Biomedical subjects
Publications and source records attributed to J L Vitek.
Pallidotomy has been re-explored for the treatment of Parkinson's disease and is now being used for the treatment of medically intractable dystonia. Although initial results are favourable for both disorders, determination of the long term benefits will require well controlled clinical trials.
We used gratings of alternating ridges and grooves in a quantitative psychophysical investigation of tactile perception in patients with Parkinson's disease (PD) and age-matched normal controls. The groove width required for threshold discrimination of grating orientation was 25% higher in the control subjects compared to younger individuals studied previously (p = 0.004), indicating a small but significant decline in tactile spatial acuity with age. Relative to age-matched controls, patients with PD showed a twofold increase in the tactile spatial threshold (p = 3.07 x 10(-8), with somewhat greater impairment on the side more affected clinically (p = 0.03). Testing with the forearm prone, as compared to supine, produced a small improvement in the acuity of patients (p = 0.01) but not controls (p = 0.26). PD patients were also impaired in tactually discriminating grating roughness: their difference limens were over three times higher than those of controls (p = 5.74 x 10(-5)) for gratings differing in groove width, and over twice as high (p = 0.0003) for gratings differing in ridge width. We conclude that PD significantly impairs performance on these tactile tasks.
1. Microeletrode mapping of the pallidum and adjacent structures allows for precise target identification and localization of critical structures, i.e., optic tract, internal capsule, and external pallidum, which must be spared from lesioning. 2. Microelectrode mapping has provided physiologic-anatomic correlation of determining the optimal target location as related to clinical outcome and has helped to refine the role of stimulation as a tool for target localization. 3. The improved accuracy of this technique should result in more accurate lesion placement which should improve long-term outcome and decrease morbidity.
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The effects of posterior internal pallidal ablation (GPi pallidotomy) on parkinsonian signs and symptoms were studied in 15 patients with medically intractable Parkinson's disease (PD). The sensorimotor territory of the internal portion of the globus pallidus and the adjacent optic tract and internal capsule were identified with microelectrode recording and stimulation. Radiofrequency lesions were then created in the identified sensorimotor territory. Pallidotomy significantly improved all cardinal parkinsonian motor signs (tremor, rigidity, akinesia/bradykinesia, and gait dysfunction) and reduced drug-induced motor fluctuations and dyskinesias. The improvements occurred predominately contralateral to the lesion, but were also present ipsilaterally. Early postoperative (3-month), mean total United Parkinson's Disease Rating Scale scores improved by 30.1% from preoperative values. Mean combined "on/off" Schwab and England Scale scores, a measure of functional independence, increased from 48.8% to 73.0% postoperatively. The mean total United Parkinson's Disease Rating Scale and Schwab and England scores did not show a statistically significant decline over the 1-year postoperative period. Surgery resulted in little morbidity, including a lack of significant deficits on neuropsychological and psychiatric testing. Physical and social functioning and vitality measures on the Medical Outcome Scale also showed significant improvement over the postoperative period. The findings of this pilot study demonstrate that ablation of the sensorimotor portion of the internal pallidum is a highly effective treatment for advanced PD, with benefits sustained at 1 year.
We have developed methods to detect and discern burst and oscillatory patterns of neuronal activity. In them, a burst period is defined as an interval in which there are a significantly higher number of spikes as compared to other intervals in the spike train. Oscillation is defined as a spike train in which significant periodicity is detected in its autocorrelogram. The main feature of our burst detection method is that discharge density (i.e., the number of spikes in a short interval) is used instead of the interspike interval. This enables one to assess the likelihood of having burst periods in a spike train. We use the Lomb periodogram to detect periodicity in an autocorrelogram. This method gives one significance of periodicity detected and enables the detection of multiple frequencies in an autocorrelogram. The advantage of these methods is discussed in comparison with the other methods used to detect bursting and oscillatory activity.
1. The functional organization of motor responses to microstimulation throughout the primate "motor" thalamus including nucleus ventralis lateralis, pars oralis (VLo); nucleus ventralis posterior lateralis, pars oralis (VPLo); nucleus ventralis lateralis, pars caudalis (VLc); and portions of ventralis anterior (VA) and area X, was systematically studied in awake monkeys. A total of 2,021 sites were examined for their response to microstimulation. Of these, 1,123 were histologically verified as to their location within the motor thalamus. At or near each site, isolated neurons were examined for their responses to somatosensory examination and active movement (n = 1,272). This study was carried out as part of a larger study examining the responses of neurons in the motor thalamus to somatosensory examination, torque-induced limb perturbations, and active movement in a visuomotor step-tracking task. 2. Microstimulation at < or = 40 microA evoked movements in the contralateral limbs, trunk, or face. Evoked movements of the limb were generally maximal about a single joint. 3. There was a differential response to microstimulation between subnuclei of the motor thalamus. In order of decreasing frequency, the percentages of sites within each subnucleus from which movements were evoked were as follows: VPLo, 93% (449 of 483); VLo, 21% (57 of 272); VLc, 11% (15 of 140); VA, 1% (1 of 85); and reticular nucleus, 0% (0 of 65). In VPLc, 44% (34 of 78) of sites examined were microexcitable. However, these were almost all within 500 microns of the border of VPLo, suggesting they may have occurred as a result of current spread to adjacent VPLo. Although area X was not sampled in its entirety, it did not appear to be microexcitable. 4. Microexcitable responses had a somatotopic organization, similar to that for neuronal responses to sensorimotor examination, with leg responses found most laterally and arm and face responses found progressively more medially. 5. Zones in VPLo generally ranging from 500 to 1,500 microns were found in which microstimulation resulted in the same motor response. These microexcitable zones resemble those described for the striatum and were termed thalamic microexcitable zones (TMZ). TMZs also resemble cortical efferent zones in that both are somatotopically organized, may affect a single muscle or group of muscles, have low thresholds for microstimulation with sharp boundaries that lie adjacent to other microexcitable zones with the opposite effects, and are of approximately the same dimension. 6. This study suggest that a fundamental unit of motor organization, i.e., single muscle or joint, is preserved at the thalamic level in the form of TMZs, and that these fundamental units of organization may contribute to the modular organization of the cortex.
It is now widely accepted that the basal ganglia (BG) are functionally organized with several segregated loops which start at a certain area in the cortex and project back to the same area in the cortex through the thalamus. The detailed functional organization of the BG motor loop has been described and used successfully to explain the mechanism of hypo- and hyper-kinetic disorders caused by BG disorders. Recent physiological and anatomical studies have provided new information concerning the function of these nuclei. The indirect pathway from the striatum to the external globus pallidus and then to the internal globus pallidus may be much more important than previous thought. The subthalamic nucleus may transmit excitatory input from the cortex as well as acting as a driving force on the globus pallidus. The role of BG output on the thalamus may not be to transfer information to the cortex via thalamocortical neurons, but rather to modulate the activity of cortico-thalamocortical loops. By varying it's discharge rate, the BG can change the membrane potentials of thalamocortical neurons which may result in focusing the activity of a specific cortico-thalamo-cortical loop and/or switching it to another.
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1. To examine the functional organization of the primate "motor" thalamus, neuronal activity was studied systematically in awake behaving monkeys throughout the nucleus ventralis lateralis, pars oralis (VLo), nucleus ventralis posterior lateralis, pars oralis (VPLo), ventralis lateralis, pars caudalis (VLc), and portions of ventralis anterior (VA) and Area X. In addition, portions of the sensory nucleus ventralis posterior lateralis, pars caudalis (VPLc) were explored. Isolated neurons were examined for their responses to somatosensory examination and active movement (n = 919) and for their response to torque-induced joint displacements (n = 375). A total of 684 neurons was determined histologically to lie within specific subnuclei of the motor (n = 574) or sensory (n = 110) thalamus. 2. The sensorimotor response properties of neurons in the thalamic subnuclei showed clear differences in their response to somatosensory examination. In order of decreasing frequency, the percent of neurons responding to passive somatosensory examination in each subnucleus were as follows: VPLc, 96% (106/110), VPLo, 93% (252/270), VLc, 77% (43/56), VLo, 37% (59/155), Area X, 22% (12/53), and VA, 12% (5/40). Conversely, neurons that responded only to active movement were most frequent in VLo, 44% (68/155), VA, 45% (18/40), and Area X, 40% (21/53) and relatively infrequent in VLc 11% (6/56) and VPLo, 3% (7/270). In VPLc, no neurons were found that responded only to active movement (0/110). 3. A well-defined somatotopic organization was found in VLo, VPLo, and VPLc and was suggested strongly for VLc. Individual body regions were represented in a series of lamellae, organized in a partial onion skin-like arrangement with the leg represented in the outermost lamella, and the trunk, arm, and orofacial regions represented in successively deeper lamellae. In general the body representations, although present for each subnucleus thoroughly examined, i.e., VLo, VPLo, and VPLc, also were contiguous across subnuclei. Based on the available data, a clear somatotopic picture could not be discerned for Area X or VA. 4. Responses to torque application were more common in neurons in VPLo (77%; 60/78) and VLc (73%; 16/22) than in VLo (44%; 12/27). Mean latencies were shortest for neurons in VPLo (25 +/- 14 ms; mean +/- SD) and the bordering (shell) region of VPLc (22 +/- 15 ms) and were approximately twice as long in VLc (51 +/- 23 ms) and VLo (47 +/- 21 ms).(ABSTRACT TRUNCATED AT 400 WORDS)
The electrophysiologic basis of parkinsonian tremor is discussed in terms of the central oscillator and peripheral feedback hypotheses of tremor. Recent studies in monkeys and humans suggest that parkinsonian tremor may result from the activity of a central oscillator, possibly located in the basal ganglia. Peripheral somatosensory input seems to modulate tremor and central nervous system activity related to tremor.
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The present findings suggest that the trend toward greater diversification of hospital services is likely to be most strongly influenced by state Medicaid policies and certain hospital characteristics. Increasing Medicaid eligibility and payment levels is likely to have a positive effect on services diversification. Growth in the number of inpatient services provided and a more severe case mix are also likely to be involved with greater service diversification. Affiliation with a not-for-profit hospital system is likely to be associated with more diversified hospital services but not affiliation with an investor-owned system. There is also some indication that the overall portfolio of services which a hospital offers in regard to market share and market growth characteristics influences diversification. Specifically, a low market share portfolio is likely to be associated with less diversification. Competition is likely to be associated with more diversification; particularly for hospitals belonging to systems. The effect of competition on hospital strategy and services diversification is a particularly important area for further investigation. Increasing Medicaid payment and eligibility levels are also likely to have a positive effect on the provision of services which are usually unprofitable. Raising such levels is likely to be particularly beneficial to inner-city hospitals who are already providing a greater number of such services. However, the present data suggest that investor-owned hospitals are least likely to provide such services. Increasing Medicaid eligibility levels is also likely to be associated with fewer services for which charity care has to be provided. State regulation in the form of rate review and certificate of need is likely to be associated with more services for which hospitals provide some charity care. But such policies alone do not deal with the larger issue of how to finance care for the medically indigent. Present data suggest the charity care issue may be particularly salient in markets characterized by a relatively high degree of competition. Finally, investor-owned hospitals provide as many services involving charity care as not-for-profit system hospitals, although investor-owned system hospitals provide fewer such services than not-for-profit freestanding hospitals. Throughout, the findings indicate the importance of distinguishing between ownership and system affiliation. Previous research has failed to make a distinction between ownership form and system affiliation, thus attributing to ownership form differences which, as present findings suggest, appear to be more associated with system affiliation.(ABSTRACT TRUNCATED AT 400 WORDS)
The effects of stimulating the cerebellar surface on abnormal segmental reflexes were examined in monkeys rendered spastic by either bilateral or unilateral decortication of areas 1, 2, 3, 4 and 6. Rectified, integrated electromyographic (EMG) activity from the biceps and triceps as well as the torque were recorded and averaged during successive flexion-extension movements of the arm produced by a displacement controlled torque motor. Two movement paradigms were employed. The first consisted of a ramp and hold paradigm with an initial rapid flexion of the forearm, a subsequent two second period during which the arm position was held constant, and a rapid extension returning the limb to the initial position. In the second paradigm, the forearm was modulated sinusoidally at several different frequencies. Cerebellar stimulating electrodes were placed over the paravermal region bilaterally. Different frequencies (10 to 300 HZ) and different charge densities (1.5 to 10 microC/cm2) were used in each animal. In each experimental trial short periods of cerebellar stimulation (10 to 30 minutes) were interspersed between control periods. As observed in some types of clinical spasticity, flexion or extension of the extremity was capable of evoking coactivation of the biceps and triceps. Cerebellar surface stimulation reduced the amplitude of the phasic and tonic stretch reflexes recorded from the triceps during flexion and decreased the abnormal triceps response during passive shortening. The biceps response to stretch was increased by cerebellar stimulation and its abnormal response to flexion was decreased. These combined effects modified the organization of the segmental reflexes, producing a more normal reciprocal relationships of the EMG activity in the biceps and triceps. Evaluation of many different combinations of stimulus parameters revealed that not only the magnitude of the passive reflex but also the nature of the effect was dependent on stimulus parameters. Although these studies demonstrate an improvement in the abnormal reflexes present in spastic primates, they emphasize the complexities of the response evoked by cerebellar stimulation and the importance of stimulus parameters in the modifications produced by this technique.
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