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We report on thalamic recordings in a patient with chronic disorder of consciousness (DOC). Implantation of central thalamic deep brain stimulation (CT-DBS) electrodes was chosen, as this treatment has been reported to display beneficial effects with respect to behavioural responsiveness in DOC. Local field potential (LFP) oscillations were recorded from central thalamic electrodes and their changes elicited by speech stimuli consisting either of familiar voices addressing the patient or unfamiliar non-addressing phrases were studied. In response to familiar-addressing speech we observed modulation of oscillatory activity in the beta and theta band within the central thalamus accompanied by an increase in thalamocortical coherence in the theta band. Furthermore, the theta phase was coupled to the amplitude of gamma locally in the thalamus. These findings indicate a local and long-range cross-frequency response which is not only indicative of the principle involvement of the central thalamus in processing emotional and cognitive information, but also point towards intact physiological functions that may serve as a marker in diagnosing DOC patients and determining novel targets and parameters concerning therapeutic efforts.

High frequency stimulation of the ventral intermedius nucleus (Vim) of the thalamus is successfully used for the treatment of postural tremor. Target coordinates are most commonly calculated using a statistical method. Here, we compare a statistical and an individual targeting method, using an histology-based three-dimensional deformable brain atlas which allows localization of the Vim on individual patient's MR images by adaptation of the atlas onto the patient's brain. Twenty-nine consecutive patients had electrodes implanted in the Vim uni-or bilaterally for severe essential tremor. Thirty-five targets were determined by calculating the statistical target and then using the deformable atlas to compute the individual target. Pythagorean distance between these targets was calculated. Statistical and individual targets were compared by double blind evaluation of perioperative stimulation effects. For most cases (n = 24), the Pythagorean distance was higher than 1.5 mm. In 79% of these cases, the definitive electrode was implanted using the position of the individual target. For the remaining cases (n = 11, distance < 1.5 mm), the definitive electrode was implanted according to the statistical target location in 73% of the cases. As a whole, when individual target was used, it was located at least 2 mm more medial than the statistical one in 86% cases. These results suggest that Vim target determination based on a statistical method might be inaccurate. In particular, laterality might be overestimated, leading to nonoptimal clinical results. In clinical practice, this means that microelectrode exploration during Vim surgery should include at least one trajectory more medial than the statistical target., (Copyright © 2010 Movement Disorder Society.)

The deep brain nuclei play an important role in many brain functions and particularly motor control. Damage to these structures result in movement disorders such as in Parkinson's disease or Huntington's disease, or behavioural disorders such as Tourette syndrome. In this paper, we propose to study the connectivity profile of the deep nuclei to the motor, associative or limbic areas and we introduce a novel tool to build a probabilistic atlas of these connections to the cortex directly on the surface of the cortical mantel, as it corresponds to the space of functional interest. The tool is then applied on two populations of healthy volunteers and patients suffering from severe Huntington's disease to produce two surface atlases of the connectivity of the basal ganglia to the cortical areas. Finally, robust statistics are used to characterize the differences of that connectivity between the two populations, providing new connectivity-based biomarkers of the pathology.

Depth recordings in patients with Parkinson's disease on dopaminergic therapy have revealed a tendency for oscillatory activity in the basal ganglia that is sharply tuned to frequencies of approximately 70 Hz and increases with voluntary movement. It is unclear whether this activity is essentially physiological and whether it might be involved in arousal processes. Here we demonstrate an oscillatory activity with similar spectral characteristics and motor reactivity in the human thalamus. Depth signals were recorded in 29 patients in whom the ventral intermediate or centromedian nucleus were surgically targeted for deep brain stimulation. Thirteen patients with four different pathologies showed sharply tuned activity centred at approximately 70 Hz in spectra of thalamic local field potential (LFP) recordings. This activity was modulated by movement and, critically, varied over the sleep-wake cycle, being suppressed during slow wave sleep and re-emergent during rapid eye movement sleep, which physiologically bears strong similarities with the waking state. It was enhanced by startle-eliciting stimuli, also consistent with modulation by arousal state. The link between this pattern of thalamic activity and that of similar frequency in the basal ganglia was strengthened by the finding that fast thalamic oscillations were lost in untreated parkinsonian patients, paralleling the behaviour of this activity in the basal ganglia. Furthermore, there was sharply tuned coherence between thalamic and pallidal LFP activity at approximately 70 Hz in eight out of the 11 patients in whom globus pallidus and thalamus were simultaneously implanted. Subcortical oscillatory activity at approximately 70 Hz may be involved in movement and arousal.

Background: Tourette syndrome (TS) is thought to result from dysfunction of the associative-limbic territories of the basal ganglia, and patients with severe symptoms of TS respond poorly to medication. High-frequency stimulation has recently been applied to patients with TS in open studies using the centromedian-parafascicular complex (CM-Pf) of the thalamus, the internal globus pallidus (GPi), or the anterior limb of the internal capsule as the principal target., Objective: To report the effect of high-frequency stimulation of the CM-Pf and/or the GPi, 2 associative-limbic relays of the basal ganglia, in patients with TS., Design: Controlled, double-blind, randomized crossover study., Setting: Medical research., Patients: Three patients with severe and medically refractory TS., Intervention: Bilateral placement of stimulating electrodes in the CM-Pf (associative-limbic part of the thalamus) and the GPi (ventromedial part)., Main Outcome Measures: Effects of thalamic, pallidal, simultaneous thalamic and pallidal, and sham stimulation on neurologic, neuropsychological, and psychiatric symptoms., Results: A dramatic improvement on the Yale Global Tic Severity Scale was obtained with bilateral stimulation of the GPi (reduction in tic severity of 65%, 96%, and 74% in patients 1, 2, and 3, respectively). Bilateral stimulation of the CM-Pf produced a 64%, 30%, and 40% reduction in tic severity, respectively. The association of thalamic and pallidal stimulation showed no further reduction in tic severity (60%, 43%, and 76%), whereas motor symptoms recurred during the sham condition. No neuropsychological, psychiatric, or other long-term adverse effect was observed., Conclusions: High-frequency stimulation of the associative-limbic relay within the basal ganglia circuitry may be an effective treatment of patients with TS, thus heightening the hypothesis of a dysfunction in these structures in the pathophysiologic mechanism of the disorder.

The pathophysiology of parkinsonian tremor remains a matter of debate with two opposing hypotheses proposing a peripheral and a central origin, respectively. A central origin of tremor could arise either from a rhythmic activity of the internal segment of the globus pallidus (GPi) or from a structure such as the thalamus, outside the basal ganglia. In this study, single-unit recordings were performed in three 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated monkeys within the GPi and within three territories of the motor thalamus (delimited by their afferent inputs from the GPi, the substantia nigra and the cerebellum, respectively). For each recorded neuron, we compared the variations in firing rate and pattern in tremor and no tremor periods. Tremor either occurred spontaneously or was induced by external stimulation. When the animals entered into a tremor period we observed: (i) an increase in the mean firing rate in about half of the recorded neurons of the motor thalamus; and (ii), a change from an irregular to a rhythmic discharge within the range of tremor frequency (5-7 Hz) in about 10% of the recorded neurons of the motor thalamus (pallidal and cerebellar territories) and the GPi. Most of the thalamic neurons that exhibited a rhythmic discharge during tremor were found to be sensitive to external stimulation. Because the changes in firing rate occurred predominantly in the motor thalamus and not in the GPi, and because a fast rhythmic discharge of 10-15 Hz was frequently observed in the GPi and not in the motor thalamus, we conclude that thalamic activity is not a simple reproduction of basal ganglia output. Moreover, we suggest that thalamic processing of basal ganglia outputs could participate in the genesis of tremor, and that this thalamic processing could be influenced by sensory inputs and/or changes in attentional level elicited by external stimulation.

This study presents an analysis of the distribution and organization pattern of axons originating from the substantia nigra pars reticulata and projecting to the thalamus in monkeys. Biotin dextran amine was iontophoretically injected into different parts of the substantia nigra pars reticulata of monkeys (African green monkeys and macaques). In whatever part of the substantia nigra the injection was made, numerous axonal endings were found to be distributed within different thalamic regions: the ventral anterior nucleus and mainly its magnocellular part, the most ventromedial part of the ventral lateral nucleus, and the mediodorsal and parafascicular nuclei. Moreover, the nigrothalamic projection appeared to be topographically organized. Ten anterogradely labeled axons were reconstructed from serial sections. The axons terminated in three to six terminal fields per axon located in a relatively small portion of only one thalamic region. These terminal fields were variable in size and comprised 4-43 very thin, varicose branches. They consisted either of different axonal branches of the same axon or of different axons and covered 10-31 thalamic cell bodies. These findings demonstrate that the overall morphological organization of individual nigral axons is complex and allows single axons to influence thalamic neurons via a combination of divergent, convergent, and amplification processes., (Copyright 2002 Wiley-Liss, Inc.)

Saccade adaptation can be experimentally induced by systematically displacing a visual cue during a targeting saccade. Non-human primate studies have highlighted the crucial role of the cerebellum for saccade adaptation, but its neural substrates in humans are poorly understood. Recent physiological experiments suggest that, in addition to cerebellar structures, cortical areas may be involved as well. We have therefore hypothesized that saccade adaptation may rely on a cerebello-cerebral network, in which the cerebellar thalamus may link cerebellar and cerebral structures. To test this hypothesis, we studied saccade adaptation in a group of four patients with a thalamic lesion, with (n = 2) or without (n = 2) involvement of the cerebellar thalamus. Compared to healthy subjects, saccade adaptation was reduced in patients with associated cerebellar syndrome, but normal in patients without cerebellar syndrome. These results are consistent with the hypothesis that cerebello-thalamic pathways contribute to saccade adaptation in humans and suggest that the thalamus relays adaptation-related information from the cerebellum to cerebral cortical oculomotor areas.

This study presents a three-dimensional analysis of pallido-thalamic axons and axonal endings in the monkey (Macaca mulatta and M. irus). Injections of the anterograde tracer biocytin were made in the dorsal, associative region of the medial pallidum. Numerous axonal endings were observed within the pallidal territory of the lateral region of the thalamus and the central complex. Individual axons were reconstructed from serial sections and traced in three dimensions. Two axons made a collateral branch in the ventral part of the lateral region and ended in the central complex. In the pallidal territory of the lateral region, axons divided several times before ending in different parts of the territory in a 'bunch', a characteristic dense terminal arborization. Axonal endings in the central complex were differently organized. Our data show that associative medial pallidal information is distributed throughout the pallidal territory of the lateral region and the pars media of the central complex by means of individual axons with numerous branches and axonal endings specific to each of the two targets.

This study presents three-dimensional tracings of axons and axonal endings of associative pallido-thalamic axons in the monkey (Macaca mulatta, M. irus). Injections of the anterograde tracer biocytin were made in the dorsal, associative region of the medial pallidum. Numerous axonal endings were observed throughout the pallidal territory of the thalamus. Four individual axons were reconstructed from serial sections and traced in three dimensions. The initial branch of each axon subdivided successively, each new branch ending in a different part of the pallidal territory. Each of the latter branches ended in a characteristic, extremely dense terminal arborization, that we called a bunch. Associative medial pallidal information may therefore be distributed throughout the pallidal territory by means of numerous branches and bunches.

Neuronal morphology was analyzed in the central complex (centre median-parafascicular complex) of macaques and humans. Cell bodies were described from Nissl material. Golgi-impregnated dendritic arborizations were reconstructed from serial sections and digitized in three dimensions by computer-assisted microscopy. The central complex was subdivided into three parts on the basis of cytoarchitectonic and hodological criteria: pars parafascicularis (medial), pars media (intermediate), and pars paralateralis (lateral). The mean cross-sectional areas of cell bodies were identical (181 microns2) in the three parts in macaques. In humans they were larger in the pars parafascicularis (304 microns2) than in the other parts (248 and 240 microns2). Small local circuit neurons were found throughout the complex. Large projection neurons differed statistically in the three parts. In macaques, pars parafascicularis neurons had few dendritic stems and tips (3-11) and a short total dendritic length (2,000 microns). Pars paralateralis neurons had more ramified (5-60) and longer (5,800 microns) dendrites. They bore numerous axonlike processes. Pars media neurons had intermediate characteristics (5-19; 2,400 microns). In humans, pars parafascicular neurons had similar topological characteristics (3-12) but longer dendrites (3,000 microns) than in the monkey. Pars paralateralis neurons had more branched (6-71) and longer (9,000 microns) dendrites, with more numerous axonlike processes. Pars media neurons also had intermediate characteristics (4-25; 3,800 microns). The present study supports a tripartite subdivision of the primate central complex and demonstrates significant interspecies differences.

The distribution of axons arising from the central complex (or centre médian-parafascicular complex) and terminating in the striatum was studied in seven macaques and one squirrel monkey. Deposits of anterograde tracers were made in the two lateral-most subdivisions of the central complex, i.e., the middle part (or pars media) and the lateral part (or pars paralateralis). All injections avoided the pars parafascicularis. The intrastriatal distribution of labeled axonal endings was mapped in relation to the standard ventricular (CA-CP) system of coordinates. Labeled endings were observed in the major posterior and dorsal parts of the putamen (excluding its anteromedial and ventral parts) and also in a restricted ventrolateral part of the caudate nucleus. The topography of the central territory of the striatum, defined as the striatal space receiving axons from the central complex, was found to correspond exactly to that of the cortical sensorimotor territory delineated after cortical injections. The termination pattern of the central axons within the striatum was patchy. Viewed as a whole, the irregular and hazy patches formed oblique streaks, parallel one with the other. The three-dimensional reconstructions of data from transverse sections revealed that the streaks were bi-dimensional pictures of three-dimensional parasagittal layers covering the whole anteroposterior extent of the cortical sensorimotor territory of the striatum. Our work shows that the pars media of the central complex, which receives selectively pallidal afferent axons (François et al., '88: Brain Res. 473:181-186), is the main source of the centroputaminal projection. The probable implication of this in a closed sensorimotor loop of the basal ganglia is discussed.

The distribution of the neurons of the central complex (or "centre médian-parafascicular complex") and of other thalamic regions projecting to the striatum was studied using a cartographic technique based on ventricular landmarks. The brain of a macaque was used as a reference for the cytoarchitectonic study of the complex. Three parts were isolated: the pars parafascicularis (or medial part), the pars media (or middle part) and the pars paralateralis (or lateral part). Wheat germ agglutinin conjugated to horseradish peroxidase was stereotaxically injected into either the sensorimotor or the associative territory of the striatum (i.e. the striatal space occupied by the axonal endings coming from either the sensorimotor or the associative cortex) of four macaques. Neurons projecting to the sensorimotor territory of the striatum were found to be located within the pars media (middle part) of the central complex while neurons projecting to the associative territory of the striatum were located within the pars parafascicularis. In all experimental cases, labelled neurons were scarce or absent in the pars paralateralis (or lateral part). Outside the central complex, neurons projecting to the sensorimotor territory of the striatum were scattered within the lateral part of the lateral mass, in the intralaminar nuclei and in the posterior part of the internal lamina. Neurons projecting to the associative territory of the striatum were observed mainly in the paraventricular region, dorsal to the rostral part of the lateral mass, and in the dorsolateral part of the nucleus oralis medialis. Our three-dimensional analysis of the clusters of the central complex cells projecting to the two striatal territories justifies the partitioning of the central complex into three parts. The pars media (or middle part), which projects to the sensorimotor territory of the striatum, receives selectively pallidal afferent axons. It belongs to the Nauta-Mehler loop, a closed loop linking the central complex to the basal ganglia. The pars parafascicularis, which projects to the associative territory of the striatum, seems more related to oculomotor neuronal systems. The pars paralateralis (or lateral part) appears to have very little, if any, relation with the striatum.

The respective topographic distribution of the pallidal neurons projecting to the central complex (centre médian-parafascicular complex) and to the oral part of the lateral mass of the thalamus was studied by using a topographic technique based on ventricular landmarks. WGA-HRP was stereotactically injected into the central complex of 4 macaques and into the oral part of the lateral mass of the thalamus of 3 others. Neurons projecting to the central complex were located in the caudal, lateral and ventral region of the ipsilateral medial nucleus of the pallidum. Pallidal neurons projecting to the lateral mass of the thalamus were more numerous and occupied the entire volume of the medial pallidum apart from a small rostral and dorsomedial region. The location of the pallido-central complex neurons appeared to be included in that of the neurons projecting to the lateral mass. As very few neurons of this shared region were unlabeled, it is very likely that the same pallidal neurons project to both targets. The pallido-central complex neurons were located in the region crossed by axons coming from the putaminal sensorimotor territory of the striatum. These results provide further evidence that Nauta and Mehler's loop is a real closed loop probably involved in sensorimotor processing.

In this prospective double blind randomised "N of 1" study, a patient with a severe form of burette's syndrome was treated with ,bilateral high frequency stimulation of the centromedian-parafascicular complex (Ce-Pf) of the thalamus, the internal part of the globus pallidus (GPi), or both. Stimulation of either target improved tic severity by 70%, markedly ameliorated coprolalia, and eliminated self injuries. Severe turns of Tourette's syndrome may benefit from stimulation of neuronal circuits within the basal ganglia, thus confirming the role of the dysfunction of limbic striato-paullido-thalamo-cortical systems in this disorder. [ABSTRACT FROM AUTHOR]