Medial Forebrain Bundle Stimulation as a Pathophysiological Mechanism for Hypomania in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Coenen, Volker A.; Honey, Christopher R.; Hurwitz, Trevor A.; Rahman, A. Abdel; McMaster, Jacqueline; Bürgel, Uli; Mädler, Burkhard

doi:10.1227/01.neu.0000345631.54446.06

Cited by 176 publications

(171 citation statements)

References 27 publications

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“…We observed that brainstem pathways in the tegmentum of the medulla and pons sampled in this study converge into newly described caudal and rostral divisions of an MHB in the midbrain, and in turn, into the MFB on either side of the third ventricle. Recently, the MFB was visualized for the first time in the human brain with diffusion tractography (Coenen et al, 2009(Coenen et al, , 2012 and was shown to traverse the anterior limb of the internal capsule on its way to the prefrontal cortex. We confirmed the capsular trajectory of the slMFB and its prefrontal connections, but we also visualized connections with the insula and superior temporal gyrus, two forebrain targets that are known to contribute to homeostatic regulation.…”

Section: Human Central Homeostatic Network 195 Discussionmentioning

confidence: 99%

The Structural Connectome of the Human Central Homeostatic Network

et al. 2016

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Homeostatic adaptations to stress are regulated by interactions between the brainstem and regions of the forebrain, including limbic sites related to respiratory, autonomic, affective, and cognitive processing. Neuroanatomic connections between these homeostatic regions, however, have not been thoroughly identified in the human brain. In this study, we perform diffusion spectrum imaging tractography using the MGH-USC Connectome MRI scanner to visualize structural connections in the human brain linking autonomic and cardiorespiratory nuclei in the midbrain, pons, and medulla oblongata with forebrain sites critical to homeostatic control. Probabilistic tractography analyses in six healthy adults revealed connections between six brainstem nuclei and seven forebrain regions, several over long distances between the caudal medulla and cerebral cortex. The strongest evidence for brainstem-homeostatic forebrain connectivity in this study was between the brainstem midline raphe and the medial temporal lobe. The subiculum and amygdala were the sampled forebrain nodes with the most extensive brainstem connections. Within the human brainstem-homeostatic forebrain connectome, we observed that a lateral forebrain bundle, whose connectivity is distinct from that of rodents and nonhuman primates, is the primary conduit for connections between the brainstem and medial temporal lobe. This study supports the concept that interconnected brainstem and forebrain nodes form an integrated central homeostatic network (CHN) in the human brain. Our findings provide an initial foundation for elucidating the neuroanatomic basis of homeostasis in the normal human brain, as well as for mapping CHN disconnections in patients with disorders of homeostasis, including sudden and unexpected death, and epilepsy.

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Section: Human Central Homeostatic Network 195 Discussionmentioning

confidence: 99%

The Structural Connectome of the Human Central Homeostatic Network

et al. 2016

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“…Previous reports have already implicitly used this technique and may serve as further validation. 6,21,22 We estimated the spatial accuracy of registered preoperative MR imaging and pre-and postoperative CT with the creation of individual fiber tracts to be better than 1.5 mm. All herewith presented results have to be judged and discussed within this precision.…”

Section: In Vivo Validationmentioning

confidence: 99%

Explaining Clinical Effects of Deep Brain Stimulation through Simplified Target-Specific Modeling of the Volume of Activated Tissue

Mädler

Coenen

2012

AJNR Am J Neuroradiol

117

111

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BACKGROUND AND PURPOSE:Although progress has been made in understanding the optimal anatomic structures as target areas for DBS, little effort has been put into modeling and predicting electromagnetic field properties of activated DBS electrodes and understanding their interactions with the adjacent tissue. Currently, DBS is performed with the patient awake to assess the effectiveness and the side effect spectrum of stimulation. This study was designed to create a robust and rather simple numeric and visual tool that provides sufficient and practical relevant information to visualize the patient's individual VAT.

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“…Stimulation of the inferior and medial STN corresponding to the limbic subnucleus of the STN has been proposed as a likely structure. Our own studies also suggest the medial forebrain bundle as a candidate (Coenen et al, 2009). Clinically, stimulation induced hypomania can usually be improved by either reducing the volume of tissue activated or by stimulating a more dorsal contact.…”

Section: Subthalamic Nucleus -Stnmentioning

confidence: 55%