Vliv hluboké mozkové stimulace subthalamického jádra na emoční a motivační procesy u pacientů s Parkinsonovou nemocí

Souhrn: Mechanismus nárůstu hmotnosti nebo afektivních a behaviorálních změn, které se vyskytují u pacientů s Parkinsonovou nemocí (PN) léčených hlubokou mozkovou stimulací subthalamického jádra (DBS STN) je nejasný. Domnívali jsme se, že některé tyto nonmotorické vedlejší účinky mohou být způsobené ovlivněním motivačních procesů. Motivační procesy vyvolané příjemnými a nepříjemnými podněty mohou být subjektivně hodnoceny pomocí přisouzení motivační důležitosti podnětům nebo pomocí afektivní modulace úlekové reakce. Ta poskytuje objektivní míru změn v emoční reaktivitě: úleková reakce je fyziologicky zesílena nepříjemnými a oslabena příjemnými podněty, tyto změny odráží aktivaci averzivního a apetitivního motivačního systému. Cílem naší práce bylo hodnocení vlivu DBS STN na motivační procesy vyvolané obrázky ze 4 různých kategorií: dvě zobrazující primární odměny erotiku a jídlo, averzivní podněty (hrozby a oběti) a neutrální pomocí subjektivních přisouzení motivační důležitosti prezentovaným podnětům (Studie 1.) a pomocí modulace akustického blink reflexu (ABR) (Studie 2.) u pacientů s PN po celonočním vysazení dopaminergní medikace ve stavu s se zapnutou (DBS ON) a vypnutou (DBS OFF) stimulací. Výsledky byly porovnány s výsledky získanými u kontrol. Studie 1. 20 pacientů s PN a 18 vázaných kontrol...Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral...Neurologická klinika 1. LF UK a VFNDepartment of Neurology First Faculty of Medicine and General University HospitalFirst Faculty of Medicine1. lékařská fakult

A loud auditory stimulus overcomes voluntary movement limitation in cervical dystonia

Background Patients with cervical dystonia (CD) present with an impaired performance of voluntary neck movements, which are usually slow and limited. We hypothesized that such abnormality could involve defective preparation for task execution. Therefore, we examined motor preparation in CD patients using the StartReact method. In this test, a startling auditory stimulus (SAS) is delivered unexpectedly at the time of the imperative signal (IS) in a reaction time task to cause a faster execution of the prepared motor programme. We expected that CD patients would show an abnormal StartReact phenomenon. Methods Fifteen CD patients and 15 age matched control subjects (CS) were asked to perform a rotational movement (RM) to either side as quick as possible immediately after IS perception (a low intensity electrical stimulus to the II finger). In randomly interspersed test trials (25%) a 130 dB SAS was delivered simultaneously with the IS. We recorded RMs in the horizontal plane with a high speed video camera (2.38 ms per frame) in synchronization with the IS. The RM kinematic-parameters (latency, velocity, duration and amplitude) were analyzed using video-editing software and screen protractor. Patients were asked to rate the difficulty of their RMs in a numerical rating scale. Results In control trials, CD patients executed slower RMs (repeated measures ANOVA, p<0.10−5), and reached a smaller final head position angle relative to the midline (p<0.05), than CS. In test trials, SAS improved all RMs in both groups (p<0.10−14). In addition, patients were more likely to reach beyond their baseline RM than CS (χ2, p<0.001) and rated their performance better than in control trials (t-test, p<0.01). Conclusion We found improvement of kinematic parameters and subjective perception of motor performance in CD patients with StartReact testing. Our results suggest that CD patients reach an adequate level of motor preparation before task execution

Multi-centre classification of functional neurological disorders based on resting-state functional connectivity.

BACKGROUND Patients suffering from functional neurological disorder (FND) experience disabling neurological symptoms not caused by an underlying classical neurological disease (such as stroke or multiple sclerosis). The diagnosis is made based on reliable positive clinical signs, but clinicians often require additional time- and cost consuming medical tests and examinations. Resting-state functional connectivity (RS FC) showed its potential as an imaging-based adjunctive biomarker to help distinguish patients from healthy controls and could represent a "rule-in" procedure to assist in the diagnostic process. However, the use of RS FC depends on its applicability in a multi-centre setting, which is particularly susceptible to inter-scanner variability. The aim of this study was to test the robustness of a classification approach based on RS FC in a multi-centre setting. METHODS This study aimed to distinguish 86 FND patients from 86 healthy controls acquired in four different centres using a multivariate machine learning approach based on whole-brain resting-state functional connectivity. First, previously published results were replicated in each centre individually (intra-centre cross-validation) and its robustness across inter-scanner variability was assessed by pooling all the data (pooled cross-validation). Second, we evaluated the generalizability of the method by using data from each centre once as a test set, and the data from the remaining centres as a training set (inter-centre cross-validation). RESULTS FND patients were successfully distinguished from healthy controls in the replication step (accuracy of 74%) as well as in each individual additional centre (accuracies of 73%, 71% and 70%). The pooled cross validation confirmed that the classifier was robust with an accuracy of 72%. The results survived post-hoc adjustment for anxiety, depression, psychotropic medication intake, and symptom severity. The most discriminant features involved the angular- and supramarginal gyri, sensorimotor cortex, cingular- and insular cortex, and hippocampal regions. The inter-centre validation step did not exceed chance level (accuracy below 50%). CONCLUSIONS The results demonstrate the applicability of RS FC to correctly distinguish FND patients from healthy controls in different centres and its robustness against inter-scanner variability. In order to generalize its use across different centres and aim for clinical application, future studies should work towards optimization of acquisition parameters and include neurological and psychiatric control groups presenting with similar symptoms

The effects of deep brain stimulation of the subthalamic nucleus on emotional and motivational processing in Parkinson's disease patients

Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral..

The effects of deep brain stimulation of the subthalamic nucleus on emotional and motivational processing in Parkinson's disease patients

Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral..

Functional movement disorder

[no abstract available

Bridging structural and functional biomarkers in functional movement disorder using network mapping

Abstract Background  There are gaps in our neurobiological understanding of functional movement disorder (FMD). Objectives We investigated gray matter volumetric profiles in FMD, and related findings to resting‐state functional connectivity (rsFC) profiles using Human Connectome Project data. Methods Volumetric differences between 53 FMD patients and 50 controls were examined, as well as relationships between individual differences in FMD symptom severity and volumetric profiles. Atrophy network mapping was also used to probe whether FMD‐related structural alterations preferentially impacted brain areas with dense rsFC. Results Compared to controls without neurological comorbidities (albeit with mild depression and anxiety as a group), the FMD cohort did not show any volumetric differences. Across patients with FMD, individual differences in symptom severity negatively correlated with right supramarginal and bilateral superior temporal gyri volumes. These findings remained significant adjusting for FMD subtype or antidepressant use, but did not remain statistically significant adjusting for depression and anxiety scores. Symptom severity‐related structural alterations mapped onto regions with dense rsFC—identifying several disease epicenters in default mode, ventral attention, and salience networks. Conclusions This study supports that FMD is a multinetwork disorder with an important role for the temporoparietal junction and its related connectivity in the pathophysiology of this condition. More research is needed to explore the intersection of functional neurological symptoms and mood

A loud auditory stimulus overcomes voluntary movement limitation in cervical dystonia.

BackgroundPatients with cervical dystonia (CD) present with an impaired performance of voluntary neck movements, which are usually slow and limited. We hypothesized that such abnormality could involve defective preparation for task execution. Therefore, we examined motor preparation in CD patients using the StartReact method. In this test, a startling auditory stimulus (SAS) is delivered unexpectedly at the time of the imperative signal (IS) in a reaction time task to cause a faster execution of the prepared motor programme. We expected that CD patients would show an abnormal StartReact phenomenon.MethodsFifteen CD patients and 15 age matched control subjects (CS) were asked to perform a rotational movement (RM) to either side as quick as possible immediately after IS perception (a low intensity electrical stimulus to the II finger). In randomly interspersed test trials (25%) a 130 dB SAS was delivered simultaneously with the IS. We recorded RMs in the horizontal plane with a high speed video camera (2.38 ms per frame) in synchronization with the IS. The RM kinematic-parameters (latency, velocity, duration and amplitude) were analyzed using video-editing software and screen protractor. Patients were asked to rate the difficulty of their RMs in a numerical rating scale.ResultsIn control trials, CD patients executed slower RMs (repeated measures ANOVA, pConclusionWe found improvement of kinematic parameters and subjective perception of motor performance in CD patients with StartReact testing. Our results suggest that CD patients reach an adequate level of motor preparation before task execution

Attention impairment in motor functional neurological disorders: a neuropsychological study

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2022.Objective: Our objective was to assess cognitive functioning across multiple cognitive domains using a standardised neuropsychological battery in patients with motor functional neurological disorders (mFND). Methods: Thirty patients with clinically established mFND and 30 age-, sex- and education-matched control subjects underwent a thorough neuropsychological assessment evaluating (1) attention including processing speed, (2) executive functions including working memory, (3) short-term memory, (4) speech and language and (5) visuospatial functions. Performance validity tests (PVT) and self-report measures of depression, anxiety and cognitive complaints were included in the assessment. Only patients with valid test performance were included in the analysis. Results: Three patients scored below the cut-off scores in PVT. Patients performed significantly worse than controls in the following areas: (1) the attention domain which included a slow processing speed (p = 0.005, Cohen's d = 0.89), (2) executive functions (p = 0.01, Cohen's d = 0.88) and (3) speech and language domains (p = 0.025, Cohen's d = 0.77). Patients with mFND showed greater intra-individual variability in cognitive performance (p = 0.005, Cohen's d = 0.94). Cognitive impairments were independent of depressive symptoms, which were higher in mFND patients. Conclusion: This study revealed both subjective and objective cognitive impairment in patients with mFND. The neuropsychological profile in mFND was characterised primarily by attentional impairment including a slow processing speed and a high intra-individual variability in cognitive performance. Cognitive impairment was associated with a valid test performance, highlighting that the deficits observed were not likely to be explained by a lack of effort in the patient group. Attention is considered to play a key role in mFND pathophysiology, and the results suggest that such impairments are objectively measurable.The study was supported by the Ministry of Health of the Czech Republic, AZV No. 16-29651A.info:eu-repo/semantics/publishedVersio