Lesions in monkey globus pallidus externus exacerbate parkinsonian symptoms

To further define the role of the external segment of the globus pallidus (GPe) in the development of parkinsonian motor signs, two rhesus monkeys were made parkinsonian with the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Behavioral assessments of bradykinesia and akinesia as well as single neuron recordings in the internal segment of the globus pallidus (GPi) were performed in both monkeys before and after ablating the sensorimotor portion of GPe. The effects of apomorphine on behavior and neuronal activity were also assessed in the parkinsonian monkeys before and after GPe ablation. We found that lesions in GPe exacerbated parkinsonian symptoms, altered neuronal activity in GPi, and reduced the therapeutic effects of apomorphine. These results support the hypothesis that GPe can influence GPi neuronal activity and is directly involved in parkinsonism. In addition, these data suggest that the inclusion of GPe in pallidotomy lesions for the treatment of Parkinson's disease can block the beneficial effects of antiparkinsonian medications and should be avoided.     

Pallidal stimulation: Effect of pattern and rate on bradykinesia in the non-human primate model of Parkinson's disease

Deep brain stimulation (DBS) involves the delivery of continuous, fixed-frequency electrical pulses to specific brain regions; however the reliance of therapeutic benefit on the fixed-frequency nature of the stimulation pattern is currently unknown. To address this, we investigated the effect of changes in the pattern and frequency of DBS in the internal segment of the globus pallidus (GPi) on bradykinesia in a single, hemi-parkinsonian monkey. Therapeutic parameters (i.e., contacts, pulse width, amplitude) were established for fixed-frequency stimulation at 135 Hz based on improved movement times during a reach and retrieval task. Thereafter, the pattern and frequency of stimulation were varied to assess the effect of variability, bursting and oscillatory patterns of stimulation on bradykinesia. During fixed-frequency stimulation, performance improved as a function of increasing pulse rate (P < 0.01). Using a temporally irregular pattern at the same average frequency failed to alter therapeutic benefit relative to the fixed-frequency condition. Introducing an 80 Hz burst pattern (20 bursts/s at 4 pulses/burst) improved bradykinesia (P < 0.01) relative to both “OFF” and 80 Hz fixed-frequency conditions, yielding results comparable to fixed-frequency stimulation at 135 Hz with 40% less current drain. Compared to burst and fixed-frequency stimulations, oscillatory patterns at 4 and 8 Hz were less effective. These results suggest that lower frequency stimulation delivered in a regular bursting pattern may be equally effective and require lower energy than higher frequency continuous patterns of stimulation, thereby prolonging battery life and call into question the role of bursting activity in the pathogenesis of bradykinesia.     

Decoupling neuronal oscillations during subthalamic nucleus stimulation in the parkinsonian primate

Subthalamic nucleus (STN) stimulation is a popular treatment for Parkinson's disease; however, its effect on neuronal activity is unclear. We performed simultaneous multi-electrode recordings in the STN and its targets, the globus pallidus internus (GPi) and externus (GPe) in the parkinsonian non-human primate during high frequency STN macro-stimulation. Our results indicate that in the parkinsonian state the abnormal neuronal oscillatory activity in the 10-15 Hz range is coherent within and between nuclei. We further show that STN macro-stimulation results in a reduction of oscillatory activity in the globus pallidus. In addition, a functional decoupling of the STN from its pallidal targets is evidenced by the reduced STN-GPi coherence, that effectively removes the STN synchronous oscillatory drive of basal ganglia output. This decoupling results in reduced coherence between neurons within the GPi which resume an independent neuronal activity pattern. This decorrelation of the basal ganglia output may result in a reduction of the fluctuations of the basal ganglia inhibitory control over thalamic neurons which may potentially contribute to the beneficial effects of deep brain high-frequency stimulation.     

Acute stimulation in the external segment of the globus pallidus improves parkinsonian motor signs.

High frequency (>100Hz) electrical stimulation in both the external (GPe) and internal (GPi) segments of the globus pallidus was effective in improving parkinsonian motor signs. Improvement generally occurred at short latency (<5-10 seconds) in both GPe and GPi but was often (50% of the time) delayed in GPi. Dyskinetic movements were observed during stimulation within GPe and GPi but were more frequent in GPe (20% vs. 9%). These findings suggest that electrical stimulation in both GPe and GPi may ameliorate parkinsonian motor signs. The mechanisms responsible for these observations, however, may differ. The tendency for delayed responses with GPi stimulation suggests a more complex spatial-temporal profile of stimulation on the electrical activity of GPi neurons and/or its effect on network activity in pallido-thalamo-cortical circuitry. The rarity of delayed effects with GPe stimulation suggests a more direct role of synaptic inhibition or normalization of neuronal activity of GPi either directly by means of activation of striatopallidal fibers passing through GPe (direct pathway), by means of activation of GPe-->GPi or GPe-->subthalamic nucleus projections (indirect pathway) or indirectly by means of the tonic activation of adjacent fiber pathways. These data provide a rationale for the exploration of electrical stimulation in GPe in patients with medically intractable Parkinson's disease and provide a basis on which to develop further investigations into the use of chronic electrical stimulation for the treatment of Parkinson's disease and other movement disorders.     

External pallidal stimulation improves parkinsonian motor signs and modulates neuronal activity throughout the basal ganglia thalamic network

Deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) and the subthalamic nucleus (STN) are effective for the treatment of advanced Parkinson's disease (PD). We have shown previously that DBS of the external segment of the globus pallidus (GPe) is associated with improvements in parkinsonian motor signs; however, the mechanism of this effect is not known. In this study, we extend our findings on the effect of STN and GPi DBS on neuronal activity in the basal ganglia thalamic network to include GPe DBS using the 1-methyl-4-phenyl-1.2.3.6-tetrahydropyridine (MPTP) monkey model. Stimulation parameters that improved bradykinesia were associated with changes in the pattern and mean discharge rate of neuronal activity in the GPi, STN, and the pallidal [ventralis lateralis pars oralis (VLo) and ventralis anterior (VA)] and cerebellar [ventralis lateralis posterior pars oralis (VPLo)] receiving areas of the motor thalamus. Population post-stimulation time histograms revealed a complex pattern of stimulation-related inhibition and excitation for the GPi and VA/VLo, with a more consistent pattern of inhibition in STN and excitation in VPLo. Mean discharge rate was reduced in the GPi and STN and increased in the VPLo. Effective GPe DBS also reduced bursting in the STN and GPi. These data support the hypothesis that therapeutic DBS activates output from the stimulated structure and changes the temporal pattern of neuronal activity throughout the basal ganglia thalamic network and provide further support for GPe as a potential therapeutic target for DBS in the treatment of PD.     

Spontaneous firing patterns of epileptic neurons in the monkey motor cortex

We recorded the activity of single cells in an alumina-induced epileptogenic focus in precentral cortex of an awake monkey. The firing patterns of 12 units exhibiting the “long first interval” burst pattern were studied in detail. When the monkey was quiescent, the spontaneous activity of these cells consisted of repeated bursts in which the initial spike was followed by a long first interval and then by a high-frequency afterburst. If the interval between the long first interval burst and the preceding activity was less than 100 msec, an inverse relationship between the duration of afterburst and the interburst interval was observed. When cell activity increased sufficiently (sometimes accompanied by overt motor activity) these cells fired at a tonic rate characteristic of normal precentral cells. In all cells, single pyramidal tract shocks elicited a short latency (0.6–1 msec) antidromic spike which could be followed after a long first interval by an afterburst. In most cells the afterburst spikes were slightly larger and longer than the initial spikes (and the spikes occurring during tonic activity). In two cells the afterburst spikes were clearly compounded of two parts, which varied independently as a function of electrode depth and probably represented activation of two regions of the cell. These observations suggest that the afterburst may be triggered by a pacemaker mechanism in a remote region of the same cell.     

帕金森病大鼠苍白球神经元放电模式的分析

目的 探讨帕金森病(Parkinson's disease,PD)大鼠苍白球(globus pallidus,GP)神经元的放电模式,为研究帕金森病的病理生理过程提供实验依据.方法 大鼠30只,应用6-羟基多巴胺(6-hydroxydopamine,6-OHDA)建立PD大鼠模型(模型组),多种方法对模型进行评价.在立体定向仪引导下记录PD模型组及正常生理状态下大鼠(对照组,10只)GP神经元放电活动,并对其放电模式进行分析.结果 模型组大鼠中有13只行为学及病理学检测结果符合PD模型标准.电生理记录显示对照组大鼠GP神经元放电频率为6±2Hz,模型组大鼠GP神经元放电频率为21±3Hz,模型组大鼠的放电频率显著高于对照组(P＜0.05).对照组共记录到四种形式的放电模式,模型组记录到三种.对照组GP神经元簇发放电模式的比例为11%,而模型组GP神经元簇发放电模式的比例术后四周为59%,术后八周为61%,两者比较具有统计学意义(P＜0.05).结论 PD模型大鼠GP神经元较生理状态下放电频率明显增加,其放电模式也有明显变化,簇状放电模式比例增大.这可能在帕金森病的病理生理变化中具有重要作用.     

Modulation of firing activity by endogenous GABA_A receptors in the globus pallidus of MPTP-treated parkinsonian mice

The globus pallidus in rodents,equivalent to the external segment of the globus pallidus in primates,plays an important role in movement regulation.Previous studies have shown abundant γ-aminobutyric acid（GABA）ergic innervation and GABAA receptors in the globus pallidus.In this study,we investigated the effects of endogenous GABAA receptors on the spontaneous firing activity of pallidal neurons in both normal and MPTP-treated mice using multi-barrel electrodes extracellular recordings in vivo.We found that in normal mice,pressure ejection of 0.1 mmol/L gabazine,a specific GABA A receptor antagonist,increased the spontaneous firing rate of globus pallidus neurons by 27.6 ± 5.6%.Furthermore,in MPTP mice（14 days after MPTP treatment）,0.1 mmol/L gabazine increased the firing rates by 51.0 ± 7.9%,significantly greater than in normal mice.These results suggest that endogenous GABAA receptors modulate the activity of globus pallidus neurons.The present findings may provide a rationale for investigations into the potential role of GABAA receptors in Parkinson’s disease.     

Operantly conditioned firing patterns of epileptic neurons in the monkey motor cortex

In an awake rhesus monkey we operantly conditioned the activity of single precentral pyramidal tract cells near a chronic alumina-induced epileptic focus. Units chosen for conditioning fired predominantly in stereotyped high-frequency long-first-interval bursts. Most units also exhibited brief periods of tonic regular firing, typical of normal precentral cells. The proportion of spikes occurring as long-first-interval bursts was determined on the basis of interspike intervals and defined as the epileptic index. Operantly reinforcing transient increases in unit activity with applesauce produced increases in average rates in all nine cells, with no consistent change in the mean epileptic index. Reinforcing transient decreases in firing rate produced a clear decrease in average rate for two cells, no sustained rate changes in six, and an increase in one; the average epileptic index did not change consistently, although transient pauses in cell activity were invariably preceded and followed by long-first-interval bursts. Reinforcing decreases in the epileptic index produced a sustained drop in the number of long-first-interval bursts/min and a concomitant increase in both regular firing and total rate. Reinforcing an increase in epileptic index produced no consistent changes. These results suggest that firing patterns of epileptic cells may be synaptically modified in awake animals. Analysis of reinforced responses suggest that transient increases in synaptic drive generating higher rates may also decrease the proportion of long-first-interval bursts.     

Modulation of firing activity by endogenous GABAA receptors in the globus pallidus of MPTP-treated parkinsonian mice

The globus pallidus in rodents, equivalent to the external segment of the globus pallidus in primates, plays an important role in movement regulation. Previous studies have shown abundant γ-aminobutyric acid (GABA)ergic innervation and GABA_A receptors in the globus pallidus. In this study, we investigated the effects of endogenous GABA_A receptors on the spontaneous firing activity of pallidal neurons in both normal and MPTP-treated mice using multi-barrel electrodes extracellular recordings in vivo. We found that in normal mice, pressure ejection of 0.1 mmol/L gabazine, a specific GABA_A receptor antagonist, increased the spontaneous firing rate of globus pallidus neurons by 27.6 ± 5.6%. Furthermore, in MPTP mice (14 days after MPTP treatment), 0.1 mmol/L gabazine increased the firing rates by 51.0 ± 7.9%, significantly greater than in normal mice. These results suggest that endogenous GABA_A receptors modulate the activity of globus pallidus neurons. The present findings may provide a rationale for investigations into the potential role of GABA_A receptors in Parkinson’s disease.     

Pallidal deep brain stimulation is effective, and improves quality of life in primary segmental and generalized dystonia

Background –  Dystonia is one of the most prevalent movement disorders, and may lead to abnormal postures, pain, significant disability and social isolation if not well treated. In widespread segmental or generalized dystonia efficient treatment options were lacking until the recent introduction of deep brain stimulation of the internal globus pallidus (pallidal DBS).
Methods –  The first case series and single-blinded controlled study showed promising results regarding the effect of pallidal DBS on dystonic movements, pain and disability, but the impact of this treatment on health-related quality of life (HRQoL) remained uncertain. Then, as part of the first randomized, and sham stimulation-controlled trial performed by the DBS for Dystonia Study Group, HRQoL was evaluated using the Short Form-36 Health Survey (SF-36) at baseline, after the 3 months sham-controlled phase, and after 6 months of continuous pallidal DBS, in 40 patients with severe primary segmental or generalized dystonia.
Results –  The 3-month sham-stimulation controlled phase resulted in significant improvement of dystonic movements, pain and disability in the active stimulation group, and four of the eight SF-36 domain scores also improved significantly compared with the sham-stimulated group. After 6 months of active stimulation in all patients, significant improvement in all eight SF-36 domains was observed, with comparable improvement in the segmental and generalized dystonia groups.
Conclusion –  Convincing evidence has been obtained that pallidal DBS effectively reduces dystonia-related symptoms, and markedly improves HRQoL in patients suffering from otherwise intractable, primary segmental or generalized dystonia, thus providing new opportunities for this patient group.     

Pallidal neuronal discharge in Huntington's disease: support for selective loss of striatal cells originating the indirect pathway

Chorea is the predominant motor manifestation in the early symptomatic phase of adult onset Huntington's disease (HD). Pathologically, this stage is marked by differential loss of striatal neurons contributing to the indirect pathway. This pattern of neuronal loss predicts decreased neuronal firing rates in GPi and increased firing rates in GPe, the opposite of the changes in firing rate known to occur in Parkinson's disease (PD). We present single-unit discharge characteristics (33 neurons) observed in an awake patient with HD (41 CAG repeats) undergoing microelectrode guided surgery for pallidal deep brain stimulation. Pallidal single-unit activity at "rest" and during voluntary movement was discriminated off line by principal component analysis and evaluated with respect to discharge rate, bursting, and oscillatory activity in the 0-200 Hz range. 24 GPi and 9 GPe units were studied, and compared with 132 GPi and 50 GPe units from 14 patients with PD. The mean (+/-SEM) spontaneous discharge rate for HD was 58+/-4 for GPi and 73+/-5 for GPe. This contrasted with discharge rates in PD of 95+/-2 for GPi and 57+/-3 for GPe. HD GPi units showed more bursting than PD GPi units but much less oscillatory activity in the 2-35 Hz frequency range at rest. These findings are consistent with selective early loss of striatal cells originating the indirect pathway.     

Lesion of the subthalamic nucleus or globus pallidus does not cause chaotic firing patterns in basal ganglia neurons in rats

The basal ganglia appears to play an important role in behavioral selection. One model (Berns and Sejnowski’s) of basal ganglia function argues that the subthalamic nucleus plays a critical role in this selection process and predicts that the subthalamic nucleus prevents the basal ganglia and its re-entrant circuits with the thalamus and cerebral cortex from developing chaotic oscillations. We tested this prediction by generating three-dimensional sequential interval state space plots of the spike trains from 684 globus pallidus, substantia nigra pars reticulata and subthalamic neurons recorded in intact, subthalamic lesioned and globus pallidus lesioned rats, neurons which had previously been analyzed with more standard statistical methods. Only 1 neuron (a globus pallidus neuron in a subthalamic lesioned rat) of the 684 showed a chaotic attractor. In no case did subthalamic nucleus lesion induce a chaotic firing pattern elsewhere in the basal ganglia.     

High frequency extradural motor cortex stimulation transiently improves axial symptoms in a patient with Parkinson's disease

In a primate model of Parkinson's disease (PD), the benefit of extradural motor cortex stimulation (EMCS) was associated with high‐frequency stimulation (130 Hz), whereas no significant motor improvement was achieved at 10 Hz or intermediate frequencies of stimulation. We report the case of a 72‐year‐old female patient affected by severe PD who underwent bilateral EMCS. In baseline med‐off condition the patient was unable to arise from a chair and to stand without assistance. Stimulation at 3 and 60 Hz failed to provide any improvement of symptoms, whereas, when stimulating at 130 Hz, axial akinesia and walking improved consistently: the patient, in med‐off condition, was able to arise from chair and to walk without assistance. The patient underwent two brain 99mTc‐ Ethylcysteinate Dimer‐SPECT studies: semiquantitative and Statistical Parametric Mapping revealed that the regional cerebral perfusion was significantly increased in the supplementary motor area during stimulation at 130 Hz. After five months, the benefit of EMCS gradually disappeared. © 2008 Movement Disorder Society     

Mood improvement after deep brain stimulation of the internal globus pallidus for tardive dyskinesia in a patient suffering from major depression

Deep brain stimulation (DBS) has the unique characteristic to very precisely target brain structures being part of functional brain circuits in order to reversibly modulate their function. It is an established adjunctive treatment of advanced Parkinson's disease and has virtually replaced ablative techniques in this indication. Several cases have been published relating effectiveness in neuroleptics-induced tardive dyskinesia. It is also investigated as a potential treatment of mood disorders. We report on the case of a 62 years old female suffering from a treatment refractory major depressive episode with comorbid neuroleptic-induced tardive dyskinesia. She was implanted a deep brain stimulation treatment system bilaterally in the globus pallidus internus and stimulated for 18 months. As well the dyskinesia as also the symptoms of depression improved substantially as measured by the Hamilton Rating Scale of Depression (HRSD) score and the Burke-Fahn-Marsden-Dystonia-Rating-Scale (BFMDRS) score. Scores dropped for HRSD from 26 at baseline preoperatively to 13 after 18 months; and for BFMDRS from 27 to 17.5. This case illustrates the potential of deep brain stimulation as a technique to be investigated in the treatment of severe and disabling psychiatric and movement disorders. DBS at different intracerebral targets being actually investigated for major depression might have similar antidepressant properties because they interact with the same cortico-basal ganglia-thalamocortical network found to be dysfunctional in major depression.     

Dopaminergic signals in primary motor cortex

Brainstem monoamine areas such as the ventral tegmental area (VTA) send dopaminergic projections to the cerebral cortex that are widely distributed across different cortical regions. Whereas the projection to prefrontal areas (PFC) has been studied in detail, little is known about dopaminergic projections to primary motor cortex (M1). These projections have been anatomically characterized in rat and primate M1. Primates have even denser dopaminergic projections to M1 than rats. The physiological role, the effects of dopaminergic input on the activity of M1 circuits, and the behavioral function of this projection are unknown. This review explores the existing anatomical, electrophysiological and behavioral evidence on dopaminergic projections to M1 and speculates about its functional role. The projection may explain basic features of motor learning and memory phenomena. It is of clinical interest because of its potential for augmenting motor recovery after a brain lesion as well as for understanding the symptomatology of patients with Parkinson's disease. Therefore, targeted investigations are necessary.     

A chronic MPTP model reproducing the slow evolution of Parkinson's disease: evolution of motor symptoms in the monkey

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) has been shown to induce parkinsonism both in man and non-human primates. Several models have now been developed, but acute MPTP administration does not consistently reproduce all the clinical features of the disease. To mirror the slow evolution observed in human pathology, a chronic model of intoxication is necessary. The present study describes a chronic MPTP protocol in the monkey. Six monkeys received daily injections of MPTP (0.2 mg/kg i.v.) until they reached a score over 8 on the clinical rating scale (15.5 days±1.1). Full parkinsonism was first obtained on the 22nd day. Levodopa testing (20 mg/kg per os) alleviated motor abnormalities (51%), proving the parkinsonian nature of these disturbances. Histological lesions reproduced those observed in Parkinson's disease with a decrease in tyrosine hydroxylase immunoreactivity of 90%. This model so could be of great interest for the study of the dynamic physiopathological changes which occur in Parkinson's disease and consequently for research on new neuroprotective therapies.     

Abnormal influences of passive limb movement on the activity of globus pallidus neurons in parkinsonian monkeys

Extracellular single unit activity was recorded in the globus pallidus of waking Macaca fascicularis during passive limb movement. The main upper and lower limb joints were investigated bilaterally. The animals were either intact or rendered parkinsonian by the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Cell counts showed that at least 90% of nigral neurons of the compacta-type were degenerated in the parkinsonian animals. In the intact animals, only 17% of the pallidal neurons responded to the natural stimulus. As already reported by others, the responses were typically related to movement about a single contralateral joint and in only one direction. In the parkinsonian animals, however, more neurons responded, often more vigorously, to the same stimulation. In many of these neurons the responses were elicited by movement about more than one joint of both upper and lower limbs or ipsi-and contralateral sides and in more than one direction. The increase in number and magnitude and loss of specificity of responses were much greater in the internal pallidal segment, where the number of responding neurons quadrupled. These results suggest that dopaminergic mechanisms regulate gain and selectivity in the basal ganglia. In animals with decreased dopaminergic functions, the excessive and unselective motor responses may explain all 3 major signs of parkinsonism: rigidity, tremor and akinesia.     

Somatotopic blocking of sensation with navigated transcranial magnetic stimulation of the primary somatosensory cortex

We demonstrate that spatially accurate and selective stimulation is crucial when cortical functions are studied by the creation of temporary lesions with transcranial magnetic stimulation (TMS). Previously, the interpretation of the TMS results has been hampered by inaccurate knowledge of the site and strength of the induced electric current in the brain. With a Navigated Brain Stimulation (NBS) system, which provides real-time magnetic resonance image (MRI)-guided targeting of the TMS-induced electric field, we found that TMS of a spatially restricted cortical S1 thenar area is sufficient to abolish sensation from a weak electric stimulation of the corresponding skin area. We demonstrate that with real-time navigation, TMS can be repeatably directed at millimeter-level precision to a target area defined on the MRI. The stimulation effect was temporally and spatially specific: the greatest inhibition of sensation occurred when TMS was applied 20 ms after the cutaneous test stimulus and the TMS effect was sensitive to 8-13 mm displacements of the induced electric field pattern. The results also indicate that TMS selectively to S1 is sufficient to abolish perception of cutaneous stimulation of the corresponding skin area.