Subthalamic-Cortical Network Reorganization during Parkinson’s Tremor
Peter M Lauro, Shane Lee, Umer Akbar, Wael F. Asaad.
Abstract: Tremor, a common and often primary symptom of Parkinson’s disease, has been modeled with distinct onset and maintenance dynamics. To identify the neurophysiologic correlates of each state, we acquired intraoperative cortical and subthalamic nucleus recordings from ten (9M, 1F) patients performing a naturalistic visual-motor task. From this task we isolated short epochs of tremor onset and sustained tremor. Comparing these epochs, we found that the subthalamic nucleus was central to tremor onset, as it drove both motor cortical activity and tremor output. Once tremor became sustained, control of tremor shifted to cortex. At the same time, changes in directed functional connectivity across sensorimotor cortex further distinguished the sustained tremor state.
SIGNIFICANCE STATEMENT: Tremor is a common symptom of Parkinson’s disease (PD). While tremor pathophysiology is thought to involve both basal ganglia and cerebello-thalamic-cortical circuits, it is unknown how these structures functionally interact to produce tremor. In this manuscript, we analyzed intracranial recordings from the subthalamic nucleus and sensorimotor cortex in patients with PD undergoing deep brain stimulation (DBS) surgery. Using an intraoperative task, we examined tremor in two separate dynamic contexts: when tremor first emerged, and when tremor was sustained. We believe that these findings reconcile several models of Parkinson’s tremor, while describing the short-timescale dynamics of subcortical-cortical interactions during tremor for the first time. These findings may describe a framework for developing proactive and responsive neurostimulation models for specifically treating tremor.
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Wael F. Asaad, MD, PhD
Sidney A. Fox and Dorothea Doctors Fox Professor of Ophthalmology and Visual Science
Professor of Neurosurgery and Neuroscience
Vice-Chair, Research
Director, Functional and Epilepsy Neurosurgery Program
Director, Laboratory for Neurophysiology and Neuromodulation
Associate Director, Neurosurgery Residency Training Program
Director, Fellowship in Functional & Epilepsy Neurosurgery
Professor of Neurosurgery and Neuroscience
Vice-Chair, Research
Director, Functional and Epilepsy Neurosurgery Program
Director, Laboratory for Neurophysiology and Neuromodulation
Associate Director, Neurosurgery Residency Training Program
Director, Fellowship in Functional & Epilepsy Neurosurgery