Brain Stimulation 13 (2020) 1612e1613
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Brain Stimulation
journal homepage: http://www.journals.elsevier.com/brain-stimulation
Bilateral nucleus basalis of Meynert deep brain stimulation for
dementia with Lewy bodies: A randomised clinical trial
To the editor
Deep brain stimulation (DBS) of the nucleus basalis of Meynert
(NBM) has been suggested as a potential strategy for dementia.
James Gratwicke et al. reported a randomized, double-blind, cross-
over trial of NBM DBS in six Lewy body dementia patients [1]. They
found no consistent improvements in clinical outcome measures,
although the severity of neuropsychiatric symptoms alleviated in
3/5 patients. In addition, functional connectivity changed in the
default mode and frontoparietal networks.
Fig. 1. (A) The NBM area. (B) Cholinergic neurons (dots) dispersed in the NBM. (C)
Electrode contact located in the NBM but not close to the cholinergic neurons. (D)
Electrode contact located in the NBM surrounded by cholinergic neurons, which are
beneath the cross-point of the AC and external medullary lamina (the crack between
the GPe and PuT).
https://doi.org/10.1016/j.brs.2020.09.020
1935-861X/© 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/
).
They targeted the Ch4i subsector of the NBM. However, they did
not provide a detailed method of locating the NBM. They demon-
strated that the NBM is visible on MRI. If the NBM is visible, then
it should appear as a macroscopic body. As shown in Fig. 1-A, a large
area was reported. However, to treat dementia, the real target is
cholinergic neurons, which are dispersed in that area, as indicated
by the dots shown in Fig. 1-B. If the contact location is defined ac-
cording to a large NBM area, targeting cholinergic neurons is not
sufficiently accurate. As shown in Fig. 1-C, although the contact is
located in the NBM, it is not very close to the cholinergic neurons.
Thus, the stimulation effects cannot be guaranteed.
We reviewed related anatomical articles regarding the NBM [2e4]
and found that there always are some cholinergic neurons beneath
the external globus pallidus (GPe) and near the anterior commissure
(AC), which is just below the putamen. To improve the target’s accu-
racy, we use the AC and external medullary lamina, which is located
between the GPe and putamen, as landmarks. The target location is
just beneath the cross-point of the AC and external medullary lamina,
as shown in Fig. 1-D. We believe that our method could more accu-
rately target cholinergic neurons than the authors’ technique.
Funding
This study was supported by the National Nature Science Foun-
dation of China (No. 61761166004).
Declaration of competing interest
The authors have no conflicts of interest associated with this
publication.
Abbreviations
GPe external globus pallidus
GPi internal globus pallidus
PuT putamen
AC anterior commissure
OT optic tract
Amg amygdala
NBM nucleus basalis of Meynert
References
[1] Gratwicke J, Zrinzo L, Kahan J, Peters A, Brechany U, McNichol A, et al. Bilateral
nucleus basalis of Meynert deep brain stimulation for dementia with Lewy
bodies A randomised clinical trial. Brain Stimul 2020;13(4):1031e9.
W. Liu and D.-Y. Yu Brain Stimulation 13 (2020) 1612e1613

[2] Zaborszky L, Hoemke L, Mohlberg H, Schleicher A, Amunts K, Zilles K. Stereo- Dong-Yan Yu*
taxic probabilistic maps of the magnocellular cell groups in human basal fore-
Weihai Municipal Third Hospital, Weihai, Shandong, China, 264205
brain. Neuroimage 2008;42(3):1127e41.
[3] Mesulam MM, Geula C. Nucleus basalis (Ch4) and cortical cholinergic innerva-
tion in the human brain: observations based on the distribution of acetylcho- *
Corresponding author.
linesterase and choline acetyltransferase. J Comp Neurol 1988;275(2):216e40.
[4] Higgins GA, Mufson EJ. NGF receptor gene expression is decreased in the nu-
E-mail addresses: yudongyan@outlook.com,
cleus basalis in Alzheimer’s disease. Exp Neurol 1989;106(3):222e36. yudongyan@outlook.com (D.-Y. Yu).

27 April 2020
Wei Liu
Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong
University, No.70, Heping Road, Weihai, Shandong, China, 264200
E-mail address: liuwei881x@outlook.com.

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