Developing better digital health measures of Parkinson's disease using free living data and a crowdsourced data analysis challenge.

One of the promising opportunities of digital health is its potential to lead to more holistic understandings of diseases by interacting with the daily life of patients and through the collection of large amounts of real-world data. Validating and benchmarking indicators of disease severity in the home setting is difficult, however, given the large number of confounders present in the real world and the challenges in collecting ground truth data in the home. Here we leverage two datasets collected from patients with Parkinson's disease, which couples continuous wrist-worn accelerometer data with frequent symptom reports in the home setting, to develop digital biomarkers of symptom severity. Using these data, we performed a public benchmarking challenge in which participants were asked to build measures of severity across 3 symptoms (on/off medication, dyskinesia, and tremor). 42 teams participated and performance was improved over baseline models for each subchallenge. Additional ensemble modeling across submissions further improved performance, and the top models validated in a subset of patients whose symptoms were observed and rated by trained clinicians.

Dissociation of tic generation from tic expression during the sleep-wake cycle.

Motor tics, the hallmark of Tourette syndrome (TS), are modulated by different behavioral and environmental factors. A major modulating factor is the sleep-wake cycle in which tics are attenuated to a large extent during sleep. This study demonstrates a similar reduction in tic expression during sleep in an animal model of chronic tic disorders and investigates the underlying neural mechanism. We recorded the neuronal activity during spontaneous sleep-wake cycles throughout continuous GABAA antagonist infusion into the striatum. Analysis of video streams and concurrent kinematic assessments indicated tic reduction during sleep in both frequency and intensity. Extracellular recordings in the striatum revealed a state-dependent dissociation between motor tic expression and their macro-level neural correlates ("LFP spikes") during the sleep-wake cycle. Local field potential (LFP) spikes, which are highly correlated with tic expression during wakefulness, persisted during tic-free sleep and did not change their properties despite the reduced behavioral expression. Local, micro-level, activity near the infusion site was time-locked to the LFP spikes during wakefulness, but this locking decreased significantly during sleep. These results suggest that whereas LFP spikes encode motor tic generation and feasibility, the behavioral expression of tics requires local striatal neural activity entrained to the LFP spikes, leading to the propagation of the activity to downstream targets and consequently their motor expression. These findings point to a possible mechanism for the modulation of tic expression in patients with TS during sleep and potentially during other behavioral states.

Dynamic input-dependent encoding of individual basal ganglia neurons.

Computational models are crucial to studying the encoding of individual neurons. Static models are composed of a fixed set of parameters, thus resulting in static encoding properties that do not change under different inputs. Here, we challenge this basic concept which underlies these models. Using generalized linear models, we quantify the encoding and information processing properties of basal ganglia neurons recorded in-vitro. These properties are highly sensitive to the internal state of the neuron due to factors such as dependency on the baseline firing rate. Verification of these experimental results with simulations provides insights into the mechanisms underlying this input-dependent encoding. Thus, static models, which are not context dependent, represent only part of the neuronal encoding capabilities, and are not sufficient to represent the dynamics of a neuron over varying inputs. Input-dependent encoding is crucial for expanding our understanding of neuronal behavior in health and disease and underscores the need for a new generation of dynamic neuronal models.

Beta oscillations in the parkinsonian primate: Similar oscillations across different populations.

Parkinson's disease (PD) is characterized by excessive beta band oscillations (BBO) in neuronal spiking activity across basal ganglia (BG) nuclei. High frequency stimulation of the subthalamic nucleus, an effective treatment for PD, suppresses these oscillations. There is still a heated debate on the origin and propagation of BBO and their association to clinical symptoms. The key prerequisite in addressing these issues is to obtain an accurate estimation of the subpopulation of oscillatory neurons and the magnitude of their oscillations. Studies have shown that neurons in different BG nuclei vary dramatically in the magnitude of their oscillations. However, the stochastic nature of neuronal activity subsamples the oscillatory neuronal rate functions, thus causing standard spectral analysis methods to be dramatically biased by biological and experimental factors such as variations in the neuronal firing rate across BG nuclei. In order to overcome these biases, and directly analyze the expression of BBO within BG nuclei, we used a novel objective method, the modulation index. This method reveals that unlike previous spectral results, individual neurons in the different nuclei display similar magnitudes of oscillations, whereas only the size of the oscillatory subpopulation varies between nuclei. During stimulation, the magnitude of the BBO does not change but the fraction of oscillatory neurons decreases in the globus pallidus internus, leading to a significant change in BG output. This non-biased oscillation quantification thus enables the reconstruction of oscillations at the single neuron and nuclei population levels, and calls for a reassessment of the role of BBO during PD.

Quantifying spike train oscillations: biases, distortions and solutions.

Estimation of the power spectrum is a common method for identifying oscillatory changes in neuronal activity. However, the stochastic nature of neuronal activity leads to severe biases in the estimation of these oscillations in single unit spike trains. Different biological and experimental factors cause the spike train to differentially reflect its underlying oscillatory rate function. We analyzed the effect of factors, such as the mean firing rate and the recording duration, on the detectability of oscillations and their significance, and tested these theoretical results on experimental data recorded in Parkinsonian non-human primates. The effect of these factors is dramatic, such that in some conditions, the detection of existing oscillations is impossible. Moreover, these biases impede the comparison of oscillations across brain regions, neuronal types, behavioral states and separate recordings with different underlying parameters, and lead inevitably to a gross misinterpretation of experimental results. We introduce a novel objective measure, the "modulation index", which overcomes these biases, and enables reliable detection of oscillations from spike trains and a direct estimation of the oscillation magnitude. The modulation index detects a high percentage of oscillations over a wide range of parameters, compared to classical spectral analysis methods, and enables an unbiased comparison between spike trains recorded from different neurons and using different experimental protocols.