• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 25
  • 17
  • 10
  • 6
  • 3
  • 1
  • 1
  • 1
  • 1
  • Tagged with
  • 70
  • 66
  • 48
  • 44
  • 43
  • 33
  • 22
  • 21
  • 21
  • 19
  • 18
  • 12
  • 11
  • 11
  • 10
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
41

Saccade Related Gamma Potentials Recorded in Human Subthalamic Nucleus, Globus Pallidus Interna and Ventrointermediate Nucleus of the Thalamus

Sundaram, Arun N. E. 03 December 2012 (has links)
Gamma oscillations of local field potentials (LFP) in the basal ganglia and thalamus had not been studied during saccades. Eleven patients were studied during deep brain stimulation (DBS); 6 were in the subthalamic nucleus (STN); 3 in the globus pallidus interna (GPi); and 2 in the thalamic ventralis intermedius nucleus (Vim). Patients performed horizontal saccades to visual targets while LFPs from DBS electrodes, scalp electroencephalogram (EEG), and electrooculogram (EOG) were recorded. Wavelet spectrograms were generated and saccade onset and event-related gamma synchronizations (ERS) were compared to baseline without eye motion. ERS were recorded at and after saccade onset in the STN, GPi and Vim, EEGs and EOGs; but were absent during target light illumination without saccades. ERS were symmetric in all DBS contacts and appeared identical in DBS LFPs, frontal EEGs and EOGs. These findings indicate their origin from extraocular muscle spike potentials rather than brain neural activity.
42

Χρήση του μοντέλου Izhikevich για προσομοίωση της νευροφυσιολογικής λειτουργίας του υποθαλαμικού πυρήνα με βάση δυναμικά τοπικού πεδίου

Παπαμιχάλης, Βασίλειος 27 December 2010 (has links)
Στην παρούσα εργασία μελετάμε τη μοντελοποίηση του υποθαλαμικού πυρήνα των βασικών γαγγλίων με χρήση του μαθηματικού νευρωνικού μοντέλου Izhikevich. Βάση της μελέτης μας αποτελούν μικροηλεκτροδιακές καταγραφές, που έχουν ληφθεί κατά τη διάρκεια νευροχειρουργικών επεμβάσεων εν τω βάθει εγκεφαλικής διέγερσης, για τη συμπτωματική θεραπεία της νόσου Πάρκινσον. Θα ξεκινήσουμε με μια εισαγωγή στην φυσιολογία του νευρικού κυττάρου και στην ανατομία των βασικών γαγγλίων. Θα αναλύσουμε τα βασικά ποιοτικά μοντέλα που ερμηνεύουν τη συμμετοχή των τελευταίων σε κινητικές διεργασίες, αλλά και την εμπλοκή τους στη νόσο Πάρκινσον. Μετά από μια σύντομη αναφορά στη μέθοδο της εν τω βάθει διέγερσης και στις μικροηλεκτροδιακές καταγραφές, θα εστιάσουμε στα δυναμικά τοπικού πεδίου και στη νευροφυσιολογική σημασία τους. Συνεχίζοντας, θα κάνουμε μια περιεκτική ανασκόπηση των βασικότερων μαθηματικών μοντέλων νευρώνων και ύστερα θα επικεντρωθούμε στον υποθαλαμικό πυρήνα, περιγράφοντας δύο πρόσφατα μοντέλα που έχουν κατασκευαστεί για την προσομοίωση των νευρώνων αυτού. Έπειτα, θα περάσουμε στην περιγραφή του μοντέλου Izhikevich και στην τροποποίησή του για την αναπαραγωγή των χαρακτηριστικών του νευρώνα του υποθαλαμικού πυρήνα. Κατόπιν, θα αναλύσουμε τη μεθοδολογία που ακολουθήσαμε στην παρούσα υλοποίηση και τις βασικές θεωρήσεις της μοντελοποίησης μας. Θα ολοκληρώσουμε με την παρουσίαση των αποτελεσμάτων, το σχολιασμό αυτών και τις ιδέες για μελλοντική επέκταση της μεθόδου μας. / The main objective of this MSc thesis is the study of subthalamic nucleus, by using the Izhikevich neuron model. Microelectrode recordings, taken during deep brain stimulation operations for Parkinson’s disease, have been used for that purpose. In chapters 1-2, there is an introduction to the physiology of the neuron and the basal ganglia anatomy. In the two following chapters, we are analyzing the basic qualitative models that describe the involvement of the basal ganglia in movements and the pathophysiology of Parkinson’s disease. We are briefly discussing the method of deep brain stimulation, microelectrode recordings processing and the extraction of local field potentials. In chapter 5, the basic mathematical neuron models are discussed. We are focusing on the subthalamic nucleus and we are describing two recently developed mathematical models of the subthalamic neuron. In chapter 6, we are outlining Izhikevich neuron model and its modification in order to describe the subthalamic neuron. In addition, we are analyzing the methodology developed for the implementation of the modeling process and our basic considerations. In chapter 7, the results of the simulation are presented and discussed, so that our conclusions provide ideas for further research.
43

Νευροφυσιολογική μελέτη της επίδρασης του εν τω βάθει του εγκεφάλου (DBS) στη λειτουργία του αυτόνομου νευρικού συστήματος (ΑΝΣ) σε ασθενείς με νόσο Parkinson

Τραχάνη, Ευτυχία 14 February 2012 (has links)
Σκοπός της μελέτης : H διερεύνηση της επίδρασης του εν τω βάθει εγκεφαλικού ερεθισμού στον υποθαλάμιο πυρήνα (STN-DBS) στη λειτουργία του Αυτόνομου Νευρικού Συστήματος (ΑΝΣ) σε ασθενείς με Νόσο Πάρκινσον. Μέθοδος-Υλικό: Στη μελέτη έλαβαν μέρος 24 ασθενείς με ιδιοπαθή νόσο Πάρκινσον και 24 υγιείς μάρτυρες με πλήρη αντιστοιχία ως προς το φύλο και την ηλικία (μέσος όρος ηλικίας± σταθερά απόκλιση, 62.1±9.4 έτη). Η εκτίμηση των ασθενών έγινε 3 μέρες προ χειρουργείου ενώ ελάμβαναν κανονικά την αγωγή τους και 6 μήνες μετά την επέμβαση σε “on DBS/ on medication” κατάσταση. Όλοι οι ασθενείς συμπλήρωσαν ένα ερωτηματολόγιο σχετικά με τα συμπτώματα από το ΑΝΣ και υπεβλήθησαν σε μέτρηση της Αρτηριακής Πίεσης (ΑΠ) σε ύπτια θέση καθώς και στο 1ο και 3ο λεπτό μετά από απότομη έγερση από ύπτια σε όρθια θέση. Η νευροφυσιολογική εκτίμηση ασθενών και μαρτύρων περιελάμβανε: α. μέτρηση της συμπαθητικής δερματικής απάντησης (ΣΔΑ) από την παλάμη και το πέλμα με ηλεκτρικό ερεθισμό, β. μελέτη της διακύμανσης του καρδιακού ρυθμού (ΚΡ) ως προς τον χρόνο στις φάσεις της ήρεμης και βαθιάς αναπνοής (Rest RR IV και DB RR IV), κατά τη δοκιμασία Valsalva (Valsalva ratio) και κατά το Τilt-test (Tilt ratio). Με τη φασματική ανάλυση της πεντάλεπτης καταγραφής του ΚΡ σε ηρεμία που πραγματοποιήθηκε αργότερα υπολογίστηκαν οι παράμετροι LF, HF, LFnorm, HF norm, TP και ο λόγος LF/HF. Αποτελέσματα: Το 45,8% των ασθενών είχαν ορθοστατική υπόταση πριν και 12,5% μετά την επέμβαση, αλλά κατά τη στατιστική ανάλυση των μετρήσεων αυτών δεν πρόεκυψε σημαντική διαφορά μεταξύ των δύο ομάδων. Βρέθηκε σημαντική μείωση της συχνότητας των διαταραχών εφίδρωσης, της ακράτειας και της δυσκοιλιότητας στην μετεγχειρητική εκτίμηση (p<0,005). Στη ΣΔΑ μεταξύ των ασθενών πριν και μετά το STN-DBS δε βρέθηκαν στατιστικά σημαντικές διαφορές. Συνολικά 6 ασθενείς είχαν παθολογική ή απούσα ΣΔΑ πριν το χειρουργείο και 7 μετά (χ 2, p=0,114). Στις παραμέτρους Rest RR IV, DB RR IV, Valsalva ratio & Tilt ratio δε διαπιστώθηκε σημαντική διαφορά προ και μετά DBS (p>0.,050) και ήταν μάλιστα και προ- και μετεγχειρητικά μειωμένες στους ασθενείς απ’ ότι στους μάρτυρες (p <0,050). Σημαντική μείωση μόνο της παραμέτρου LF προέκυψε συγκρίνοντας τους ασθενείς πριν και μετά τη χειρουργική επέμβαση ενώ οι ασθενείς μετεγχειρητικά είχαν σημαντικά μειωμένες τιμές των LF, TP και LFnorm σε σχέση με τις αντίστοιχες τιμές των υγιών μαρτύρων. Δε βρέθηκε συσχέτιση (p >0,050) της κινητικής βελτίωσης λόγω DBS με τις ατομικές διαφορές των τιμών των παραμέτρων στον εκάστοτε ασθενή πριν και μετά το χειρουργείο. Συμπεράσματα: Είναι σαφής η θετική επίδραση του DBS στη μείωση της συχνότητας των διαταραχών εφίδρωσης, αλλά το χειρουργείο δεν έπαιξε αξιοσημείωτο ρόλο στις ΣΔΑ. Βρέθηκε μόνο μια μη στατιστικά σημαντική μείωση του ποσοστού των ασθενών με Ο.Υ., ενώ καμία επίδραση δεν υπήρξε στις παθολογικές τιμές του Κ.Ρ. των ασθενών. H φασματική ανάλυση του Καρδιακού Ρυθμού δεν έδειξε αλλαγή στην ισορροπία μεταξύ συμπαθητικής και παρασυμπαθητικής λειτουργίας λόγω DBS. Γενικό συμπέρασμα είναι ότι STN-DBS ωφελεί σημαντικά την κινητική βελτίωση, αλλά δεν έχει αξιόλογη, θετική ή αρνητική, επίδραση στη ρύθμιση της λειτουργίας του ΑΝΣ. / Purpose: To assess the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on the autonomic nervous system function in patients with advanced Parkinson’s disease (PD). Material- Methods: Twenty-four patients with idiopathic PD (mean age±SD, 62.1±9.4 years old) were examined 3 days before and 6 months after DBS, “on medication” state both times. Each examination session included registration of autonomic symptoms by means of a semi-structural questionnaire, blood pressure (BP) recording at supine position and at the first and third minute after sudden change from supine to standing position and a neurophysiological assessment. The neurophysiological examination included: a. recording of sympathetic skin response (SSR) from both palms and a sole, b. time domain analysis of RR interval variation during normal and deep breathing, during Valsalva manoeuvre and during tilt test. By off-line performed frequency domain analysis of heart rate variation the Total Power, the Low Frequency band, the High Frequency band and their normalized units were estimated. The neurophysiological measurements were compared to those of 24 healthy controls matched for age and sex. Results: Orthostatic hypotension was present in 45.8% of the patients preoperatively and 12.5% postoperatively, whereas statistical analysis showed no significant difference in BP measurements between pre- and post DBS studies. A statistical significant reduction in the frequency of autonomic symptoms such as constipation, sweating disturbances and urgency was established after implantation. In SSR measurements no change was found between patients before and after DBS. Six out of 24 patients has abnormal or absent SSR before surgery and 7 afterwards (χ 2, p =0.114). The values of time domain variables were both pre and postoperatively lower in patients than in controls. A significant reduction was found in LF band after the implantation. There was no correlation between individual, deep brain stimulation-related changes of motor function and corresponding neurophysiological measurements. Conclusions: The positive effect of STN-DBS on the sweating disturbances reported by patients is established, whereas no influence was found on SSR measurements. Subthalamic stimulation had no effect on the abnormal heart rate regulation of the patients, but a non significant reduction in orthostatic hypotension was noticed. Finally through spectral analysis no effect on the balance of sympathetic and parasympathetic function was found. Overall, despite its clear benefit on motor performance, STN-DBS had no considerable, positive or negative, impact on the autonomic regulation.
44

Váhové změny u pacientů s Pakinsonovou nemocí, kteří byli léčeni hlubokou mozkovou stimulací. / Weight changes in patients with Parkinson's disease treated with Deep Brain Stimulation.

Undus, Lucie January 2018 (has links)
1 Abstract Body weight changes have been described in the course of Parkinson's disease (PD) as well as following bilateral deep brain stimulation of the subthalamic nucleus (STN DBS) performed in advanced PD. According to the literature weight changes occur in 50-100% of patients who undergo STN DBS. In the last 15 years extensive efforts have been put in understanding the underlying mechanisms behind the weight changes following STN DBS in advanced PD patients however many sources still report conflicting evidence. Improved motor status, reduction in dyskinesias, decrease in energy expenditure, dopaminergic medication reduction, modification of food intake, hormonal factors, regional effects of stimulation were all speculated to cause this weight gain. We hypothesized that patients who underwent STN DBS procedure in our center would gain weight as reported in the literature (study 1, study 2). The etiology of post STN DBS weight gain has not been fully elucidated up to date, in our second study we further hypothesized that the weight changes are due to dysregulation of food related hormones and parameters (study 2). In the third study we hypothesized that weight gain is associated with position of active electrode contact (study 3). Aims of the study: The primary aims of our studies were to assess body...
45

Efeitos adversos produzidos pela estimulação cerebral profunda aguda do núcleo subtalâmico e suas correlações com características neuroanatômicas, localização do eletrodo e parâmetros de estimulação / Side effects produced by acute deep brain stimulation of the subthalamic nucleus and their correlations with neuroanatomic characteristics, electrode location and stimulation parameters

Caio César Marconato Simões Matias 01 July 2016 (has links)
A estimulação cerebral profunda do núcleo subtalâmico (NST) é um tratamento bem estabelecido para os sintomas refratários à medicação em paciente com doença de Parkinson avançada. Além do procedimento de implante, a programação dos eletrodos é uma etapa fundamental para atingir os resultados desejados. A primeira etapa da programação é estabelecer os limiares para efeitos adversos. Contudo, a correlação entre a localização do eletrodo e o limiar para efeitos adversos associados à estimulacao das estruturas adjacentes ainda não é bem estabelecida. Características neuroanatômicas e a localização dos eletrodos foram identificadas utilizando-se um programa de planejamento de cirurgia estereotáxica, enquanto os parâmetros de estimulação e os efeitos adversos foram obtidos dos prontuários médicos. As correlações entre estas variáveis foram testadas através de análises univariadas e análises multivariadas. Estimulação monopolar produziu efeitos adversos capsulares (EA-C) em 208 dos 316 contatos (65,8%) e efeitos adversos não-capsulares (EA-NC) em 223 dos 316 contatos (70,6%). A ocorrência de EA-C esteve associada com o número do contato (p = 0,009) e com a coordenada \"Z\" (p = 0,03), enquanto o limiar de voltagem para EA-C esteve correlacionado com o ângulo da cápsula interna (p = 0,035). A ocorrência de EA-NC esteve associada com o número do contato (p = 0,005), \"X\" (p = 0,03), \"Y\" (p = 0,004) e com a distância para o núcleo rubro (p = 0,001 e p = 0,003). Houve correlação entre o limiar de voltagem para EA-NC e o ângulo da cápsula interna (p = 0,006), o ângulo coronal do eletrodo (p = 0,02), \"X\" (p = 0,001), \"Y\" (p < 0,001), \"Z\" (p < 0,001) e com as distâncias para a cápsula interna (p = 0,02) e para o núcleo rubro (p = 0,004 e p < 0,001). EA-C estiveram associados com os contatos mais distais do eletrodo e com localização mais profunda, bem como com maior angulação da cápsula interna. EA-NC estiveram associados com os contatos mais distais do eletrodo, localizados mais medial, posterior e inferiormente e mais próximos do núcleo rubro. Ademais, houve associação entre EA-NC e eletrodos implantados com maior ângulo coronal, bem como com maior angulação da cápsula interna. Estes achados poderão ser úteis no desenvolvimento de novas estratégias para o planejamento do implante de eletrodos de estimulação cerebral profunda. / Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for medically refractory motor symptoms of patients with advanced Parkinson\'s disease. Programming of the device is as relevant to patient outcome as accurate implantation of the electrodes. The first step of DBS programming is to identify the thresholds to side effects. However, the relationship between lead location and the threshold to adverse effects is not fully understood. Anatomical measurements and electrode location were evaluated on a stereotactic surgical planning software, whereas stimulation parameters and side effects were obtained from medical records. Correlations among these variables were tested using univariate and multivariable analyses. Monopolar stimulation elicited capsular side effects (CSEs) in 208 of 316 contacts (65.8%) and noncapsular side effects (NCSEs) in 223 of 316 contacts (70.6%). The occurrence of CSEs was correlated with contact number (p = 0,009) and with the \"Z\" coordinate (p = 0,03), whereas voltage threshold to CSEs exhibited correlation with the internal capsule angle (p = 0,035). The occurrence of NCSEs was correlated with contact number (p = 0,005), \"X\" (p = 0,03), \"Y\" (p = 0,004), and the distance to the red nucleus (p = 0,001 and p = 0,003). There was correlation between voltage threshold to NCSEs and the internal capsule angle (p = 0,006), electrode\'s coronal angle (p = 0,02), \"X\" (p = 0,001), \"Y\" (p < 0,001), \"Z\" (p < 0,001), and the distances to the internal capsule (p = 0,02) and to the red nucleus (p = 0,004 and p < 0,001). CSEs were associated with more distally contacts, with deeper localization, as well as with greater internal capsule angles. NCSEs were associated with more distally contacts, with localization more medial, posterior and inferior, and closer to the red nucleus. Moreover, there was a correlation between NCSEs and electrodes implanted with greater coronal angles, as well as with greater internal capsule angles. These findings can be useful to inform novel targeting strategies for deep brain stimulation lead implantation.
46

Efeito do treino de marcha em esteira com e sem suporte de peso em pacientes com doença de Parkinson em uso de estimulação cerebral profunda / Effects of treadmill training with and without body weight support in Parkinson\'s Disease patients in use of deep brain stimulation

Natália Mariana Silva Luna 02 July 2015 (has links)
Introdução: A disfunção da marcha é um dos maiores comprometimentos funcionais do paciente com a doença de Parkinson (DP). A estimulação cerebral profunda do núcleo subtalâmico tem mostrado melhora da marcha e equilíbrio. Esse efeito pode ser mantido e potencializado por programas de reabilitação motora específicos, como o treino em esteira sem e com suporte de peso corporal. No entanto, faltam estudos desses treinos em pacientes com a DP em uso desta estimulação. Objetivo: Comparar parâmetros cinemáticos lineares e angulares da marcha de pacientes com a DP em uso de estimulação cerebral profunda bilateral do núcleo subtalâmico, antes e após dois treinamentos: esteira sem e com suporte de peso corporal, associados à cinesioterapia convencional. Métodos: 12 pacientes (60,9 ± 10,6 anos; 20 ± 7 anos de doença e 20 ± 4 meses de tempo de cirurgia) completaram ambos os treinos em estudo cruzado fixo. Os pacientes passaram por 8 semanas de treino de marcha em esteira sem suporte de peso corporal e programa de cinesioterapia convencional, seguidas por 6 semanas de período sem intervenção. Posteriormente, realizaram 8 semanas de treino de marcha em esteira com suporte de peso corporal e o mesmo programa de cinesioterapia regular. As intervenções tiveram frequência de duas vezes por semana e duração de 90 minutos por sessão. A análise cinemática da marcha envolveu oito câmeras infravermelhas que detectaram 19 marcadores reflexivos nos membros inferiores dos pacientes. A análise estatística utilizou o teste Wilcoxon e foi adotado valor de p <= 0,05 como estatisticamente significante. Resultados: Ambos os treinos não mostraram diferenças significativas nos parâmetros lineares. Após o treino com suporte, observou-se aumento significativo dos seguintes parâmetros angulares: amplitude de movimento da pelve (inclinação, obliquidade e rotação); amplitude de movimento do quadril (abduçãoadução e rotação); % da fase de balanço que corresponde à flexão máxima do joelho e amplitude de movimento da progressão do pé. Conclusão: O treino em esteira com suporte de peso corporal mostrou capacidade de promover mudanças em parâmetros cinemáticos angulares da marcha. As implicações do treino em suspensão podem ter sido somadas aos efeitos neurofisiológicos da estimulação cerebral profunda e então desencadeado a melhora da mobilidade dos membros inferiores durante a marcha / Introduction: Gait disturbance is one of the hallmark features of Parkinson\'s disease (PD). Subthalamic nucleus deep brain stimulation (DBS) has shown improvements in gait and balance, and this effect can be maintained and enhanced by specific motor rehabilitation programs, such treadmill training without and with body weight support. However, at present there is a paucity of research on these combined interventions in PD with of this stimulation. Objective: To compare training-induced changes in gait linear and angular kinematic parameters among patients with PD who have used bilateral subthalamic nucleus DBS, and a combined intervention of conventional physical therapy with either treadmill training with body weight support or without support. Methods: 12 patients (age: 60.9 ± 10.6 years; disease duration: 20 ± 7 years; and time since DBS surgery: 20 ± 4 months) completed both training protocols in a fixed cross-over design. All patients received 8 weeks of treadmill training without body weight support in conjunction with conventional physical therapy, followed by a 6 weeks wash out period of no training. Thereafter, all patients received 8 weeks of body weight support treadmill training, in conjunction with the same conventional physical therapy. Both interventions had a frequency of two times per week, and duration of 90 minutes per session. Gait kinematic analysis involved eight infrared cameras that detected 19 reflective spherical markers attached to the limb lower of patients. Statistical analysis used the Wilcoxon and was adopted the value of p <= 0,05 as statistically significant. Results: Both the training no showed significant differences in linear parameters. After the body weight support training, observed there was a significant increase in following angular parameters: pelvis\' range of motion (tilt, obliquity, rotation); hip\'s range of motion (abduction-adduction and rotation); % Knee maximal flexion on Swing phase and foot progression\' range of motion. Conclusion: Treadmill training with body weight support showed an ability to promote changes in gait angular kinematic parameters. The implications of this training may have been added to the neurophysiological effects of DBS and then triggered the improved of mobility of lower limbs during gait
47

Avaliação quantitativa dos efeitos da levodopa e da estimulação do núcleo subtalâmico sobre o equilíbrio em pacientes com doença de Parkinson / Quantitative evaluation of the effects of levodopa and bilateral subthalamic stimulation on postural control in patients with Parkinson´s disease

Rachael Brant Machado Rodrigues 23 March 2016 (has links)
INTRODUÇÃO: Os efeitos da levodopa (LD) e da estimulação cerebral profunda (ECP) de núcleo subtalâmico (STN) sobre o equilíbrio e sintomas axiais são até o momento controversos. OBJETIVOS: Avaliar quantitativamente os efeitos da ECP de STN e da LD sobre o equilíbrio estático em pacientes com DP operados, em comparação com a LD em pacientes não operados. MÉTODOS: Trinta e um pacientes submetidos a ECP de STN entre 3 meses e 1 ano e meio antes da avaliação e 26 controles portadores de DP não operados, estágios Hoehn e Yahr 2 a 4 foram avaliados usando UPDRS para avaliação clínica e plataforma de força para avaliar oscilações posturais. O primeiro grupo foi avaliado com ECP e sem medicação, com ECP e com medicação e sem ECP e sem medicação. O segundo grupo foi avaliado com e sem medicação. Cada paciente foi avaliado com os olhos abertos e fechados. O deslocamento do centro de pressão anteroposterior, laterolateral, a área, velocidade e deslocamento total linear foram medidos pela plataforma de força. Os dados paramétricos foram comparados usando o teste t de Student e os dados não-paramétricos foram comparados pelo teste de Kruskal-Wallis. A avaliação clínica consistiu na parte 3 da escala UPDRS e na escala Hoehn e Yahr. Nível de significância estatística considerada foi p=0,05. RESULTADOS: Os pacientes não operados oscilaram mais quando sob efeito da levodopa do que sem medicação. No grupo operado, a maior oscilação é no grupo com ECP desligada e sem medicação. Tende a reduzir sob efeito da ECP apresenta redução significativa sob efeito simultâneo de ECP e levodopa. CONCLUSÃO: A associação da ECP de NST com medicação tem impacto positivo sobre o controle postural. O efeito da ECP de NST reverte o efeito negativo da levodopa sobre as oscilações observadas em pacientes não operados / INTRODUCTION: The effects of bilateral subthalamic (STN) DBS and medication on balance and on axial symptoms in PD have been so far inconsistent. OBJECTIVE: To assess quantitatively the effects of DBS on static balance in PD. METHODS: Thirty-one patients submitted to STN DBS over 3 months before and 26 non-operated controls with PD on Hoehn & Yahr stage \"on\" 2 to 4 were evaluated using UPDRS and a force plate to measure sway. The first group was evaluated on-DBS/off-medication, on-DBS/on-medication and off-DBS/off-medication. The second group was evaluated on and off medication. Each group was assessed with eyes open and then closed. Antero-posterior, laterolateral postural displacements of the center of pressure (COP), as well as 95% sway area, path length and speed of oscillation were analyzed and compared using t-Student test for parametrical data and Kruskal-Wallis test for non-parametrical data. Level of significance was set to p < 0.05. Clinical assessment consisted of UPDRS part 3 and Hoehn & Yahr scores for each of the conditions. RESULTS: Control patients tended to oscillate more in the on medication condition than off medication. DBS patients tended to oscillate more in the off-DBS/off medication condition, with a tendency to decrease the sway when on DBS/off medication with additional decrease when on DBS/on medication. CONCLUSION: Association of bilateral STN DBS and medication positively influences postural control in PD and surgery reverses the tendency of medication to increase body sway in non-operated patients
48

United in Diversity : A Physiological and Molecular Characterization of Subpopulations in the Basal Ganglia Circuitry

Viereckel, Thomas January 2017 (has links)
The Basal Ganglia consist of a number of different nuclei that form a diverse circuitry of GABAergic, dopaminergic and glutamatergic neurons. This complex network is further organized in subcircuits that govern limbic and motor functions in humans and other vertebrates. Due to the interconnection of the individual structures, dysfunction in one area or cell population can affect the entire network, leading to synaptic and molecular alterations in the circuitry as a whole. The studies in this doctoral thesis aimed at characterizing restricted subpopulations of neurons in the Basal Ganglia circuitry and their importance in the wider function of the network. To this end, we identified subpopulations of neurons in the subthalamic nucleus (STN), substantia nigra (SN) and ventral tegmental area (VTA), characterized their molecular profile and investigated their physiological role in the circuitry. Within the mouse STN, reduction of glutamatergic neurotransmission in a subpopulation expressing Paired-like homeodomain transcription factor 2 (Pitx2) led to structural alterations in the nucleus as well as biochemical alterations of the dopaminergic system in the Nucleus accumbens (NAc) and changes in reward-related behavior. In the ventral midbrain, we identified and characterized novel marker genes selective to the VTA or SN. Of these, transient receptor potential cation channel subfamily V member 1 (TrpV1) marks a population of mainly glutamatergic neurons in the VTA which project to the NAc, while gastrin releasing peptide (Grp) is expressed in a population of dopaminergic neurons neuroprotected in Parkinson's disease. Furthermore, we discovered that disruption of glutamatergic co-release of dopaminergic neurons expressing dopamine transporter (DAT), diminishes fast EPSCs and glutamate release but does not affect the acquisition of reward-related behavioral tasks. To selectively quantify glutamate release from specific subpopulations, we devised a technique combining glutamate-amperometry and optogenetics. This was used to measure glutamate released from Pitx2-expressing synaptic terminals in the Globus pallidus as well as DAT- or TrpV1-expressing terminals in the NAc. In summary, this doctoral thesis has furthered understanding of the function and importance of specific subpopulations within the Basal Ganglia circuitry and provides a novel means to investigate glutamate in the intact rodent brain within clearly defined, restricted cell populations.
49

Rôle du striatum, du noyau subthalamique et du globus pallidus externe dans les processus motivationnels : étude électrophysiologique de l'influence de la force et de la récompense dans une tâche visuo-motrice chez le singe / Role of the striatum, the subthalamic nuclus and the external part of the globus pallidus in motivational processes : electrophysiological study of the influence of the force and the reward in a visuo-motor task in monkeys.

Nougaret, Simon 13 February 2015 (has links)
Les ganglions de la base forment un ensemble de structures sous-corticales connues pour leur implication dans les processus sensori-moteurs, cognitifs et motivationnels. L’objectif de ce travail était d’approfondir le rôle des neurones du noyau subthalamique (NST), des neurones de projections et interneurones cholinergiques du striatum et des neurones du globus pallidus externe (GPe) dans la mise en place et l’exécution d’un comportement dans différents contextes motivationnels. Nous nous sommes intéressés à l’influence de l’effort et de la récompense sur l’activité de ces neurones grâce à une approche comportementale associée à des enregistrements extracellulaires unitaires chez le singe éveillé. L’influence de ces facteurs a été appréhendée dans une tâche visuo-motrice dans laquelle différents niveaux d’effort et de récompense étaient imposés à l’animal. Nos résultats comportementaux ont montré une prise en compte de la valeur des stimuli par les animaux. Les résultats électrophysiologiques obtenus montrent une implication de chacune des populations étudiées dans le traitement des informations relatives à l’effort et à la récompense. Ils suggèrent un rôle des neurones du NST, du striatum et du GPe respectivement dans la mise en place, l’exécution et l’évaluation de l’action sur la base de la valeur subjective de la récompense. Nos résultats apportent des informations nouvelles sur les substrats neurophysiologiques qui sous-tendent les processus motivationnels dans la circuiterie des ganglions de la base. / The basal ganglia form a set of subcortical structures known to be involved in sensorimotor, cognitive and motivational processes. The aim of this work was to study the role of the subthalamic nucleus (STN) neurons, the cholinergic interneurons and the projection neurons of the striatum and the neurons of the external part of the globus pallidus (GPe) in the establishment and the execution of a behavior under different motivational contexts. We examined the influence of effort and reward on the activity of these neurons with a behavioral approach combined with extracellular recordings in awake monkeys. The influence of these factors has been investigated in a visuo-motor task in which different levels of effort and reward were imposed on the animal. Our behavioral results showed a consideration of the value of the visual stimuli by the animals. Electrophysiological results showed an implication of each of the neuronal populations studied in the encoding of force and reward related information. These data suggest a role of STN, striatum and GPe in the establishment, the execution and the update of the benefit of the action based on subjective reward value. Our results bring out new features on the neurophysiological substrates underlying motivational processes in basal ganglia circuitry.
50

Modification d'expression de NR2B lors de dyskinésies de la patte avant chez le rat induites par traitement chronique à la L-DOPA ou par stimulation à haute fréquence du Noyau Subthalamique / Modification of NR2B expression during forelimb dyskinesia induced by L-DOPA treatment or by high-frequency stimulation of the subthalamic nucleus in rat

Quintana, Adrien 08 July 2011 (has links)
La stimulation à haute fréquence (SHF) du noyau subthalamique (NST) joue un rôle essentiel chez les patients Parkinsoniens dans l'amélioration des troubles moteurs pour lesquels la dopa-thérapie n'est plus satisfaisante. Tout comme l'administration à long terme de L-DOPA, la SHF du NST, peut aussi, selon l'intensité de stimulation, évoquer des mouvements dyskinétiques. Ces dyskinésies sont considérées comme un phénomène d'apprentissage moteur pathologique, secondaire à une altération de la transmission glutamatergique et sont sous-tendues par des modifications durables d'expression génique, notamment dans le striatum. L'objectif de ce travail de thèse est d'étudier et de comparer les mécanismes moléculaires des dyskinésies induites par la L-DOPA à celles induites par la SHF, en se focalisant plus particulièrement sur la sous unité NR2B des récepteurs NMDA. Dans un premier temps, nous avons montré par immunohistochimie que la sous unité NR2B est hyperphosphorylée dans le NST et l'EP suite à l'induction de dyskinésie par la SHF du NST chez l'animal sain. Ces résultats ont été confirmés par la suite dans un modèle animal de la maladie de Parkinson, le rat 6-OHDA. La comparaison de ces modifications avec celles observées chez le rat 6-OHDA rendus dyskinétique par un traitement chronique à la L-DOPA nous permet de suggérer que l'induction des dyskinésies est associée à une hyperphosphorylation de NR2B au sein d'une voie subthalamo-entopédonculaire alors qu'une activation de NR2B dans le striatum semble être impliquée dans l'expression des dyskinésies. Enfin, nos résultats mettent également en évidence une implication différentielle des deux structures de sorties des ganglions de la base dans les processus akinétiques et dyskinésiogènes. / High frequency stimulation of the subthalamic nucleus (STN-HFS) alleviates parkinsonian motor symptoms and indirectly improves dyskinesia by decreasing L-DOPA requirement. However, inappropriate stimulation can also trigger dyskinetic movements Dyskinesia are thought to be a pathological learning process due to an overactive glutamate transmission within the basal ganglia. Moreover, several molecular changes seem to be involved in this process. The aim of the present study is to compare the molecular mechanisms of dyskinesia induced by L-DOPA and by STN-HFS, by focusing more particularly on the NR2B-containing NMDA receptor. We show by immunohistochemistry that NR2B subunit is hyperphosphorylated within the STN and the EP during a dyskinesiogenic STN-HFS in normal rats. Similar results are obtained from 6-OHDA rats, a model of Parkinson disease. Comparison of these results with those observed in 6-OHDA dyskinetic rats chronically treated with L-DOPA suggest that dyskinesia induction is associated with an hyperphosphorylation of NR2B within a subthalamo-entopeduncular network while activation of NR2B within the striatum seem to be involved in the expression of dyskinesia. A different implication of the two output of the basal ganglia in akinetic and dyskinesiogenic process is also demonstrated. STAR Date de soutenance : 8 juillet 2011 Thèse sur travaux: non

Page generated in 0.0977 seconds