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Parkinson Disease: HELP
Articles by Alberto Priori
Based on 34 articles published since 2010
(Why 34 articles?)
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Between 2010 and 2020, A. Priori wrote the following 34 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Stormy weather in the human basal ganglia. 2013

Giannicola, Gaia / Priori, Alberto. · ·Clin Neurophysiol · Pubmed #23085390.

ABSTRACT: -- No abstract --

2 Review Diagnostic biomarkers for Parkinson's disease at a glance: where are we? 2018

Cova, Ilaria / Priori, Alberto. ·Neurology Unit, L. Sacco University Hospital, Milan, Italy. · Department of Health Sciences, "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy. alberto.priori@unimi.it. ·J Neural Transm (Vienna) · Pubmed #30145631.

ABSTRACT: Parkinson's disease (PD) is a neurodegenerative disorder whose aetiology remains unclear: degeneration involves several neurotransmission systems, resulting in a heterogeneous disease characterized by motor and non-motor symptoms. PD causes progressive disability that responds only to symptomatic therapies. Future advances include neuroprotective strategies for use in at-risk populations before the clinical onset of disease, hence the continuing need to identify reliable biomarkers that can facilitate the clinical diagnosis of PD. In this evaluative review, we summarize information on potential diagnostic biomarkers for use in the clinical and preclinical stages of PD.

3 Review Cerebellar transcranial direct current stimulation in neurological disease. 2016

Ferrucci, Roberta / Bocci, Tommaso / Cortese, Francesca / Ruggiero, Fabiana / Priori, Alberto. ·Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy ; Dipartimento di Scienze della Salute, Università degli Studi di Milano, via Rudinì 8, 20142 Milan, Italy. · Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy. · Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy ; Dipartimento di Scienze della Salute, Università degli Studi di Milano, via Rudinì 8, 20142 Milan, Italy ; III Clinica Neurologica, Polo Ospedaliero San Paolo, via Rudinì 8, 20142 Milan, Italy. ·Cerebellum Ataxias · Pubmed #27595007.

ABSTRACT: Several studies have highlighted the therapeutic potential of transcranial direct current stimulation (tDCS) in patients with neurological diseases, including dementia, epilepsy, post-stroke dysfunctions, movement disorders, and other pathological conditions. Because of this technique's ability to modify cerebellar excitability without significant side effects, cerebellar tDCS is a new, interesting, and powerful tool to induce plastic modifications in the cerebellum. In this report, we review a number of interesting studies on the application of cerebellar tDCS for various neurological conditions (ataxia, Parkinson's disease, dystonia, essential tremor) and the possible mechanism by which the stimulation acts on the cerebellum. Study findings indicate that cerebellar tDCS is a promising therapeutic tool in treating several neurological disorders; however, this method's efficacy appears to be limited, given the current data.

4 Review The adaptive deep brain stimulation challenge. 2016

Arlotti, Mattia / Rosa, Manuela / Marceglia, Sara / Barbieri, Sergio / Priori, Alberto. ·Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Electronics, Computer Science and Systems, University of Bologna, Cesena, Italy. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Engineering and Architecture, University of Trieste, Trieste, Italy. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Unità di Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. · Department of Health Sciences, University of Milan, Fondazione IRCCS Ca'Granda, Milan, Italy. Electronic address: alberto.priori@unimi.it. ·Parkinsonism Relat Disord · Pubmed #27079257.

ABSTRACT: Sub-optimal clinical outcomes of conventional deep brain stimulation (cDBS) in treating Parkinson's Disease (PD) have boosted the development of new solutions to improve DBS therapy. Adaptive DBS (aDBS), consisting of closed-loop, real-time changing of stimulation parameters according to the patient's clinical state, promises to achieve this goal and is attracting increasing interest in overcoming all of the challenges posed by its development and adoption. In the design, implementation, and application of aDBS, the choice of the control variable and of the control algorithm represents the core challenge. The proposed approaches, in fact, differ in the choice of the control variable and control policy, in the system design and its technological limits, in the patient's target symptom, and in the surgical procedure needed. Here, we review the current proposals for aDBS systems, focusing on the choice of the control variable and its advantages and drawbacks, thus providing a general overview of the possible pathways for the clinical translation of aDBS with its benefits, limitations and unsolved issues.

5 Review Technology for deep brain stimulation at a gallop. 2015

Priori, Alberto. ·Clinical Center for Neurostimulation, Neurotechnology and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and University of Milan, Italy. ·Mov Disord · Pubmed #26011821.

ABSTRACT: -- No abstract --

6 Review Adaptive deep brain stimulation (aDBS) controlled by local field potential oscillations. 2013

Priori, Alberto / Foffani, Guglielmo / Rossi, Lorenzo / Marceglia, Sara. ·Centro Clinico per le Neuronanotecnologie e la Neurostimolazione, Fondazione IRCCS Ospedale Maggiore, Policlinico, Mangiagalli e Regina Elena, Università di Milano, via F. Sforza 35, 20122, Milan, Italy. alberto.priori@unimi.it ·Exp Neurol · Pubmed #23022916.

ABSTRACT: Despite their proven efficacy in treating neurological disorders, especially Parkinson's disease, deep brain stimulation (DBS) systems could be further optimized to maximize treatment benefits. In particular, because current open-loop DBS strategies based on fixed stimulation settings leave the typical parkinsonian motor fluctuations and rapid symptom variations partly uncontrolled, research has for several years focused on developing novel "closed-loop" or "adaptive" DBS (aDBS) systems. aDBS consists of a simple closed-loop model designed to measure and analyze a control variable reflecting the patient's clinical condition to elaborate new stimulation settings and send them to an "intelligent" implanted stimulator. The major problem in developing an aDBS system is choosing the ideal control variable for feedback. Here we review current evidence on the advantages of neurosignal-controlled aDBS that uses local field potentials (LFPs) as a control variable, and describe the technology already available to create new aDBS systems, and the potential benefits of aDBS for patients with Parkinson's disease.

7 Review Neurophysiology of deep brain stimulation. 2012

Rosa, Manuela / Giannicola, Gaia / Marceglia, Sara / Fumagalli, Manuela / Barbieri, Sergio / Priori, Alberto. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. ·Int Rev Neurobiol · Pubmed #23206677.

ABSTRACT: We review the data concerning the neurophysiology of deep brain stimulation (DBS) in humans, especially in reference to Parkinson's disease. The electric field generated by DBS interacts with the brain in complex ways, and several variables could influence the DBS-induced biophysical and clinical effects. The neurophysiology of DBS comprises the DBS-induced effects per se as well as neurophysiological studies designed to record electrical activity directly from the basal ganglia (single-unit or local field potential) through the electrodes implanted for DBS. In the subthalamic nucleus, DBS locally excites and concurrently inhibits at single-unit level, synchronizes low-frequency activity, and desynchronizes beta activity and also induces neurochemical changes in cyclic guanosine monophosphate (cGMP) and GABA concentrations. DBS-induced effects at system level can be studied through evoked potentials, autonomic tests, spinal cord segmental system, motor cortical and brainstem excitability, gait, and decision-making tasks. All these variables are influenced by DBS, suggesting also distant effects on nonmotor structures of the brain. Last, advances in understanding the neurophysiological mechanisms underlying DBS led researchers to develop a new adaptive DBS technology designed to adapt stimulation settings to the individual patient's clinical condition through a closed-loop system controlled by signals from the basal ganglia.

8 Review What neurophysiological recordings tell us about cognitive and behavioral functions of the human subthalamic nucleus. 2011

Marceglia, Sara / Fumagalli, Manuela / Priori, Alberto. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Department of Neurological Sciences, University of Milan, Italy. sara.marceglia@policlinico.mi.it ·Expert Rev Neurother · Pubmed #21158561.

ABSTRACT: The behavioral implications of deep brain stimulation (DBS) observed in Parkinson's disease patients provided evidence for a possible nonexclusively motor role of the subthalamic nucleus (STN) in basal ganglia circuitry. Basal ganglia pathophysiology can be studied directly by the analysis of neural rhythms measured in local field potentials recorded through DBS electrodes. Recent studies demonstrated that specific oscillations in the STN are involved in cognitive and behavioral information processing: action representation is mediated through β oscillations (13-35 Hz); cognitive information related to decision-making processes is mediated through the low-frequency oscillation (5-12 Hz); and limbic and emotional information is mediated through the α oscillation (8-12 Hz). These results revealed an important involvement of STN in decisional processes, cognitive functions, emotion control and conflict that could explain the post-DBS occurrence of behavioral disturbances.

9 Article Deep brain stimulation in Parkinson's disease: A multicentric, long-term, observational pilot study. 2019

Scelzo, Emma / Beghi, Ettore / Rosa, Manuela / Angrisano, Serena / Antonini, Angelo / Bagella, Caterina / Bianchi, Elisa / Caputo, Elena / Lena, Francesco / Lopiano, Leonardo / Marcante, Andrea / Marceglia, Sara / Massaro, Francesco / Modugno, Nicola / Pacchetti, Claudio / Pilleri, Manuela / Pozzi, Nicolo Gabriele / Romito, Luigi Michele / Santilli, Marco / Tamma, Filippo / Weis, Luca / Zibetti, Maurizio / Priori, Alberto. ·"Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan and Fondazione IRCCS Ca' Granda - Ospedale Maggiore, Milan, Italy. · Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri IRCCS, Milan, Italy. · Department of Neuroscience, University of Turin, Italy. · Department of Neuroscience (DNS), University of Padua, Italy. · Movement Disorder Unit, Department of Clinical Neurosciences, IRCCS Carlo Besta Neurological Institute, Milan, Italy. · Department of Neurology, "F. Miulli" General Hospital, Acquaviva delle Fonti, Italy. · Department of Neurology, Parkinson's Center, IRCCS Neuromed, Pozzilli, Italy. · Parkinson Unit, IRCCS San Camillo Hospital, Venice, Italy. · "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan and Fondazione IRCCS Ca' Granda - Ospedale Maggiore, Milan, Italy; Department of Engineering and Architecture, University of Trieste, Trieste, Italy. · Parkinson and movement disorders Unit, IRCCS Mondino Foundation, Pavia, Italy. · Department of Neurology, Villa Margherita, Private clinic, Arcugnano, Vicenza, Italy. · "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan and Fondazione IRCCS Ca' Granda - Ospedale Maggiore, Milan, Italy; Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy. Electronic address: alberto.priori@unimi.it. ·J Neurol Sci · Pubmed #31476620.

ABSTRACT: BACKGROUND: The impact of deep brain stimulation (DBS) on cognitive and urinary disorders, falls, and eventually hospitalizations and mortality in Parkinson's disease (PD) is still debated. OBJECTIVE: We compared the rates of dementia, mild cognitive impairment (MCI), urinary incontinence, nocturia, falls, hospitalizations, and mortality in a cohort of PD patients undergoing DBS with a cohort of medically-treated patients chosen as controls. METHODS: We conducted a retrospective pilot study in six Italian DBS centers. 91 PD patients receiving DBS and 91 age- and gender-matched controls receiving the best medical treatment alone with a minimum follow-up of one year were enrolled. Clinical data were collected from baseline to the last follow-up visit using an ad-hoc developed web-based system. RESULTS: The risk of dementia was similar in the two groups while patients in the surgical cohort had lower rates of MCI, urinary incontinence, nocturia, and falls. In contrast, the risk of hospital admissions related to PD was higher in the surgical cohort. However, when excluding hospitalizations related to DBS surgery, the difference between the two cohorts was not significant. The surgical cohort had a lower number of hospitalizations not related to PD. The risk of death was similar in the two groups. CONCLUSION: Despite a higher risk of hospitalization, patients receiving DBS had a lower rate of MCI, urinary incontinence, nocturia and falls, without evidence of an increased risk of dementia and mortality. Although these findings need to be confirmed in prospective studies, they seem to suggest that DBS may play a significant role in the management of non-motor symptoms and common complications of advanced PD.

10 Article Subthalamic Neural Activity Patterns Anticipate Economic Risk Decisions in Gambling. 2018

Mazzoni, A / Rosa, M / Carpaneto, J / Romito, L M / Priori, A / Micera, S. ·Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, 56025, Italy. · Clinical Center for Neurostimulation, Neurotechnology and Movement Disorders Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy. · Movement Disorders Department, Neurological Institute Carlo Besta, Milan, 20133, Italy. · "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy. · Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering and Center for Neuroprosthetics, School of Engineering, École polytechnique fédérale de Lausanne, Lausanne, CH-1015, Switzerland. ·eNeuro · Pubmed #29445770.

ABSTRACT: Economic decision-making is disrupted in individuals with gambling disorder, an addictive behavior observed in Parkinson's disease (PD) patients receiving dopaminergic therapy. The subthalamic nucleus (STN) is involved in the inhibition of impulsive behaviors; however, its role in impulse control disorders and addiction is still unclear. Here, we recorded STN local field potentials (LFPs) in PD patients with and without gambling disorder during an economic decision-making task. Reaction times analysis showed that for all patients, the decision whether to risk preceded task onset. We compared then for both groups the STN LFP preceding high- and low-risk economic decisions. We found that risk avoidance in gamblers correlated with larger STN LFP low-frequency (<12-Hz) fluctuations preceding task onset. In particular, the amplitude of low-frequency LFP fluctuations carried significant information about future decisions. Decisions of patients not affected by gambling disorder were instead not correlated with pretask STN LFP. Our results suggest that STN activity preceding task onset affects risk decisions by preemptively inhibiting attraction to high but unlikely rewards in favor of a long-term payoff.

11 Article Eight-hours adaptive deep brain stimulation in patients with Parkinson disease. 2018

Arlotti, Mattia / Marceglia, Sara / Foffani, Guglielmo / Volkmann, Jens / Lozano, Andres M / Moro, Elena / Cogiamanian, Filippo / Prenassi, Marco / Bocci, Tommaso / Cortese, Francesca / Rampini, Paolo / Barbieri, Sergio / Priori, Alberto. ·From the Clinical Center for Neurotechnologies, Neuromodulation, and Movement Disorders (M.A., S.M., F.C., T.B., F.C., P.R., S.B.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano · Dipartimento di Ingegneria e Architettura (S.M., M.P.), Università degli Studi di Trieste, Italy · CINAC (G.F.), Hospital Universitario HM Puerta del Sur, and Hospital Nacional de Parapléjicos, Toledo, Spain · Department of Neurology (J.V.), University of Wurzburg, Germany · Division of Neurosurgery (A.M.L.), University of Toronto, ON, Canada · Division of Neurology (E.M.), Centre Hospitalier Universitaire de Grenoble, France · Department of Medico-Surgical Sciences and Biotechnologies (F.C.), Sapienza University Rome Polo Pontino, Rome · and "Aldo Ravelli" Research Center (A.P.), Department of Health Sciences, University of Milan & Ospedale San Paolo, Milan, Italy. ·Neurology · Pubmed #29444973.

ABSTRACT: OBJECTIVES: To assess the feasibility and clinical efficacy of local field potentials (LFPs)-based adaptive deep brain stimulation (aDBS) in patients with advanced Parkinson disease (PD) during daily activities in an open-label, nonblinded study. METHODS: We monitored neurophysiologic and clinical fluctuations during 2 perioperative experimental sessions lasting for up to 8 hours. On the first day, the patient took his/her daily medication, while on the second, he/she additionally underwent subthalamic nucleus aDBS driven by LFPs beta band power. RESULTS: The beta band power correlated in both experimental sessions with the patient's clinical state (Pearson correlation coefficient CONCLUSIONS: The main findings of our study are that aDBS is technically feasible in everyday life and provides a safe, well-tolerated, and effective treatment method for the management of clinical fluctuations. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with advanced PD, aDBS is safe, well tolerated, and effective in controlling PD motor symptoms.

12 Article Adaptation and psychometric properties of the Italian version of the Non-Motor Symptoms Questionnaire for Parkinson's disease. 2017

Cova, I / Di Battista, M E / Vanacore, N / Papi, C P / Alampi, G / Rubino, A / Valente, M / Meco, G / Contri, P / Di Pucchio, A / Lacorte, E / Priori, A / Mariani, C / Pomati, S. ·Department of Clinical Sciences, Institute of Clinical Neurology, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy. ilaria.cova@unimi.it. · Neurology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, "San Paolo" University Hospital, Milan, Italy. ilaria.cova@unimi.it. · Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy. · Cognitive Impairment Center, Local Health Authority 9 of Treviso, Treviso, Italy. · National Centre of Epidemiology, National Institute of Health, Rome, Italy. · Parkinson's Clinical Trials Centre, Neurological Centre of Latium (NCL), Rome, Italy. · Department of Clinical Sciences, Institute of Clinical Neurology, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy. · Neurology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, "San Paolo" University Hospital, Milan, Italy. ·Neurol Sci · Pubmed #28150102.

ABSTRACT: Although non-motor symptoms (NMS) of Parkinson's disease (PD) are very common also in early stages of the disease, they are still under-recognized. Screening tools for non-motor symptoms, such as non-motor symptoms questionnaire (NMSQuest), help clinicians to recognize NMS and to evaluate if patients could require further assessment or specific treatments. To validate an adapted Italian version of NMSQuest and study its psychometric properties, Italian PD patients self-completed Italian NMSQuest, and then underwent a standard clinical evaluation including motor assessment (by Hoehn and Yahr staging, unified Parkinson's disease rating scale part III) and non-motor assessment (by Montreal cognitive assessment, Beck depression inventory, neuropsychiatric inventory, Epworth sleepiness scale, scale for outcomes in Parkinson's disease-Autonomic and movement disorder society-sponsored revision of the unified Parkinson's disease rating scale part I). Somatic comorbidities were quantified using the modified cumulative illness rating scale (CIRS). Seventy-one subjects were assessed (mean age years 69.8 ± 9.6 SD; 31% women; mean duration of disease 6.3 ± 4.6 years; H&Y median 2). Italian NMSQuest showed adequate satisfactory clinimetrics in terms of data quality, precision, acceptability, internal consistency and reliability. A significant correlation was found between NMSQuest and most of non-motor assessment scales, while no significant correlation appeared with motor severity as well as with age of patients, disease duration, levodopa equivalent daily dose, L-DOPA/dopamine agonists assumption and CIRS total score. The Italian version of the NMSQuest resulted as a reliable instrument for screening NMS in Italian PD patients.

13 Article Validation of the Italian version of the Non Motor Symptoms Scale for Parkinson's disease. 2017

Cova, I / Di Battista, M E / Vanacore, N / Papi, C P / Alampi, G / Rubino, A / Valente, M / Meco, G / Contri, P / Di Pucchio, A / Lacorte, E / Priori, A / Mariani, C / Pomati, S. ·Institute of Clinical Neurology, Department of Clinical Sciences, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy; Neurology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, "San Paolo" University Hospital, Milan, Italy. Electronic address: ilaria.cova@unimi.it. · Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy; Cognitive Impairment Center, Local Health Authority 9 of Treviso, Treviso, Italy. · National Centre of Epidemiology, National Institute of Health, Rome, Italy. · Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy. · Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy; Parkinson's Clinical Trials Centre [Neurological Centre of Latium (NCL)], Rome, Italy. · Institute of Clinical Neurology, Department of Clinical Sciences, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy. · Neurology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, "San Paolo" University Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Fondazione IRCCS Ca' Granda, Milan, Italy. ·Parkinsonism Relat Disord · Pubmed #28029554.

ABSTRACT: OBJECTIVE: To validate the adapted Italian version of the Non-Motor Symptoms Scale (NMSS), a tool to assess non-motor symptoms (NMS) in Parkinson's disease (PD). METHODS: A cross cultural adaptation of the NMSS into Italian and a psychometric analysis of the translated version of the NMSS was carried out in patients with PD from two university centres-affiliated hospitals. The quality of data and the acceptability, reliability and construct validity of NMSS were analyzed. The following standard scales were also applied: Hoehn and Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) part III, Montreal Cognitive Assessment, Beck Depression Inventory, Neuropsychiatric Inventory, Epworth Sleepiness Scale, Autonomic Scale for Outcomes in Parkinson's disease-Motor, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part I and Modified Cumulative Illness Rating Scale (CIRS). Levodopa equivalent daily dose (LEDD) was calculated. RESULTS: Seventy-one patients with PD were assessed (mean age years 69.8 ± 9.6 SD; 31% women; mean length of disease 6.3 ± 4.6 years; H&Y median: 2). Mean NMSS was 39.76 (SD 31.9; skewness 0.95). The total score of NMSS was free of floor or ceiling effects and showed a satisfactory reliability (Cronbach's alpha coefficient on total score was 0.72 [range for domains: 0.64-0.73], SEM value was 3.88 [½ SD = 31.90]). Significant positive correlations were found among total NMSS and other NMS standard tests, but no significant correlation appeared with UPDRS part III, CIRS and LEDD. CONCLUSIONS: The Italian NMSS is a comprehensive and helpful measure for NMS in native Italian patients with PD.

14 Article Risk of Infection After Local Field Potential Recording from Externalized Deep Brain Stimulation Leads in Parkinson's Disease. 2017

Rosa, Manuela / Scelzo, Emma / Locatelli, Marco / Carrabba, Giorgio / Levi, Vincenzo / Arlotti, Mattia / Barbieri, Sergio / Rampini, Paolo / Priori, Alberto. ·Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Unit of Stereotactic Functional and Neuroendoscopic Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Unit of Clinical Neurophysiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; III Department of Health Sciences, University of Milan & Ospedale San Paolo, Milan, Italy. Electronic address: alberto.priori@unimi.it. ·World Neurosurg · Pubmed #27686508.

ABSTRACT: OBJECTIVE: Adaptive deep brain stimulation (aDBS) controlled by local field potentials (LFPs) is considered a promising treatment for advanced Parkinson's disease (PD). The clinical research investigating aDBS functioning is performed using external deep brain stimulation (DBS) systems that require LFP recording through the temporary externalization of DBS leads. Although research examining LFP was first undertaken more than 20 years ago, only a few studies concern lead externalization and LFP recording safety. In the present retrospective study, we assessed the risk of infection related to these procedures. METHODS: A total of 105 patients with PD who underwent DBS surgery and lead externalization at our hospital from 2002 to 2014 were included in the present study. The medical records were used to collect clinical data and information concerning surgical site infections. We assessed the infection incidence in our cohort and the risk of infection related to the LFP recording procedure. RESULTS: The incidence of infections in patients who underwent lead externalization was 2.8%, which was consistent with the postoperative infectious risk reported in the literature (Wilcoxon signed rank test; P > 0.05). Moreover, the LFP recording procedure did not significantly increase the infection risk (LFP recordings vs. no LFP recordings: 2.5% vs. 4.2%; Fisher exact test; P > 0.05). CONCLUSIONS: DBS lead externalization and LFP recording are safe and do not increase the postoperative infection risk in patients with PD who undergo DBS surgery. Our retrospective study supported further clinical research in the field of LFP-based aDBS.

15 Article Abnormal sexuality in Parkinson's disease: fact or fancy? 2016

Ferrucci, Roberta / Panzeri, Marta / Ronconi, Lucia / Ardolino, Gianluca / Cogiamanian, Filippo / Barbieri, Sergio / Barone, Paolo / Bertolasi, Laura / Padovani, Alessandro / Priori, Alberto. ·Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy; III Clinica Neurologica, Polo Ospedaliero San Paolo, Milano, Italy. · Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università degli Studi di Padova, Italy. · Dipartimento Di Filosofia, Sociologia, Pedagogia e Psicologia Applicata, Università degli Studi di Padova, Italy. · Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy. · Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Italy. · Unità di Neurologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. · Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Brescia, Italy. · Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy; III Clinica Neurologica, Polo Ospedaliero San Paolo, Milano, Italy. Electronic address: alberto.priori@unimi.it. ·J Neurol Sci · Pubmed #27653856.

ABSTRACT: PURPOSE: Patients with Parkinson's disease (PD) variably report sexual dysfunctions. We assessed sexuality in PD by comparing sexual function between a large group of patients with idiopathic PD and a group of subjects without PD. METHODS: We recruited 121 patients with mild-to-moderate PD (aged 40-80years) from four Italian Movement Disorder Clinics and 123 non-Parkinsonian controls (NPC) (aged 40-80years). Sexual function was assessed with four scales: the Brief Index of Sexual Functioning (BISF-M for men; BISF-W for women), the International Index of Erectile Function (IIEF), and the Female Sexual Function Index (FSFI). Both groups also underwent assessment with the Beck Depression Inventory (BDI) and the Mini Mental State Examination (MMSE), and patients were assessed with the Parkinson's Disease Questionnaire-8 (PDQ-8). RESULTS: No differences in total score were found between PD and NPC for any sexual function scale (BISF-M, BISF-W, IIEF, FSFI: p>0.05). However, the Orgasm/Pleasure Domain (BISF, D5) was significantly lower in male patients than in controls. CONCLUSION: Our findings fail to confirm previous findings that PD is associated with a significant sexual impairment. NPC and patients with PD have comparable sexual function in both sexes. Thus, rather than dismissing sexual dysfunction as a normal parkinsonian symptom, physicians should refer patients to sexual medicine specialists who can investigate and discuss problems fully, diagnose possible comorbidities, and suggest appropriate treatments.

16 Article An external portable device for adaptive deep brain stimulation (aDBS) clinical research in advanced Parkinson's Disease. 2016

Arlotti, Mattia / Rossi, Lorenzo / Rosa, Manuela / Marceglia, Sara / Priori, Alberto. ·Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Electronics, Computer Science and Systems, University of Bologna, Cesena, Italy. Electronic address: mattia.arlotti@policlinico.mi.it. · Newronika s.r.l., Milano, Italy. Electronic address: lorenzo.rossi@newronika.com. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: manuela.rosa@policlinico.mi.it. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Engineering and Architecture, University of Trieste, Trieste, Italy. Electronic address: smarceglia@units.it. · Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Sciences, University of Milan, Ospedale San Paolo, Milan, Italy. Electronic address: alberto.priori@unimi.it. ·Med Eng Phys · Pubmed #27029510.

ABSTRACT: Compared to conventional deep brain stimulation (DBS) for patients with Parkinson's Disease (PD), the newer approach of adaptive DBS (aDBS), regulating stimulation on the basis of the patient's clinical state, promises to achieve better clinical outcomes, avoid adverse-effects and save time for tuning parameters. A remaining challenge before aDBS comes into practical use is to prove its feasibility and its effectiveness in larger groups of patients and in more ecological conditions. We developed an external portable aDBS system prototype designed for clinical testing in freely-moving PD patients with externalized DBS electrodes. From a single-channel bipolar artifact-free recording, it analyses local field potentials (LFPs), during ongoing DBS for tuning stimulation parameters, independent from the specific feedback algorithm implemented. We validated the aDBS system in vitro, by testing both its sensing and closed-loop stimulation capabilities, and then tested it in vivo, focusing on the sensing capabilities. By applying the aDBS system prototype in a patient with PD, we provided evidence that it can track levodopa and DBS-induced LFP spectral power changes among different patient's clinical states. Our system, intended for testing LFP-based feedback strategies for aDBS, should help understanding how and whether aDBS therapy works in PD and indicating future technical and clinical advances.

17 Article Cerebellar and Motor Cortical Transcranial Stimulation Decrease Levodopa-Induced Dyskinesias in Parkinson's Disease. 2016

Ferrucci, Roberta / Cortese, Francesca / Bianchi, Marta / Pittera, Dario / Turrone, Rosanna / Bocci, Tommaso / Borroni, Barbara / Vergari, Maurizio / Cogiamanian, Filippo / Ardolino, Gianluca / Di Fonzo, Alessio / Padovani, Alessandro / Priori, Alberto. ·Fondazione IRCCS Ca' Granda, Milan, Italy. · Università degli Studi di Milano, Milan, Italy. · Spedali Civili di Brescia, Università degli Studi di Brescia, Brescia, Italy. · Università degli Studi di Pisa, Pisa, Italy. · Fondazione IRCCS Ca' Granda, Milan, Italy. alberto.priori@unimi.it. · Università degli Studi di Milano, Milan, Italy. alberto.priori@unimi.it. · III Clinica Neurologica, Polo Ospedaliero San Paolo, Milan, Italy. alberto.priori@unimi.it. ·Cerebellum · Pubmed #26542731.

ABSTRACT: Transcranial direct current stimulation (tDCS) is a non-invasive technique for inducing prolonged functional changes in the human cerebral cortex. This simple and safe neurostimulation technique for modulating motor functions in Parkinson's disease could extend treatment option for patients with movement disorders. We assessed whether tDCS applied daily over the cerebellum (cerebellar tDCS) and motor cortex (M1-tDCS) improves motor and cognitive symptoms and levodopa-induced dyskinesias in patients with Parkinson's disease (PD). Nine patients (aged 60-85 years; four women; Hoehn & Yahr scale score 2-3) diagnosed as having idiopathic PD were recruited. To evaluate how tDCS (cerebellar tDCS or M1-tDCS) affects motor and cognitive function in PD, we delivered bilateral anodal (2 mA, 20 min, five consecutive days) and sham tDCS, in random order, in three separate experimental sessions held at least 1 month apart. In each session, as outcome variables, patients underwent the Unified Parkinson's Disease Rating Scale (UPDRS III and IV) and cognitive testing before treatment (baseline), when treatment ended on day 5 (T1), 1 week later (T2), and then 4 weeks later (T3), at the same time each day. After patients received anodal cerebellar tDCS and M1-tDCS for five days, the UPDRS IV (dyskinesias section) improved (p < 0.001). Conversely, sham tDCS, cerebellar tDCS, and M1-tDCS left the other variables studied unchanged (p > 0.05). Despite the small sample size, our preliminary results show that anodal tDCS applied for five consecutive days over the motor cortical areas and cerebellum improves parkinsonian patients' levodopa-induced dyskinesias.

18 Article Application of higher-order spectral analysis to local field potentials recorded in patients treated with deep brain stimulation. 2015

Marceglia, Sara / Bianchi, Anna Maria / Foffani, Guglielmo / Priori, Alberto / Cerutti, Sergio. · ·Conf Proc IEEE Eng Med Biol Soc · Pubmed #26737549.

ABSTRACT: Local field potentials (LFPs) recorded from implanted deep brain electrodes demonstrated the oscillatory nature of human basal ganglia. LFP rhythms were mainly characterized by means od power spectral analysis, thus loosing information related to rhythm phase synchronization and to event related phase modulations. Because the application of higher-order spectral analysis methodology can overcome such limitation, here we review the present applications of bispectral and cross-bispectral analysis to LFP recordings. The results obtained up to now showed that higher-order spectral analysis was able to clarify detect different rhythm synchronizations and interactions characterizing different pathologies and patient's states.

19 Article Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease. 2015

Fumagalli, Manuela / Marceglia, Sara / Cogiamanian, Filippo / Ardolino, Gianluca / Picascia, Marta / Barbieri, Sergio / Pravettoni, Gabriella / Pacchetti, Claudio / Priori, Alberto. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy. · U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy. · Unità Operativa Parkinson e Disordini del Movimento, IRCCS Istituto Neurologico Mondino, Via Mondino 2, Pavia, Italy. · Dipartimento di Economia, Management e Metodi Quantitativi, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy; Applied Research Unit for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Via Giuseppe Ripamonti 435, Milan, Italy. · Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan, Italy. Electronic address: alberto.priori@unimi.it. ·Parkinsonism Relat Disord · Pubmed #25976985.

ABSTRACT: INTRODUCTION: The possibility that deep brain stimulation (DBS) in Parkinson's disease (PD) alters patients' decisions and actions, even temporarily, raises important clinical, ethical and legal questions. Abnormal moral decision-making can lead to ethical rules violations. Previous experiments demonstrated the subthalamic (STN) activation during moral decision-making. Here we aim to study whether STN DBS can affect moral decision-making in PD patients. METHODS: Eleven patients with PD and bilateral STN DBS implant performed a computerized moral task in ON and OFF stimulation conditions. A control group of PD patients without DBS implant performed the same experimental protocol. All patients underwent motor, cognitive and psychological assessments. RESULTS: STN stimulation was not able to modify neither reaction times nor responses to moral task both when we compared the ON and the OFF state in the same patient (reaction times, p = .416) and when we compared DBS patients with those treated only with the best medical treatment (reaction times: p = .408, responses: p = .776). CONCLUSIONS: Moral judgment is the result of a complex process, requiring cognitive executive functions, problem-solving, anticipations of consequences of an action, conflict processing, emotional evaluation of context and of possible outcomes, and involving different brain areas and neural circuits. Our data show that STN DBS leaves unaffected moral decisions thus implying relevant clinical and ethical implications for DBS consequences on patients' behavior, on decision-making and on judgment ability. In conclusion, the technique can be considered safe on moral behavior.

20 Article Web-based telemonitoring and delivery of caregiver support for patients with Parkinson disease after deep brain stimulation: protocol. 2015

Marceglia, Sara / Rossi, Elena / Rosa, Manuela / Cogiamanian, Filippo / Rossi, Lorenzo / Bertolasi, Laura / Vogrig, Alberto / Pinciroli, Francesco / Barbieri, Sergio / Priori, Alberto. ·Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy. sara.marceglia@policlinico.mi.it. ·JMIR Res Protoc · Pubmed #25803512.

ABSTRACT: BACKGROUND: The increasing number of patients, the high costs of management, and the chronic progress of the disease that prevents patients from performing even simple daily activities make Parkinson disease (PD) a complex pathology with a high impact on society. In particular, patients implanted with deep brain stimulation (DBS) electrodes face a highly fragile stabilization period, requiring specific support at home. However, DBS patients are followed usually by untrained personnel (caregivers or family), without specific care pathways and supporting systems. OBJECTIVE: This projects aims to (1) create a reference consensus guideline and a shared requirements set for the homecare and monitoring of DBS patients, (2) define a set of biomarkers that provides alarms to caregivers for continuous home monitoring, and (3) implement an information system architecture allowing communication between health care professionals and caregivers and improving the quality of care for DBS patients. METHODS: The definitions of the consensus care pathway and of caregiver needs will be obtained by analyzing the current practices for patient follow-up through focus groups and structured interviews involving health care professionals, patients, and caregivers. The results of this analysis will be represented in a formal graphical model of the process of DBS patient care at home. To define the neurophysiological biomarkers to be used to raise alarms during the monitoring process, neurosignals will be acquired from DBS electrodes through a new experimental system that records while DBS is turned ON and transmits signals by radiofrequency. Motor, cognitive, and behavioral protocols will be used to study possible feedback/alarms to be provided by the system. Finally, a set of mobile apps to support the caregiver at home in managing and monitoring the patient will be developed and tested in the community of caregivers that participated in the focus groups. The set of developed apps will be connected to the already existing WebBioBank Web-based platform allowing health care professionals to manage patient electronic health records and neurophysiological signals. New modules in the WebBioBank platform will be implemented to allow integration and data exchange with mobile health apps. RESULTS: The results of this project will provide a novel approach to long-term evaluation of patients with chronic, severe conditions in the homecare environment, based on caregiver empowerment and tailored applications developed according to consensus care pathways established by clinicians. CONCLUSIONS: The creation of a direct communication channel between health care professionals and caregivers can benefit large communities of patients and would represent a scalable experience in integrating data and information coming from a clinical setting to those in home monitoring.

21 Article WebBioBank: a new platform for integrating clinical forms and shared neurosignal analyses to support multi-centre studies in Parkinson's Disease. 2014

Rossi, Elena / Rosa, Manuela / Rossi, Lorenzo / Priori, Alberto / Marceglia, Sara. ·Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, piazza Leonardo da Vinci 32, 20133 Milan, Italy. · Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. · Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, piazza Leonardo da Vinci 32, 20133 Milan, Italy. Electronic address: sara.marceglia@polimi.it. ·J Biomed Inform · Pubmed #25205596.

ABSTRACT: BACKGROUND: The web-based systems available for multi-centre clinical trials do not combine clinical data collection (Electronic Health Records, EHRs) with signal processing storage and analysis tools. However, in pathophysiological research, the correlation between clinical data and signals is crucial for uncovering the underlying neurophysiological mechanisms. A specific example is the investigation of the mechanisms of action for Deep Brain Stimulation (DBS) used for Parkinson's Disease (PD); the neurosignals recorded from the DBS target structure and clinical data must be investigated. OBJECTIVE: The aim of this study is the development and testing of a new system dedicated to a multi-centre study of Parkinson's Disease that integrates biosignal analysis tools and data collection in a shared and secure environment. METHODS: We designed a web-based platform (WebBioBank) for managing the clinical data and biosignals of PD patients treated with DBS in different clinical research centres. Homogeneous data collection was ensured in the different centres (Operative Units, OUs). The anonymity of the data was preserved using unique identifiers associated with patients (ID BAC). The patients' personal details and their equivalent ID BACs were archived inside the corresponding OU and were not uploaded on the web-based platform; data sharing occurred using the ID BACs. The system allowed researchers to upload different signal processing functions (in a .dll extension) onto the web-based platform and to combine them to define dedicated algorithms. RESULTS: Four clinical research centres used WebBioBank for 1year. The clinical data from 58 patients treated using DBS were managed, and 186 biosignals were uploaded and classified into 4 categories based on the treatment (pharmacological and/or electrical). The user's satisfaction mean score exceeded the satisfaction threshold. CONCLUSIONS: WebBioBank enabled anonymous data sharing for a clinical study conducted at multiple centres and demonstrated the capabilities of the signal processing chain configuration as well as its effectiveness and efficiency for integrating the neurophysiological results with clinical data in multi-centre studies, which will allow the future collection of homogeneous data in large cohorts of patients.

22 Article Lies tell the truth about cognitive dysfunction in essential tremor: an experimental deception study with the guilty knowledge task. 2013

Mameli, F / Tomasini, E / Scelzo, E / Fumagalli, M / Ferrucci, R / Bertolasi, L / Priori, A. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico, Milan, Italy. ·J Neurol Neurosurg Psychiatry · Pubmed #23595946.

ABSTRACT: BACKGROUND: Research conducted in the past decade challenges the traditional view that essential tremor (ET) is characterised exclusively by movement disorder, and increasingly shows that these patients have deficits in cognitive and behavioural functioning. The available evidence suggests that this impairment might arise from dysfunction in either the fronto-subcortical or cortico-cerebellar circuits. Although abnormalities in the fronto-subcortical circuits could imply difficulty in lying, no study has investigated deception in patients with ET. AIMS: To examine the cognitive functions regulating deception in patients with ET, we used a computerised task, the Guilty Knowledge Task (GKT). We also tested a group of patients with Parkinson's disease (PD), a disease associated with a known difficulty in lie production, and a group of healthy subjects (HS). RESULTS: In the GKT for deception, patients with ET responded less accurately than HS (p=0.014) but similarly to patients with PD (p=0.955). No differences between groups were found in truthful responses (p=0.488). CONCLUSIONS: Besides confirming impaired deception in patients with PD, our results show a lie production deficit in patients with ET also. These findings suggest that difficulty in lying is an aspecific cognitive feature in movement disorders characterised by fronto-subcortical circuit dysfunction, such as PD and ET. Current knowledge along with our new findings in patients with ET--possibly arising from individually unrecognised extremely mild, cognitive difficulties--should help in designing specific rehabilitative programmes to improve cognitive and behavioural disturbances in patients.

23 Article Pathological gambling in Parkinson's disease: subthalamic oscillations during economics decisions. 2013

Rosa, Manuela / Fumagalli, Manuela / Giannicola, Gaia / Marceglia, Sara / Lucchiari, Claudio / Servello, Domenico / Franzini, Angelo / Pacchetti, Claudio / Romito, Luigi / Albanese, Alberto / Porta, Mauro / Pravettoni, Gabriella / Priori, Alberto. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. ·Mov Disord · Pubmed #23554027.

ABSTRACT: Pathological gambling develops in up to 8% of patients with Parkinson's disease. Although the pathophysiology of gambling remains unclear, several findings argue for a dysfunction in the basal ganglia circuits. To clarify the role of the subthalamic nucleus in pathological gambling, we studied its activity during economics decisions. We analyzed local field potentials recorded from deep brain stimulation electrodes in the subthalamic nucleus while parkinsonian patients with (n = 8) and without (n = 9) pathological gambling engaged in an economics decision-making task comprising conflictual trials (involving possible risk-taking) and non conflictual trials. In all parkinsonian patients, subthalamic low frequencies (2-12 Hz) increased during economics decisions. Whereas, in patients without gambling, low-frequency oscillations exhibited a similar pattern during conflictual and non conflictual stimuli, in those with gambling, low-frequency activity increased significantly more during conflictual than during non conflictual stimuli. The specific low-frequency oscillatory pattern recorded in patients with Parkinson's disease who gamble could reflect a subthalamic dysfunction that makes their decisional threshold highly sensitive to risky options. When parkinsonian patients process stimuli related to an economics task, low-frequency subthalamic activity increases. This task-related change suggests that the cognitive-affective system that drives economics decisional processes includes the subthalamic nucleus. The specific subthalamic neuronal activity during conflictual decisions in patients with pathological gambling supports the idea that the subthalamic nucleus is involved in behavioral strategies and in the pathophysiology of gambling.

24 Article The effects of levodopa and deep brain stimulation on subthalamic local field low-frequency oscillations in Parkinson's disease. 2013

Giannicola, Gaia / Rosa, Manuela / Marceglia, Sara / Scelzo, Emma / Rossi, Lorenzo / Servello, Domenico / Menghetti, Claudia / Pacchetti, Claudio / Zangaglia, Roberta / Locatelli, Marco / Caputo, Elena / Cogiamanian, Filippo / Ardolino, Gianluca / Barbieri, Sergio / Priori, Alberto. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. ·Neurosignals · Pubmed #22538235.

ABSTRACT: New adaptive systems for deep brain stimulation (DBS) could in the near future optimize stimulation settings online so as to achieve better control over the clinical fluctuations in Parkinson's disease (PD). Local field potentials (LFPs) recorded from the subthalamic nucleus (STN) in PD patients show that levodopa and DBS modulate STN oscillations. Because previous research has shown that levodopa and DBS variably influence beta LFP activity (8-20 Hz), we designed this study to find out how they affect low-frequency (LF) oscillations (2-7 Hz). STN LFPs were recorded in 19 patients with PD during DBS, after levodopa medication, and during DBS and levodopa intake combined. We investigated the relationship between LF modulations, DBS duration and levodopa intake. We also studied whether LF power depended on disease severity, the patient's clinical condition and whether LF modulations were related to electrode impedances. LF power increased during DBS, after levodopa intake and under both experimental conditions combined. The LF power increase correlated with the levodopa-induced clinical improvement and the higher the electrode impedance, the greater was the LF power change. These data suggest that the LF band could be useful as a control neurosignal for developing novel adaptive DBS systems for patients with PD.

25 Article Subthalamic local field potentials after seven-year deep brain stimulation in Parkinson's disease. 2012

Giannicola, Gaia / Rosa, Manuela / Servello, Domenico / Menghetti, Claudia / Carrabba, Giorgio / Pacchetti, Claudio / Zangaglia, Roberta / Cogiamanian, Filippo / Scelzo, Emma / Marceglia, Sara / Rossi, Lorenzo / Priori, Alberto. ·Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ·Exp Neurol · Pubmed #22735488.

ABSTRACT: Studies describing subthalamic (STN) local field potentials (LFPs) recorded during deep brain stimulation (DBS) in patients with Parkinson's disease (PD), within the first month after DBS electrode implant, show that DBS modulates specific STN oscillations: whereas low-frequency (LF) oscillations (2-7 Hz) increase, beta oscillations (8-30 Hz) variably decrease. No data show whether LFPs remain stable for longer than one month after DBS surgery. Having long-term information is essential especially for use as a long-term feedback control signal for adaptive DBS systems. To evaluate how STN activity behaves years after prolonged chronic stimulation in PD we studied STN LFPs at rest without DBS and during ongoing DBS, in 11 parkinsonian patients 7 years (7.54±1.04) after STN electrode implantation for DBS (hyperchronic group) and in 16 patients 3 days after STN electrode implantation (acute group). STN LF and beta-band LFPs recorded at rest at 7 years contained almost the same information as those recorded at 3 days. STN recordings showed similar LFP responses to DBS in the acute and hyperchronic stages: whereas during ongoing DBS the LF power band increased for the whole population, beta activity decreased only in nuclei with significant beta activity at baseline. The LF/beta power ratio in all nuclei changed in both study groups, suggesting that this variable might be an even more informative marker of PD than the single LF and beta bands. Because STN LFP activity patterns and STN LFP responses to DBS stay almost unchanged for years after DBS electrode implantation they should provide a consistent feedback control signal for adaptive DBS.

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