006, 95% confidence interval, 1.3–7.5), but not beta activity (13–30 Hz) was revealed within participants across timepoints. Conclusion Low‐frequency activity is associated with dystonic motor sign severity, even months after chronic deep brain stimulation. Our findings corroborate the pathophysiological role of low‐frequency activity in dystonia and highlight the potential utility as a biomarker for adaptive neuromodulation. © 2019 International Parkinson and Movement Disorder Society

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Chronic deep brain stimulation normalizes scalp EEG activity in isolated dystonia

Cited by 27 publications

References 57 publications

Toward adaptive deep brain stimulation for dystonia

Toward adaptive deep brain stimulation for dystonia

Cortical network fingerprints predict deep brain stimulation outcome in dystonia

Pallidal low‐frequency activity in dystonia after cessation of long‐term deep brain stimulation

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