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1.
Neurobiol Dis ; 159: 105491, 2021 11.
Article in English | MEDLINE | ID: mdl-34461264

ABSTRACT

Parkinson's disease (PD) is a neurodegenerative movement disorder that is routinely treated with levodopa. Unfortunately, long-term dopamine replacement therapy using levodopa leads to levodopa-induced dyskinesias (LID), a significant and disabling side-effect. Clinical findings indicate that LID typically only occurs following the progression of PD motor symptoms from the unilateral (Hoehn and Yahr (HY) Stage I) to the bilateral stage (HY Stage II). This suggests the presence of some compensatory interhemispheric mechanisms that delay the occurrence of LID. We therefore investigated the role of interhemispheric connections of the nigrostriatal pathway on LID expression in a rat model of PD. The striatum of one hemisphere of rats was first injected with a retrograde tracer to label the ipsi- and cross-hemispheric nigrostriatal pathways. Rats were then split into groups and unilaterally lesioned in the striatum or medial forebrain bundle of the tracer-injected hemisphere to induce varying levels of hemiparkinsonism. Finally, rats were treated with levodopa and tested for the expression of LID. Distinct subsets emerged from rats that underwent the same lesioning paradigm based on LID. Strikingly, non-dyskinetic rats had significant sparing of their cross-hemispheric nigrostriatal pathway projecting from the unlesioned hemisphere. In contrast, dyskinetic rats only had a small proportion of this cross-hemispheric nigrostriatal pathway survive lesioning. Crucially, both non-dyskinetic and dyskinetic rats had nearly identical levels of ipsi-hemispheric nigrostriatal pathway survival and parkinsonian motor deficits. Our data suggest that the survival of the cross-hemispheric nigrostriatal pathway plays a crucial role in preventing the expression of LID and represents a potentially novel target to halt the progression of this devastating side-effect of a common anti-PD therapeutic.


Subject(s)
Antiparkinson Agents/adverse effects , Dyskinesia, Drug-Induced/physiopathology , Levodopa/adverse effects , Neostriatum/physiology , Parkinsonian Disorders/physiopathology , Substantia Nigra/physiology , Animals , Disease Progression , Dyskinesia, Drug-Induced/etiology , Medial Forebrain Bundle/physiopathology , Oxidopamine/toxicity , Parkinsonian Disorders/chemically induced , Rats , Sympatholytics/toxicity
2.
J Clin Neurosci ; 89: 103-105, 2021 Jul.
Article in English | MEDLINE | ID: mdl-34119251

ABSTRACT

Limited though promising evidence exists on the efficacy of Deep Brain Stimulation (DBS) of the Medial Forebrain Bundle (MFB) in otherwise intractable patients with Major Depression and Obsessive-Compulsive Disorder (OCD). Herein, we present acute and follow-up results (up to 5 years) of a 42 year old man with a diagnosis of treatment-resistant Bipolar Depression (BD) and comorbid OCD, successfully treated with DBS of the MFB. Regular follow-up visits with psychometric evaluations highlighted a considerable improvement of patient's depressive and OC symptoms at 5 years from implant. According to the limited, reported experience, we support the efficacy and tolerability of DBS of the MFB as a promising intervention in patients with treatment-resistant BD and comorbid OCD, with specific emphasis on the long-term outcome.


Subject(s)
Deep Brain Stimulation/methods , Depressive Disorder, Treatment-Resistant/therapy , Obsessive-Compulsive Disorder/therapy , Adult , Depressive Disorder, Treatment-Resistant/complications , Humans , Male , Medial Forebrain Bundle/physiopathology , Obsessive-Compulsive Disorder/complications
3.
Pharmacol Biochem Behav ; 197: 173013, 2020 10.
Article in English | MEDLINE | ID: mdl-32758524

ABSTRACT

Although extrastriatal dopaminergic (DAergic) systems are being recognized as contributors to Parkinson's disease (PD) pathophysiology, the role of extrastriatal DA depletion in L-Dopa-induced dyskinesia (LID) is still unknown. In view of the physiologic actions of DA on pallidal neuronal activity and the effects on motor behavior of local injection of DA drugs, the loss of the external (GPe, GP in rodents) and internal (GPi, entopeduncular nucleus (EP) in rodents) pallidal DAergic innervation might differentially contribute to LID. A role of pallidal serotonergic (SER) terminals in LID has been highlighted, however, the effect of DAergic innervation is unknown. We investigated the role of DAergic pallidal depletion on LID. Rats were distributed in groups which were concomitantly lesioned with 6-OHDA or vehicle (sham) in the GP, or EP, and in the medial forebrain bundle (MFB) as follows: a) MFB-sham+GP-sham, b) MFB-sham+GP-lesion, c) MFB-lesion+GP-sham, d) MFB-lesion+GP-lesion, e) MFB-sham+EP-sham, f) MFB-sham+EP-lesion, g) MFB-lesion+EP-sham, and h) MFB-lesion+EP-lesion. Four weeks later, animals were treated with L-Dopa (6 mg/kg) twice daily for 22 days.. Immunohistochemical studies were performed in order to investigate the changes in pallidal SER and serotonin transporter (SERT) levels. GP, but not EP, DAergic denervation attenuated LID in rats with a concomitant MFB lesion (p < 0.01). No differences were found in GP SERT expression between groups of animals developing or not LID. These results provide evidence of the relevance of GP DAergic innervation in LID. The conversion of levodopa to DA in GP serotonergic nerve fibers appears not to be the major mechanism underlying LID.


Subject(s)
Dyskinesia, Drug-Induced/etiology , Entopeduncular Nucleus/metabolism , Globus Pallidus/metabolism , Levodopa/adverse effects , Oxidopamine/pharmacology , Parkinson Disease, Secondary/chemically induced , Animals , Disease Models, Animal , Dopamine/metabolism , Dopaminergic Neurons/drug effects , Dopaminergic Neurons/metabolism , Entopeduncular Nucleus/drug effects , Entopeduncular Nucleus/physiopathology , Globus Pallidus/drug effects , Globus Pallidus/physiopathology , Levodopa/administration & dosage , Male , Medial Forebrain Bundle/drug effects , Medial Forebrain Bundle/metabolism , Medial Forebrain Bundle/physiopathology , Oxidopamine/administration & dosage , Rats , Rats, Sprague-Dawley , Serotonin/metabolism , Serotonin Plasma Membrane Transport Proteins/metabolism , Signal Transduction/drug effects
4.
Exp Neurol ; 327: 113224, 2020 05.
Article in English | MEDLINE | ID: mdl-32035070

ABSTRACT

BACKGROUND: Medial forebrain bundle (MFB) deep brain stimulation (DBS) has anti-depressant effects clinically and in depression models. Currently, therapeutic mechanisms of MFB DBS or how stimulation parameters acutely impact neurotransmitter release, particularly dopamine, are unknown. Experimentally, MFB DBS has been shown to evoke dopamine response in healthy controls, but not yet in a rodent model of depression. OBJECTIVE: The study investigated the impact of clinically used stimulation parameters on the dopamine induced response in a validated rodent depression model and in healthy controls. METHOD: The stimulation-induced dopamine response in Flinders Sensitive Line (FSL, n = 6) rat model of depression was compared with Sprague Dawley (SD, n = 6) rats following MFB DSB, using Fast Scan Cyclic Voltammetry to assess the induced response in the nucleus accumbens. Stimulation parameters were 130 Hz ("clinically" relevant) with pulse widths between 100 and 350 µs. RESULTS: Linear mixed model analysis showed significant impact in both models following MFB DBS both at 130 and 60 Hz with 100 µs pulse width in inducing dopamine response. Furthermore, at 130 Hz the evoked dopamine responses were different across the groups at the different pulse widths. CONCLUSION: The differential impact of MFB DBS on the induced dopamine response, including different response patterns at given pulse widths, is suggestive of physiological and anatomical divergence in the MFB in the pathological and healthy state. Studying how varying stimulation parameters affect the physiological outcome will promote a better understanding of the biological substrate of the disease and the possible anti-depressant mechanisms at play in clinical MFB DBS.


Subject(s)
Deep Brain Stimulation/methods , Depression/metabolism , Dopamine/metabolism , Medial Forebrain Bundle/metabolism , Nucleus Accumbens/metabolism , Animals , Depression/physiopathology , Disease Models, Animal , Female , Medial Forebrain Bundle/physiopathology , Nucleus Accumbens/physiopathology , Rats , Rats, Sprague-Dawley
5.
Metab Brain Dis ; 34(6): 1557-1564, 2019 12.
Article in English | MEDLINE | ID: mdl-31332728

ABSTRACT

Parkinson's disease (PD) is characterized by the progressive loss of dopaminergic neurons in the substantia nigra pars compacta. The conventional therapeutic measures which include the widely used L-DOPA therapy, are inefficient especially when dopamine loss is severe, and the physical symptoms are full blown. Since neuroinflammation is a core feature of PD, this raised the question of whether early treatment with an anti-inflammatory agent may provide a more efficient intervention for PD. In this study, we investigated the effect of bromelain (an anti-inflammatory drug) on motor responses and dopamine levels in a parkinsonian rat model. Male Sprague-Dawley rats were lesioned stereotaxically with the neurotoxin 6-OHDA. The anti-inflammatory agent, bromelain (40 mg/kg i.p) was used to treat a subset of the rats prior to or 24 h post 6-OHDA lesion. Locomotor activity was assessed after 6-OHDA injection, using the cylinder and step tests. The cortical and striatal concentrations of dopamine were also measured. 6-OHDA injection resulted in marked motor impairment which was prevented by pretreatment with bromelain prior to the lesion. Also, the injection of 6-OHDA into the medial forebrain bundle resulted in a significant reduction in dopamine concentration in the striatum and PFC. Bromelain treatment did not alter the suppression of cortical and striatal dopamine levels. Pre-treatment with bromelain reduced the motor dysfunction in the parkinsonian rat model of PD. The efficacy of treatment with bromelain does not appear to be via preservation of the dopaminergic system. The efficacy of bromelain in 6-OHDA injected rats still remains unclear.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Bromelains/therapeutic use , Medial Forebrain Bundle/drug effects , Motor Activity/drug effects , Parkinson Disease, Secondary/drug therapy , Animals , Anti-Inflammatory Agents/pharmacology , Behavior, Animal/drug effects , Bromelains/pharmacology , Cerebral Cortex/metabolism , Corpus Striatum/metabolism , Disease Models, Animal , Dopaminergic Neurons/drug effects , Dopaminergic Neurons/metabolism , Male , Medial Forebrain Bundle/metabolism , Medial Forebrain Bundle/physiopathology , Oxidopamine , Parkinson Disease, Secondary/chemically induced , Parkinson Disease, Secondary/metabolism , Parkinson Disease, Secondary/physiopathology , Rats , Rats, Sprague-Dawley
6.
Neuropsychopharmacology ; 44(7): 1224-1232, 2019 06.
Article in English | MEDLINE | ID: mdl-30867553

ABSTRACT

Short- and long-term antidepressant effects of deep brain stimulation (DBS) in treatment-resistant depression (TRD) have been demonstrated for several brain targets in open-label studies. For two stimulation targets, pivotal randomized trials have been conducted; both failed a futility analysis. We assessed efficacy and safety of DBS of the supero-lateral branch of the medial forebrain bundle (slMFB) in a small Phase I clinical study with a randomized-controlled onset of stimulation in order to obtain data for the planning of a large RCT. Sixteen patients suffering from TRD received DBS of the slMFB and were randomized to sham or real stimulation for the duration of 2 months after implantation. Primary outcome measure was mean reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) during 12 months of DBS (timeline analysis). Secondary outcomes were the difference in several clinical measures between sham and real stimulation at 8 weeks and during stimulation phases. MADRS ratings decreased significantly from 29.6 (SD +/- 4) at baseline to 12.9 (SD +/- 9) during 12 months of DBS (mean MADRS, n = 16). All patients reached the response criterion, most patients (n = 10) responded within a week; 50% of patients were classified as remitters after 1 year of stimulation. The most frequent side effect was transient strabismus. Both groups (active/sham) demonstrated an antidepressant micro-lesioning effect but patients had an additional antidepressant effect after initiation of stimulation. Both rapid onset and stability of the antidepressant effects of slMFB-DBS were demonstrated as in our previous pilot study. Given recent experiences from pivotal trials in DBS for MDD, we believe that slow, careful, and adaptive study development is germane. After our exploratory study and a large-scale study, we conducted this gateway trial in order to better inform planning of the latter. Important aspects for the planning of RCTs in the field of DBS for severe and chronic diseases are discussed including meaningful phases of intra-individual and between-group comparisons and timeline instead of single endpoint analyses.


Subject(s)
Deep Brain Stimulation , Depressive Disorder, Major/therapy , Depressive Disorder, Treatment-Resistant/therapy , Medial Forebrain Bundle/physiopathology , Adult , Aged , Depressive Disorder, Major/physiopathology , Depressive Disorder, Treatment-Resistant/physiopathology , Female , Humans , Male , Middle Aged , Treatment Outcome
7.
BMC Neurosci ; 20(1): 5, 2019 Feb 13.
Article in English | MEDLINE | ID: mdl-30760214

ABSTRACT

BACKGROUND: Accurately assessing promising therapeutic interventions for human diseases depends, in part, on the reproducibility of preclinical disease models. With the development of transgenic mice, the rapid adaptation of a 6-OHDA mouse model of Parkinson's disease that was originally described for the use in rats has come with a lack of a comprehensive characterization of lesion progression. In this study we therefore first characterised the time course of neurodegeneration in the substantia nigra pars compacta and striatum over a 4 week period following 6-OHDA injection into the medial forebrain bundle of mice. We then utilised the model to assess the anti-dyskinetic efficacy of recombinant activin A, a putative neuroprotectant and anti-inflammatory that is endogenously upregulated during the course of Parkinson's disease. RESULTS: We found that degeneration of fibers in the striatum was fully established within 1 week following 6-OHDA administration, but that the loss of neurons continued to progress over time, becoming fully established 3 weeks after the 6-OHDA injection. In assessing the anti-dyskinetic efficacy of activin A using this model we found that treatment with activin A did not significantly reduce the severity, or delay the time-of-onset, of dyskinesia. CONCLUSION: First, the current study concludes that a 3 week duration is required to establish a complete lesion of the nigrostriatal tract following 6-OHDA injection into the medial forebrain bundle of mice. Second, we found that activin A was not anti-dyskinetic in this model.


Subject(s)
Activins/pharmacology , Dyskinesia, Drug-Induced/drug therapy , Medial Forebrain Bundle/physiopathology , Neurodegenerative Diseases/physiopathology , Neuroprotective Agents/pharmacology , Parkinsonian Disorders/drug therapy , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Antiparkinson Agents/adverse effects , Antiparkinson Agents/pharmacology , Disease Progression , Dyskinesia, Drug-Induced/pathology , Dyskinesia, Drug-Induced/physiopathology , Levodopa/adverse effects , Levodopa/pharmacology , Male , Medial Forebrain Bundle/drug effects , Medial Forebrain Bundle/pathology , Mice, Inbred C57BL , Neurodegenerative Diseases/drug therapy , Neurodegenerative Diseases/pathology , Neurons/drug effects , Neurons/pathology , Neurons/physiology , Oxidopamine , Parkinsonian Disorders/pathology , Parkinsonian Disorders/physiopathology , Random Allocation , Treatment Failure
8.
Brain Stimul ; 12(3): 752-766, 2019.
Article in English | MEDLINE | ID: mdl-30765272

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a multifactorial disease which often coexists with cognitive deficits. Depression-induced cognitive deficits are known to be associated with aberrant reward processing, neurochemical and structural alterations. Recent studies have shown that chronic electrical stimulation of brain reward areas induces a robust antidepressant effect. However, the effects of repeated electrical self-stimulation of lateral hypothalamus - medial forebrain bundle (LH-MFB) on depression-induced cognitive deficits and associated neurochemical and structural alterations in the prefrontal cortex (PFC) are unknown. OBJECTIVES: We investigated the effect of chronic rewarding self-stimulation of LH-MFB in neonatal clomipramine (CLI) model of depression. During adulthood, neonatal CLI and saline administered rats were implanted with bilateral electrodes stereotaxically in the LH-MFB and trained to receive intracranial self-stimulation (ICSS) for 14 days. The rats were tested for depressive-like behaviors, learning and memory followed by estimation of PFC volumes, levels of monoamines and its metabolites in the PFC. RESULTS: We found that chronic ICSS of LH-MFB reverses CLI-induced behavioral despair and anhedonia. Interestingly, self-stimulation normalizes the impaired novel object and location recognition memory in CLI rats. The amelioration of learning impairments in CLI rats was associated with the reversal of volume loss and restoration of monoamine metabolism in the PFC. CONCLUSION: We demonstrated that repeated intracranial self-stimulation of LH-MFB ameliorates CLI-induced learning deficits, reverses altered monoamine metabolism and the atrophy of PFC. Our results support the hypothesis that chronic brain stimulation rewarding experience might be evolved as a potential treatment strategy for reversal of learning deficits in depression and associated disorders.


Subject(s)
Cognitive Dysfunction/therapy , Deep Brain Stimulation/methods , Depression/complications , Neuronal Plasticity , Prefrontal Cortex/physiopathology , Reward , Animals , Cognitive Dysfunction/etiology , Cognitive Dysfunction/physiopathology , Male , Medial Forebrain Bundle/physiopathology , Rats , Rats, Wistar , Self Stimulation
9.
Brain Stimul ; 12(2): 353-360, 2019.
Article in English | MEDLINE | ID: mdl-30522916

ABSTRACT

BACKGROUND: The ventral anterior limb of the internal capsule (vALIC) is a target for deep brain stimulation (DBS) in obsessive-compulsive disorder (OCD). Conventional surgical planning is based on anatomical landmarks. OBJECTIVE/HYPOTHESIS: We hypothesized that treatment response depends on the location of the active DBS contacts with respect to individual white matter bundle trajectories. This study thus aimed to elucidate whether vALIC DBS can benefit from bundle-specific targeting. METHODS: We performed tractography analysis of two fiber bundles, the anterior thalamic radiation (ATR) and the supero-lateral branch of the medial forebrain bundle (MFB), using diffusion-weighted magnetic resonance imaging (DWI) data. Twelve patients (10 females) who had received bilateral vALIC DBS for at least 12 months were included. We related the change in OCD symptom severity on the Yale-Brown obsessive-compulsive scale (Y-BOCS) between baseline and one-year follow-up with the distances from the active contacts to the ATR and MFB. We further analyzed the relation between treatment response and stimulation sites in standard anatomical space. RESULTS: We found that active stimulation of the vALIC closer to the MFB than the ATR was associated with better treatment outcome (p = 0.04; r2 = 0.34). In standard space, stimulation sites were largely overlapping between treatment (non)responders, suggesting response is independent of the anatomically defined electrode position. CONCLUSION: These findings suggest that vALIC DBS for OCD may benefit from MFB-specific implantation and highlight the importance of corticolimbic connections in OCD response to DBS. Prospective investigation is necessary to validate the clinical use of MFB targeting.


Subject(s)
Deep Brain Stimulation/methods , Obsessive-Compulsive Disorder/therapy , White Matter/physiopathology , Adult , Deep Brain Stimulation/adverse effects , Female , Humans , Internal Capsule/physiopathology , Male , Medial Forebrain Bundle/physiopathology , Middle Aged , Obsessive-Compulsive Disorder/physiopathology
10.
Psychol Med ; 48(16): 2684-2692, 2018 12.
Article in English | MEDLINE | ID: mdl-29493478

ABSTRACT

BACKGROUND: Reports of changes in patients' social behavior during deep brain stimulation (DBS) raised the question whether DBS induces changes in personality. This study explored if (1) DBS is associated with changes in personality in patients suffering from treatment-resistant depression (TRD), (2) how personality dimensions and depression are associated, and (3) if TRD patients' self-ratings of personality are valid. METHODS: TRD patients were assessed before DBS (n = 30), 6 months (t2, n = 21), 2 (t3, n = 17) and 5 years (t4, n = 11) after the initiation of DBS of the supero-lateral branch of the medial forebrain bundle (slMFB-DBS). Personality was measured with the NEO-Five-Factor Inventory (NEO-FFI), depression severity with Hamilton (HDRS), and Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS: Personality dimensions did not change with slMFB-DBS compared with baseline. Extraversion was negatively correlated with HDRS28 (r = -0.48, p < 0.05) and MADRS (r = -0.45, p < 0.05) at t2. Inter-rater reliability was high for the NEO-FFI at baseline (Cronbach's α = 0.74) and at t4 (α = 0.65). Extraversion [t(29) = -5.20; p < 0.001] and openness to experience [t(29) = -6.96; p < 0.001] differed statistically significant from the normative sample, and did not predict the antidepressant response. CONCLUSIONS: slMFB-DBS was not associated with a change in personality. The severity of depression was associated with extraversion. Personality of TRD patients differed from the healthy population and did not change with response, indicating a possible scar effect. Self-ratings of personality seem valid to assess personality during TRD.


Subject(s)
Deep Brain Stimulation/adverse effects , Depressive Disorder, Treatment-Resistant/physiopathology , Depressive Disorder, Treatment-Resistant/therapy , Medial Forebrain Bundle/physiopathology , Personality/physiology , Adult , Extraversion, Psychological , Female , Follow-Up Studies , Humans , Male , Middle Aged , Self-Assessment , Severity of Illness Index
11.
Behav Brain Res ; 344: 42-47, 2018 05 15.
Article in English | MEDLINE | ID: mdl-29452192

ABSTRACT

Recent studies have established methods for establishing a rodent model that mimics progressive stages of human Parkinson's disease (PD), via injection of graded doses of 6-hydroxydopamine (6-OHDA) into regions within the nigrostriatal pathway. However, the electrophysiological characteristics of the subthalamic nucleus (STN) in this model have not been fully elucidated in this model. This study aimed to investigate changes in the neuronal activity of the STN in a graded mouse model of PD. Increasing doses of 6-OHDA were unilaterally injected into the medial forebrain bundle (MFB) to produce a hemi-parkinsonian mouse model, mimicking early, moderate, advanced, and severe stages of human PD. Mice treated with higher doses of 6-OHDA demonstrated significantly lower rates of use of the impaired (contralateral) forelimb during wall contact, relative to sham mice. The STN firing rate was significantly increased in groups with >75% dopaminergic cell loss in the substantia nigra pars compacta (SNc), whereas little increase was observed in groups with partial lesions of the SNc, relative to the sham group. In addition, firing patterns of the STN in groups treated with higher doses of 6-OHDA became more irregular and exhibited burst-like patterns of activity, with dominant slow wave oscillations in the frequency range of 0.3-2.5 Hz. Our results demonstrated a strong correlation between neuronal activities in the STN and dopamine depletion in the nigrostriatal pathway, which can be manipulated by variation of 6-OHDA doses.


Subject(s)
Action Potentials/physiology , Dopamine/deficiency , Dopaminergic Neurons/physiology , Parkinsonian Disorders/physiopathology , Pars Compacta/physiopathology , Subthalamic Nucleus/physiopathology , Animals , Cell Death , Disease Progression , Dopaminergic Neurons/pathology , Dose-Response Relationship, Drug , Forelimb/physiopathology , Functional Laterality , Medial Forebrain Bundle/drug effects , Medial Forebrain Bundle/pathology , Medial Forebrain Bundle/physiopathology , Mice, Inbred C57BL , Motor Activity/physiology , Neural Pathways/pathology , Neural Pathways/physiopathology , Oxidopamine/toxicity , Parkinsonian Disorders/pathology , Pars Compacta/pathology , Random Allocation , Subthalamic Nucleus/pathology , Tyrosine 3-Monooxygenase/metabolism
12.
Transl Psychiatry ; 7(8): e1207, 2017 08 15.
Article in English | MEDLINE | ID: mdl-28809861

ABSTRACT

Although there have been previous studies of deep-brain stimulation (DBS), we present, to our knowledge, the first example of high-frequency depressive severity measurement-based DBS treatment in particular and psychiatric treatment in general. Daily post-surgical e-mail prompts for a period of 6 months resulted in 93 administrations of a computerized adaptive test (CAT) of depression severity (CAT-Depression Inventory or CAT-DI) via the internet. There was an average of 3.37 weekly measurements with an average separation of 2.12 days. No additional incentive was provided to the patient for completing the adaptive tests. The patient is a 55-year-old female with six psychiatric hospitalizations for depression, two suicide attempts, marginal response to eight electroconvulsive therapy (ECT) treatments and 35 psychotropic medications. We report results after high-frequency stimulation of the superolateral branch of the medial forebrain bundle. The CAT-DI was used for daily assessments before, during and after (remotely in response to an e-mail prompt) the DBS procedure. Two follow-up Hamilton Depression Scales (HAM-Ds) were also collected. Response to treatment varied markedly, with a decrease from severe (>75) to mild (60), which is three times the size of the uncertainty level. Although the HAM-D scores decreased, they missed the more complete temporal pattern identified by CAT-DI daily monitoring. We demonstrated feasibility of daily depressive severity measurement at high levels of precision and compliance. Clinician ratings confirm the general pattern of treatment benefit, but mask the marked variability in mood and more marked periods of benefit and decline.


Subject(s)
Deep Brain Stimulation , Depressive Disorder, Treatment-Resistant/diagnosis , Depressive Disorder, Treatment-Resistant/therapy , Female , Humans , Medial Forebrain Bundle/physiopathology , Middle Aged , Patient Compliance , Psychiatric Status Rating Scales , Severity of Illness Index , Telemedicine , Treatment Outcome
13.
Acta Histochem ; 119(1): 10-17, 2017 01.
Article in English | MEDLINE | ID: mdl-27863709

ABSTRACT

Recently, studies have provided strong evidence indicating the involvement of trace elements in the physiopathology of psychiatric disorders, particularly anxiety. We aimed, through the present study, to describe the effect of acute exposure to Cu (10mg/kg BW) on anxiety state together with the serotoninergic and dopaminergic systems in rat by means of neurobehavioral tests (elevated plus maze, dark light box) and immunohistochemistry using anti-serotonin (5HT) and anti-tyrosine hydroxylase (TH). Our data report that Cu enhanced 5HT innervation in the dorsal raphe nucleus (DRN) together with a loss of TH expression within the ventral tegmental area (VTA), Substantia nigra compacta (SNc) and their subsequent outputs including the medial forebrain bundle (MFB) and striatum. In the elevated plus maze Cu significantly increased the time and the number of entries into the open arms, and raised the time spent in the Dark Box indicating a clear reduced anxiety state induced by Cu. The present data show for the first time a powerful neuro-modulatory potential of Cu in rat which involves primarily a dysfunction of 5HT and DA neurotransmissions.


Subject(s)
Anxiety/chemically induced , Dorsal Raphe Nucleus/drug effects , Organometallic Compounds/toxicity , Pars Compacta/drug effects , Serotonin/metabolism , Tyrosine 3-Monooxygenase/metabolism , Ventral Tegmental Area/drug effects , Animals , Antibodies/chemistry , Anxiety/metabolism , Anxiety/physiopathology , Behavior, Animal/drug effects , Corpus Striatum/drug effects , Corpus Striatum/metabolism , Corpus Striatum/physiopathology , Dopamine/pharmacology , Dorsal Raphe Nucleus/metabolism , Dorsal Raphe Nucleus/physiopathology , Gene Expression , Immunohistochemistry , Injections, Intraventricular , Male , Maze Learning/drug effects , Medial Forebrain Bundle/drug effects , Medial Forebrain Bundle/metabolism , Medial Forebrain Bundle/physiopathology , Pars Compacta/metabolism , Pars Compacta/physiopathology , Rats , Rats, Wistar , Serotonin/pharmacology , Stereotaxic Techniques , Synaptic Transmission/drug effects , Tyrosine 3-Monooxygenase/genetics , Ventral Tegmental Area/metabolism , Ventral Tegmental Area/physiopathology
14.
CNS Spectr ; 22(3): 282-289, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27268576

ABSTRACT

Deep brain stimulation (DBS) is a promising putative modality for the treatment of refractory psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). Several targets have been posited; however, a clear consensus on differential efficacy and possible modes of action remain unclear. DBS to the supero-lateral branch of the medial forebrain bundle (slMFB) has recently been introduced for major depression (MD). Due to our experience with slMFB stimulation for MD, and because OCD might be related to similar dysfunctions of the reward system, treatment with slMFB DBS seams meaningful. Here we describe our first 2 cases together with a hypothetical mode of action. We describe diffusion tensor imaging (DTI) fiber tractographically (FT)-assisted implantation of the bilateral DBS systems in 2 male patients. In a selected literature overview, we discuss the possible mode of action. Both patients were successfully implanted and stimulated. The follow-up time was 12 months. One patient showed a significant response (Yale-Brown Obsessive-Compulsive Scale [YBOCS] reduction by 35%); the other patient reached remission criteria 3 months after surgery (YBOCS<14) and showed mild OCD just above the remission criterion at 12 months follow-up. While the hypermetabolism theory for OCD involves the cortico-striato-thalamo-cortical (CSTC) network, we think that there is clinical evidence that the reward system plays a crucial role. Our findings suggest an important role of this network in mechanisms of disease development and recovery. In this uncontrolled case series, continuous bilateral DBS to the slMFB led to clinically significant improvements of ratings of OCD severity. Ongoing research focuses on the role of the reward system in OCD, and its yet-underestimated role in this underlying neurobiology of the disease.


Subject(s)
Deep Brain Stimulation/methods , Medial Forebrain Bundle/physiopathology , Obsessive-Compulsive Disorder/therapy , Adult , Humans , Male , Middle Aged
15.
Behav Brain Res ; 301: 226-37, 2016 Mar 15.
Article in English | MEDLINE | ID: mdl-26748254

ABSTRACT

There is growing recognition that anxiety disorders have a greater impact on quality of life in Parkinson's disease than motor symptoms. Yet, little is known about the pathophysiology underlying this non-motor symptom in Parkinson's disease which poses a considerable barrier in developing effective treatment strategies. Here, we administered diazepam to hemiparkinsonian and non-parkinsonian rats and assessed its efficacy in three anxiety behavioral tests. At present, no information about this exists in preclinical research with sparse data in the clinical literature. Moreover, diazepam is an acute anxiolytic which makes this drug a suitable research tool to unmask differences in anxiety-like behavior. Using the unilateral, medial forebrain bundle 6-hydroxydopamine rat model of Parkinson's disease, we noted that hemiparkinsonian rats had more baseline anxiety-like behavior with 60% of them exhibiting high anxiety (HA) behavior in the elevated plus maze. In contrast, 41% of sham-lesioned rats and 8% of naïve rats exhibited HA behavior. Next, we employed the elevated plus maze and noted that diazepam (1.5mg/kg) was anxiolytic in low anxiety (LA) sham-lesioned (p=0.006) and HA sham-lesioned rats (p=0.016). Interestingly, diazepam was anxiolytic for LA hemiparkinsonian rats (p=0.017), but not for HA hemiparkinsonian rats (p=0.174) despite both groups having similar motor impairment and parkinsonian phenotype. Overall, diazepam administration unmasked differences in anxiolytic efficacy between HA hemiparkinsonian rats, LA hemiparkinsonian rats and non-parkinsonian rats. Our data suggests that neuro-circuits involved in anxiety-like behavior may differ within these groups and posits that diazepam may have reduced efficacy in certain individuals with PD anxiety disorders.


Subject(s)
Anti-Anxiety Agents/pharmacology , Anxiety Disorders/drug therapy , Diazepam/pharmacology , Parkinsonian Disorders/physiopathology , Animals , Anxiety Disorders/physiopathology , Exploratory Behavior/drug effects , Functional Laterality , Male , Medial Forebrain Bundle/physiopathology , Motor Activity/drug effects , Oxidopamine , Parkinsonian Disorders/drug therapy , Parkinsonian Disorders/psychology , Rats, Sprague-Dawley
17.
Neurosci Biobehav Rev ; 56: 345-6, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25861855

ABSTRACT

Purpose of this commentary is to discuss the relation of the nucleus accumbens (NA) with the medial forebrain bundle (MFB) and compare them as deep brain stimulation (DBS) targets in psychiatric disorders. Could a "bundle" be a more effective target than a "nucleus"? Or, more correctly, could an important "modulator" be a more effective target than a highly significant "pleasure center"? The answer hides in the fact that NA is a key component of the MFB. Thus NA dysfunction is synonym to MFB dysfunction. The NA is a "hot-spot" in the neurocircuitry of psychiatric disorders and further experimental investigation is needed for the MFB as a target for neuromodulation in depression, as well as to optimize benefit of psychiatric patients from neuromodulation treatment efforts. Are the NA and MFB two branches of the same tree? They definitely could be, particularly if the "tree" is the brain's "motivation super-system".


Subject(s)
Deep Brain Stimulation/methods , Electric Stimulation/methods , Medial Forebrain Bundle/physiopathology , Mental Disorders/physiopathology , Mental Disorders/therapy , Animals
18.
Behav Brain Res ; 288: 107-17, 2015 Jul 15.
Article in English | MEDLINE | ID: mdl-25841616

ABSTRACT

Unilateral 6-hydroxydopamine (6-OHDA) lesions of the nigrostriatal pathway produce side-biased motor impairments that reflect the motor deficits seen in Parkinson's disease (PD). This toxin-induced model in the rat has been used widely, to evaluate possible therapeutic strategies, but has not been well established in mice. With the advancements in mouse stem cell research we believe the requirement for a mouse model is essential for the therapeutic potential of these and other mouse-derived cells to be efficiently assessed. This aim of this study focused on developing a mouse model of PD using the 129 P2/OLA Hsd mouse strain as this is widely used in the generation of mouse embryonic stem cells. Both unilateral 6-OHDA medial forebrain bundle (MFB) and striatal lesion protocols were compared, with mice analysed for appropriate drug-induced rotational bias. Results demonstrated that lesioned mice responded to d-amphetamine with peak rotation dose at 5mg/kg and 10mg/kg for MFB and striatal lesions respectively. Apomorphine stimulation produced no significant rotational responses, at any dose, in either the MFB or striatal 6-OHDA lesioned mice. Analysis of dopamine neuron loss revealed that the MFB lesion was unreliable with little correlation between dopamine neuron loss and rotational asymmetry. Striatal lesions however were more reliable, with a strong correlation between dopamine neuron loss and rotational asymmetry. Functional recovery of d-amphetamine-induced rotational bias was shown following transplantation of E13 mouse VM tissue into the lesioned striatum; confirming the validity of this mouse model.


Subject(s)
Corpus Striatum/pathology , Medial Forebrain Bundle/pathology , Parkinsonian Disorders/pathology , Animals , Apomorphine/pharmacology , Corpus Striatum/drug effects , Corpus Striatum/physiopathology , Dextroamphetamine/pharmacology , Dopamine Agonists/pharmacology , Dopamine Uptake Inhibitors/pharmacology , Dopaminergic Neurons/drug effects , Dopaminergic Neurons/pathology , Dopaminergic Neurons/physiology , Dose-Response Relationship, Drug , Embryonic Stem Cells/transplantation , Female , Medial Forebrain Bundle/drug effects , Medial Forebrain Bundle/physiopathology , Mice, 129 Strain , Motor Activity/drug effects , Motor Activity/physiology , Oxidopamine , Parkinsonian Disorders/physiopathology , Parkinsonian Disorders/therapy , Rotation
19.
Neuropharmacology ; 95: 181-91, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25797491

ABSTRACT

Although the medial subdivision of the central nucleus of the amygdala (CeM) and serotonin-1A (5-HT1A) receptors are involved in the regulation of anxiety, their roles in Parkinson's disease (PD)-associated anxiety are still unknown. Here we assessed the importance of CeM 5-HT1A receptors for anxiety in rats with unilateral 6-hydroxydopamine (6-OHDA) lesion of the medial forebrain bundle (MFB). The lesion induced anxiety-like behaviors, increased the firing rate and burst-firing pattern of CeM γ-aminobutyric acid (GABA) neurons, as well as decreased dopamine (DA) levels in the striatum, medial prefrontal cortex (mPFC), amygdala and ventral part of hippocampus (vHip). Intra-CeM injection of the selective 5-HT1A receptor agonist 8-OH-DPAT produced anxiolytic effects in the lesioned rats, and decreased the firing rate of CeM GABAergic neurons in two groups of rats. Compared to sham-operated rats, the duration of the inhibitory effect on the firing rate of GABAergic neurons was shortened in the lesioned rats. The injection increased DA levels in the mPFC and amygdala in two groups of rats and the vHip in the lesioned rats, and increased 5-HT level in the lesioned rats, whereas it decreased NA levels in the mPFC in two groups of rats and the vHip in the lesioned rats. Moreover, the mean density of 5-HT1A receptor and GABA double-labeled neurons in the CeM was reduced after the lesioning. These results suggest that activation of CeM 5-HT1A receptor produces anxiolytic effects in the 6-OHDA-lesioned rats, which involves decreased firing rate of the GABAergic neurons, and changed monoamine levels in the limbic and limbic-related brain regions.


Subject(s)
8-Hydroxy-2-(di-n-propylamino)tetralin/pharmacology , Anti-Anxiety Agents/pharmacology , Anxiety Disorders/drug therapy , Central Amygdaloid Nucleus/drug effects , Parkinsonian Disorders/physiopathology , Serotonin 5-HT1 Receptor Agonists/pharmacology , Action Potentials/drug effects , Action Potentials/physiology , Animals , Anxiety Disorders/physiopathology , Central Amygdaloid Nucleus/physiopathology , Dopamine/metabolism , GABAergic Neurons/drug effects , GABAergic Neurons/physiology , Limbic System/drug effects , Limbic System/physiopathology , Male , Medial Forebrain Bundle/physiopathology , Motor Activity/drug effects , Motor Activity/physiology , Oxidopamine , Parkinsonian Disorders/psychology , Piperazines/pharmacology , Pyridines/pharmacology , Rats, Sprague-Dawley , Receptor, Serotonin, 5-HT1A/metabolism , Serotonin 5-HT1 Receptor Antagonists/pharmacology
20.
Behav Brain Res ; 284: 153-7, 2015 May 01.
Article in English | MEDLINE | ID: mdl-25698596

ABSTRACT

Parkinson's disease (PD) is characterized by abnormal motor symptoms and increased neuronal activity in the subthalamic nucleus (STN) as the disease progresses. We investigated the behavioral and electrophysiological characteristics in a mouse model mimicking the progressive stages of human PD (early, moderate, and advanced) by injecting 6-hydroxydopamine (6-OHDA) into the right medial forebrain bundle (MFB) at three different concentrations (2, 4, and 6 µg/2 µl). Significant changes in motor symptoms were demonstrated between groups in association with relative TH-positive cell loss in the substantia nigra pars compacta (SNc). Moreover, electrophysiologically assessed changes in the mean neuronal firing rate in the STN neurons were comparable to those in the early to advanced stages of human PD. Thus, the mouse model presented herein replicates the unique characteristics of each progressive stage of PD, in both motor and neurophysiological aspects, and therefore can be useful for further investigations of PD pathology.


Subject(s)
Neurons/physiology , Parkinsonian Disorders/physiopathology , Pars Compacta/physiopathology , Subthalamic Nucleus/physiopathology , Action Potentials , Animals , Body Weight , Disease Progression , Immunohistochemistry , Male , Medial Forebrain Bundle/pathology , Medial Forebrain Bundle/physiopathology , Mice, Inbred C57BL , Microelectrodes , Motor Activity/physiology , Neurons/pathology , Oxidopamine , Parkinsonian Disorders/pathology , Pars Compacta/pathology , Subthalamic Nucleus/pathology , Tyrosine 3-Monooxygenase/metabolism
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