ABSTRACT
Abstract Background Deep Brain Stimulation (DBS) is an established treatment option for refractory dystonia, but the improvement among the patients is variable. Objective To describe the outcomes of DBS of the subthalamic region (STN) in dystonic patients and to determine whether the volume of tissue activated (VTA) inside the STN or the structural connectivity between the area stimulated and different regions of the brain are associated with dystonia improvement. Methods The response to DBS was measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) before and 7 months after surgery in patients with generalized isolated dystonia of inherited/idiopathic etiology. The sum of the two overlapping STN volumes from both hemispheres was correlated with the change in BFM scores to assess whether the area stimulated inside the STN affects the clinical outcome. Structural connectivity estimates between the VTA (of each patient) and different brain regions were computed using a normative connectome taken from healthy subjects. Results Five patients were included. The baseline BFM motor and disability subscores were 78.30 ± 13.55 (62.00-98.00) and 20.60 ± 7.80 (13.00-32.00), respectively. Patients improved dystonic symptoms, though differently. No relationships were found between the VTA inside the STN and the BFM improvement after surgery (p = 0.463). However, the connectivity between the VTA and the cerebellum structurally correlated with dystonia improvement (p = 0.003). Conclusions These data suggest that the volume of the stimulated STN does not explain the variance in outcomes in dystonia. Still, the connectivity pattern between the region stimulated and the cerebellum is linked to outcomes of patients.
Resumo Antecedentes A estimulação cerebral profunda (ECP) é um tratamento estabelecido para distonias refratárias. Porém, a melhora dos pacientes é variável. Objetivo O objetivo do estudo foi descrever os desfechos da ECP da região do núcleo subtalâmico (NST) e determinar se o volume de tecido ativado (VTA) dentro do NST ou se a conectividade estrutural entre a área estimulada e diferentes regiões cerebrais estão associadas a melhora da distonia. Métodos A resposta da ECP em pacientes com distonia generalizada isolada de etiologia hereditária/idiopática foi mensurada pela escala de Burke-Fahr-Marsden Dystonia Rating Scale (BFM) antes e 7 meses após a cirurgia. A soma dos volumes do NST nos dois hemisférios foi correlacionada com a melhora nos escores do BFM para avaliar se a área estimulada dentro do NST afeta o desfecho clínico. A conectividade estrutural estimada entre o VTA de cada paciente e as diferentes regiões cerebrais foram computadas usando um conectoma normativo retirado de indivíduos saudáveis. Resultados Cinco pacientes com idade de 40,00 ± 7,30 anos foram incluídos. O BFM motor e de incapacidade basal eram de 78,30 ± 13,55 (62,00-98,00) e 20,60 ± 7,80 (13,00-32,00), respectivamente. Os pacientes melhoraram com a cirurgia, mas com variabilidade. Não houve relação entre o VTA dentro do NST e a melhora do BFM após a cirurgia (p = 0.463). Entretanto, a conectividade estrutural entre o VTA e o cerebelo correlacionaram com a melhora da distonia (p = 0.003). Conclusão Os dados sugerem que o VTA dentro do NST não explica a variabilidade do desfecho clínico na distonia. Porém, o padrão de conectividade entre a região estimulada e o cerebelo foi relacionada com o desfecho dos pacientes.
ABSTRACT
RESUMEN La enfermedad de Parkinson según la Organización Mundial de Salud, en el año 2016, afectó una persona por cada 100 mayores de 60 años, siendo en cifras absolutas 6,3 millones de personas, y para el año 2030 serán aproximadamente 12 millones de personas en todo el mundo con dicha patología. Este desorden neurodegenerativo, caracterizado por la degradación nigro-estriatal y potenciación de la vía indirecta del circuito motor de los Ganglios Basales sumado al acúmulo de Cuerpos de Lewy en diversas estructuras del Sistema Nervioso Central, afecta progresiva e inevitablemente la calidad de vida de los pacientes, los procederes ablativos del núcleo subtalámico constituyen una alternativa que propicia efecto y seguridad probada en el control de los síntomas de esta enfermedad. Por lo cual se decide describir la ablación del Núcleo subtalámico como tratamiento de la Enfermedad de Parkinson avanzada (AU).
Summary According to the World Health Organization, in 2016 Parkinson's disease affected one person per every 100 people elder 60 years, meaning 6.3 millions of people, and by 2030 it will be around 12 million persons across the world. This neurodegenerative disorder, characterized by the nigro-striatal degradation and potentiation of the indirect route of the basal ganglia motor circuit, added to the accumulation of Lewy bodies in several structures of the Central Nervous System, progressively and inevitably affects the life quality of patients. The ablative procedures of the subthalamic nucleus are an alternative that propitiates proven effect and safety in the control of this disease symptoms. Therefore, the authors decided to describe the subthalamic nucleus ablation as a treatment for advanced Parkinson's disease (AU).
Subject(s)
Humans , Male , Female , Parkinson Disease/surgery , Subthalamic Nucleus/surgery , Parkinson Disease/complications , Parkinson Disease/diagnosis , Quality of Life , Surgical Procedures, Operative/methods , Therapeutics/methods , Central Nervous System/abnormalitiesABSTRACT
Deep brain stimulation has become an option for advanced Parkinson's disease treatment since the 1990s, but the first reports are from Benabid's team, a French neurosurgeon, in the 1980s. The subthalamic nucleus (STN), more specifically its dorsolateral portion, is the most commonly stimulated brain area. One of the major aspects for a good surgical result is the accurate location of this target. Therefore, the present article aimed to identify landmarks that facilitate and refine the location of the STN using nuclear magnetic resonance imaging (NMRI) of the skull. In order to achieve this goal, a search for articles was performed using the PubMed and Science Direct online databases, and articles regarding the use of NMRI to target STN were included. The precise location of the dorsolateral portion of the STN is fundamental to achieve the best possible effect on motor symptoms and to minimize side effects. One of the most used location methods is the NMRI, associated or not with tomography or ventriculography. The location strategies can be classified as direct and indirect. Landmarks are among the indirect strategies, and the most important ones (red nucleus, Sukeroku sign, dent internal capsule sign, supramammillary commissure, mammillothalamic tract, and interpeduncular cistern) are described in the present article. The various landmarks can be combined to locate with more accuracy the dorsolateral portion of the STN and the ideal position of the electrodes to achieve the best possible clinical result.
Subject(s)
Skull/anatomy & histology , Magnetic Resonance Spectroscopy/methods , Subthalamic Nucleus/surgery , Subthalamic Nucleus/diagnostic imaging , Parkinson Disease/therapy , Image Processing, Computer-Assisted , Red Nucleus , Neurosurgical Procedures/methods , Deep Brain Stimulation/methods , Electrodes, Implanted , Interpeduncular Nucleus , Hypothalamus, PosteriorABSTRACT
Discovered in 1865 by Jules Bernard Luys, the subthalamic nucleus is a set of small nuclei located in the diencephalon, inferior to the thalamus and superior to the substantia nigra, that can be visualized in a posterior coronal section. Histologically, it consists of neurons compactly distributed and filled with a large number of blood vessels and sparse myelinated fibers. This review presents an analysis of this anatomical region, considering what is most recent in the literature. Subthalamic neurons are excitatory and use glutamate as the neurotransmitter. In healthy individuals, these neurons are inhibited by nerve cells located in the side globus pallidus. However, if the fibers that make up the afferent circuit are damaged, the neurons become highly excitable, thus causing motor disturbances that can be classified as hyperkinetic, for example ballism and chorea, or hypokinetic, for example Parkinson disease (PD). The advent of deep brain stimulation has given the subthalamic nucleus great visibility. Studies reveal that the stimulation of this nucleus improves themotor symptoms of PD.
Subject(s)
Subthalamic Nucleus/anatomy & histology , Subthalamic Nucleus/abnormalities , Subthalamic Nucleus/surgery , Parkinson Disease , Substantia Nigra/anatomy & histology , Cerebral Cortex/anatomy & histology , Corpus Striatum/anatomy & histology , Deep Brain Stimulation/methods , Globus Pallidus/anatomy & histology , Motor Cortex/anatomy & histologyABSTRACT
ABSTRACT The authors review the role of Jules Bernard Luys in the discovery of the subthalamic nucleus (STN) over 150 years ago. The relationships between the STN and movement disorders, particularly hemiballismus and Parkinson's disease, are well known. The academic life of Jules Bernard Luys can be divided into two periods: a brilliant start as a neuroanatomist, culminating in the discovery of the STN, followed by a second period marked by a shift in his academic activity and an increased interest in topics such as hysteria, hypnotism and, eventually, esotericism.
RESUMO Os autores revisam o papel de Jules Bernard Luys na descoberta do núcleo subtalâmico (NST) há mais de 150 anos. As relações da NST com distúrbios do movimento, em particular o hemibalismo e a doença de Parkinson, são bem conhecidas. A vida acadêmica de Jules Bernard Luys pode ser dividida em duas fases: a primeira, um brilhante começo de sua carreira como neuroanatomista, culminando na descoberta do NST, seguido por um segundo período marcado por uma mudança em sua atividade acadêmica, e maior interesse em tópicos como histeria, hipnotismo e finalmente esoterismo.
Subject(s)
Humans , Parkinson Disease/therapy , Subthalamic Nucleus , Dyskinesias , Deep Brain Stimulation , Hypnosis , HysteriaABSTRACT
Abstract Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment that improves motor fluctuations, dyskinesia, and tremor in Parkinson's disease (PD). After the surgery, a careful electrode programming strategy and medical management are crucial, because an imbalance between them can compromise the quality of life over time. Clinical management is not straightforward and depends on several perioperative motor and non-motor symptoms. In this study, we review the literature data on acute medical management after STN DBS in PD and propose a clinical algorithm on medical management focused on the patient's phenotypic profile at the perioperative period. Overall, across the trials, the levodopa equivalent daily dose is reduced by 30 to 50% one year after surgery. In patients taking high doses of dopaminergic drugs or with high risk of impulse control disorders, an initial reduction in dopamine agonists after STN DBS is recommended to avoid the hyperdopaminergic syndrome, particularly hypomania. On the other hand, a rapid reduction of dopaminergic agonists of more than 70% during the first months can lead to dopaminergic agonist withdrawal syndrome, characterized by apathy, pain, and autonomic features. In a subset of patients with severe dyskinesia before surgery, an initial reduction in levodopa seems to be a more reasonable approach. Finally, when the patient's phenotype before the surgery is the severe parkinsonism (wearing-off) with or without tremor, reduction of the medication after surgery can be more conservative. Individualized medical management following DBS contributes to the ultimate therapy success.
Resumo A estimulação cerebral profunda do núcleo subtalâmico (ECP NST) é um tratamento estabelecido para doença de Parkinson (DP), que leva à melhora das flutuações motoras, da discinesia e do tremor. Após a cirurgia, deve haver uma estratégia cuidadosa de programação da estimulação e do manejo medicamentoso, pois um desequilíbrio entre eles pode comprometer a qualidade de vida. O gerenciamento clínico não é simples e depende de vários sintomas motores e não motores perioperatórios. Nesta revisão, discutimos os dados da literatura sobre o tratamento clínico agudo após a ECP NST na DP e propomos um algoritmo clínico baseado no perfil fenotípico do paciente no período perioperatório. Em geral, nos estudos clínicos, a dose diária equivalente de levodopa é reduzida em 30 a 50% um ano após a cirurgia. Em pacientes que recebem altas doses de medicações dopaminérgicas ou com alto risco de impulsividade, recomenda-se redução inicial do agonista dopaminérgico após a ECP NST, para evitar síndrome hiperdopaminérgica, particularmente a hipomania. Por outro lado, uma rápida redução de agonistas dopaminérgicos em mais de 70% durante os primeiros meses pode levar à síndrome de abstinência do agonista dopaminérgico, com apatia, dor e disautonomia. Em pacientes com discinesia grave antes da cirurgia, é recomendada redução inicial na dose de levodopa. Finalmente, quando o fenótipo do paciente antes da cirurgia é o parkinsonismo grave (flutuação motora) com ou sem tremor, a redução da medicação após a cirurgia deve ser mais conservadora. O tratamento médico individualizado após a ECP contribui para o sucesso final da terapia.
Subject(s)
Humans , Parkinson Disease , Phenotype , Quality of Life , Levodopa , Treatment Outcome , Subthalamic Nucleus , Deep Brain StimulationABSTRACT
Abstract The impairments in cognitive functions such as memory, executive function, visuospatial skills and language in Parkinson's disease (PD) are drawing increasing attention in the current literature. Studies dedicated to investigating the relationship between subthalamic nucleus deep brain stimulation (STN-DBS) and cognitive functioning are contradictory. This systematic review aims to analyze the impact on the cognitive functioning of patients with PD and STN-DBS. Articles published in the 2007-2017 period were retrieved from the Medline/Pubmed databases using PRISMA criteria. The analysis of 27 articles revealed many conflicting results, precluding a consensus on a cognitive functioning standard and hampering the establishment of a neuropsychological profile for PD patients who underwent STN-DBS surgery. Further studies investigating this relationship are needed.
Resumo As deficiências nas funções cognitivas, como memória, função executiva, habilidades visuoespaciais e linguagem na doença de Parkinson (DP), estão cada vez mais chamando a atenção na literatura atual. Estudos dedicados a investigar a relação entre a estimulação cerebral profunda do núcleo subtalâmico (ECP-NST) e o funcionamento cognitivo são contraditórios. Esta revisão sistemática tem como objetivo analisar o impacto no funcionamento cognitivo de pacientes com DP e ECP-NST. Os artigos foram coletados nas bases de dados Medline / Pubmed publicadas no período de 2007-2017, utilizando os critérios do PRISMA. Após a análise de 27 artigos observou-se muitos resultados opostos, não sendo possível convencionar um padrão de funcionamento cognitivo o que dificulta o estabelecimento de um perfil neuropsicológico para pacientes com essa doença que foram submetidos à cirurgia de ECP-NST, sendo necessários mais estudos.
Subject(s)
Humans , Parkinson Disease , Cognition , Subthalamic Nucleus , Deep Brain StimulationABSTRACT
Juvenile parkinsonism (JP) is characterized by the clinical manifestation of Parkinson syndrome before the age of 21 years old. This entity is often associated with genetic mutations. After all the possibilities of clinical treatment have been exhausted, surgical treatment is recommended, performed via deep brain stimulation (DBS) in the subthalamic nucleus (STN) or in the internal segment of the globus pallidus (GPi). The present study aimed to report the case of a patient with JP who underwent DBS in the STN with good clinical response. Neuromodulation via DBS is an option for the treatment of JP. However, since this entity is very rare, and even more peculiar when treated surgically, more studies are necessary to evaluate DBS used to control refractory manifestations and levodopa-induced dyskinesia, as well as surgical complications that may occur, aiming to gather more knowledge of the surgical management of JP. Despite the dysarthria after the DBS, the patient presented a satisfactory response regarding the symptoms, corroborated by the Parkinson's Disease Questionnaire (PDQ-39) score, which was 61.19% before the procedure, and decreased to 21.05% 14 months after the DBS.
Subject(s)
Humans , Male , Adult , Subthalamic Nucleus , Parkinsonian Disorders/drug therapy , Parkinsonian Disorders/therapy , Deep Brain Stimulation , Dysarthria/complications , Quality of Life/psychology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Directional leads are used for deep brain stimulation (DBS). Two of the four contacts of the leads are divided into three parts, enabling controlled stimulation in a circumferential direction. The direction of adverse effects evoked by DBS in the subthalamic nucleus (STN) and stimulation strategies using directional leads were evaluated. METHODS: Directional leads were implanted into the bilateral STN of six parkinsonian patients (1 man, 5 women; mean age 66.2 years). The contact centers were located within the upper border of the STN, and the locations were identified electrically using microrecordings. Adverse effects were evaluated with electrical stimulation (30 μs, 130 Hz, limit 11 mA) using the directional part of each lead after surgery, and the final stimulation direction was investigated. Unified Parkinson's disease rating scale (UPDRS) scores were evaluated before and after DBS. RESULTS: Fifty-six motor and four sensory symptoms were evoked by stimulation; no adverse effect was evoked in 14 contacts. Motor and sensory symptoms were evoked by stimulation in the anterolateral direction and medial to posterolateral direction, respectively. Stimulation in the posteromedial direction produced adverse effects less frequently. The most frequently used contacts were located above the STN (63%), followed by the upper part of the STN (32%). The mean UPDRS part III and dyskinesia scores decreased after DBS from 30.2 ± 11.7 to 7.2 ± 2.9 and 3.3 ± 2.4 to 0.5 ± 0.8, respectively. CONCLUSION: The incidence of adverse effects was low for the posteromedial stimulation of the STN. Placing the directional part of the lead above the STN may facilitate the control of dyskinesia.
Subject(s)
Female , Humans , Deep Brain Stimulation , Dyskinesias , Electric Stimulation , Incidence , Parkinson Disease , Pilot Projects , Subthalamic NucleusABSTRACT
Objective@#To study the effect of short-term treatment of subthalamic nucleus (STN) deep brain stimulation (DBS) on cerebral glucose metabolism in patients with Parkinson′s disease (PD) and its relationship with the change of brain motor-related nerve pathways.@*Methods@#Five patients (2 males, 3 females; age: (63.6±11.8) years) with PD who underwent STN DBS between January 2014 and December 2018 were enrolled in this study. All patients underwent 18F-fluorodeoxyglucose (FDG) PET in " DBS-off" state before and 3 months after operation. Quantitative expression of PD-related metabolic pattern (PDRP) were calculated by scaled subprofile model/principal component analysis (SSM/PCA) on PET images. Brain regions with changes of glucose metabolism after DBS were located by statistical parametric mapping (SPM) paired t test.@*Results@#Compared with pre-operation, PDRP expression (5.1±1.3 vs 2.9±1.8) and unified Parkinson′s disease rating scale (UPDRS) motor score (50.2±8.2 vs 28.0±5.4) of PD patients were significantly decreased 3 months after STN DBS (t values: 6.17 and 3.88, both P<0.05). After DBS, the glucose metabolism of bilateral globus pallidus/putamen, caudate nucleus, thalamus, insula, pons and cerebellum decreased, while the glucose metabolism of bilateral prefrontal motor area and parietooccipital lobe increased (t=3.75, P<0.01).@*Conclusions@#Short-term STN DBS therapy can inhibit the cortico-striatum-pallidum-hypothalamus-cortex motor loop, which is abnormally excitable in the brain of PD. PDRP, as an imaging characterization of the regulation of this loop, is expected to become an imaging marker for monitoring the treatment of PD.
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Objective To study the effect of short-term treatment of subthalamic nucleus ( STN ) deep brain stimulation (DBS) on cerebral glucose metabolism in patients with Parkinson's disease (PD) and its relationship with the change of brain motor-related nerve pathways. Methods Five patients ( 2 males, 3 females;age:(63.6±11.8) years) with PD who underwent STN DBS between January 2014 and December 2018 were enrolled in this study. All patients underwent 18F-fluorodeoxyglucose (FDG) PET in "DBS-off"state before and 3 months after operation. Quantitative expression of PD-related metabolic pattern (PDRP) were calculated by scaled subprofile model/principal component analysis ( SSM/PCA) on PET images. Brain regions with changes of glucose metabolism after DBS were located by statistical parametric mapping (SPM) paired t test. Results Compared with pre-operation, PDRP expression (5.1±1.3 vs 2.9±1.8) and unified Parkinson's disease rating scale (UPDRS) motor score (50.2±8.2 vs 28.0±5.4) of PD patients were significantly decreased 3 months after STN DBS (t values:6.17 and 3.88, both P<0.05). After DBS, the glucose metabolism of bilateral globus pallidus/putamen, caudate nucleus, thalamus, insula, pons and cer-ebellum decreased, while the glucose metabolism of bilateral prefrontal motor area and parietooccipital lobe increased ( t=3.75, P<0.01) . Conclusions Short-term STN DBS therapy can inhibit the cortico-striatum-pallidum-hypothalamus-cortex motor loop, which is abnormally excitable in the brain of PD. PDRP, as an imaging characterization of the regulation of this loop, is expected to become an imaging marker for monito-ring the treatment of PD.
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Background: Deep brain stimulation is an essential therapeutic tool in Parkinson's disease. Aim: To assess the results of a series of patients with Parkinson's disease treated with micro-electrode guided subthalamic nucleus stimulation. Material and Methods: Twenty patients with idiopathic Parkinson's disease were studied (10 males). Three months after surgery, we analyzed the change in motor disturbances, medication need to control symptoms and quality of life. Results: We observed a significant improvement in all the assessed variables. Motor involvement determined as OFF hours and expressed as percentage of the day changed from 30 ± 15 to 10 ± 7% in the preoperative and postoperative periods, respectively. ON hours without dyskinesia changed from 17 ± 16 to 78 ± 21%. ON hours with dyskinesia changed from 53 ± 23 to 12 ± 15%. Medication need changed from 1,505 ± 499 to 1,214 ± 528 levodopa equivalents. Parkinson's Disease Questionnaire 39 score changed from 62.9 ± 22.7 to 34.3 ± 18.5. During the 5-year follow-up a continuous improvement of symptoms was observed. Conclusions: Micro-electrode guided subthalamic nucleus functional surgery in patients with Parkinson's disease has good immediate and late results.
Subject(s)
Humans , Male , Female , Middle Aged , Parkinson Disease/surgery , Subthalamic Nucleus/surgery , Deep Brain Stimulation/methods , Quality of Life , Severity of Illness Index , Retrospective Studies , Treatment Outcome , Deep Brain Stimulation/adverse effectsABSTRACT
No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of Parkinson's disease. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.
Subject(s)
Aged , Female , Humans , Bipolar Disorder , Deep Brain Stimulation , Depression , Electrodes , Extremities , Mood Disorders , Parkinson Disease , Subthalamic Nucleus , TremorABSTRACT
OBJECTIVE: To compare the therapeutic and adverse effects of globus pallidus interna (GPi) and subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of advanced Parkinson's disease (PD). METHODS: We retrospectively analyzed the clinical data of patients with PD who underwent GPi (n = 14) or STN (n = 28) DBS surgery between April 2002 and May 2014. The subjects were matched for age at surgery and disease duration. The Unified Parkinson's Disease Rating Scale (UPDRS) scores and levodopa equivalent dose (LED) at baseline and 12 months after surgery were used to assess the therapeutic effects of DBS. Adverse effects were also compared between the two groups. RESULTS: At 12 months, the mean changes in the UPDRS total and part I–IV scores did not differ significantly between the two groups. However, the subscores for gait disturbance/postural instability and dyskinesia were significantly more improved after GPi DBS than those after STN DBS (p = 0.024 and 0.016, respectively). The LED was significantly more reduced in patients after STN DBS than that after GPi DBS (p = 0.004). Serious adverse effects did not differ between the two groups (p = 0.697). CONCLUSION: The patients with PD showed greater improvement in gait disturbance/postural instability and dyskinesia after GPi DBS compared with those after STN DBS, although the patients had a greater reduction in LED after STN DBS. These results may provide useful information for optimal target selection for DBS in PD.
Subject(s)
Humans , Deep Brain Stimulation , Dyskinesias , Gait , Globus Pallidus , Levodopa , Parkinson Disease , Retrospective Studies , Subthalamic Nucleus , Therapeutic UsesABSTRACT
Subthalamic nucleus (STN) deep brain stimulation (DBS) has become an important surgical treatment of Parkinson disease, but its exact mechanism is still unclear.In this study, a 16-channel implantable microelectrode array (MEA) was prepared by micro-electromechanical system (MEMS) technique and later modified with platinum black/reduced Graphene Oxide/Nafion (Pt/RGO/Nafion) nanocomposites.Extracellular dopamine (DA) content and spike of dorsal striatum neurons were synchronously recorded before and after STN stimulation.The results showed that the dopamine content began to increase within 20 s after electrical stimulation and dropped to normal level after about 50 s, with the highest rising concentration of 1.72 μmol/L.At the same time, there was an increased spike activity of interneurons in the dopamine ascending phase, and the spike firing rate of medium spiny projection neurons (MSNs) was high when the concentration of DA was higher than the normal level.The MEA sensor can simultaneously record dopamine flux and physiological signals in situ, thus providing an ideal tool for neural information detection.
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Aim To investigate the effects of endocrinal petptide urocortin on subthalamic nucleus (STN) neuron''s discharge, also observe the convergence effect of UCN with dopamine (DA) and glutamate (GLU), so as to understand the regulation effects of UCN and its mechanism in Parkinson''s disease (PD).Methods Forty Sprague-Dawley rats were used in this experiment.Nerve electrophysiology method-microiontophoresis was used to observe the effects of UCN on STN neuron firing rates and firing wave.Astressin (AST, the blocker of CRF receptor 2), protein kinase A (PKA) were used to observe the effects of UCN whether via CRF-2R and PKA signal pathway.Moreover, given UCN during the period of DA and GLU, the effects of UCN on DA and GLU in STN neurons were determined.Results During the period of using the UCN, UCN could inhibit the firing rate of 82％ (27/33) STN neuron (P<0.01), and the firing discharge rates were reduced from(3.65±0.27)Hz to (2.05±0.33) Hz (P<0.01).However, the inhibitory effects of UCN in STN could be antagonized by AST.Given UCN during the period of microiontophoresis of inhibitory neurotransmitter (DA) and excited neurotransmitter (GLU), UCN could enhance the effects of DA and attenuate the excitatory effects of GLU (P<0.01).Conclusion UCN and GLU/DA in STN, UCN play inhibitory and regulated effects on STN neurotransmitters(DA and GLU)via CRF-2 receptor and PKA signal pathway.
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Objectives To investigate MRI patterns of functional connectivity(FC)in different brain areas of the subthalamic nucleus (STN)in Parkinson's Disease (PD)and its correlation with cognition.Methods We used functional magnetic resonance imaging to investigate the difference in whole-brain resting-state FC of STN between 32 patients with PD during the medicatiom ON state and 25 healthy control group(HC)matched for age,gender,and cognition,and examine the correlation between functional connectivity strength and montreal cognitive assessment (MoCA)scores.Results Compared with HC,the PD group showed increased FC in the right lingual gyrus of the left STN and the right STN showed decreased FC in the left superior frontal gyrus and the supplementary motor area(t=4.29,-3.61,and-3.83,respectively,each P ＜ 0.05),while the right STN showed only decreased FC in the right bilateral cingulate gyrus and the precuneus(t=-4.44,4.29,and-4.30,respectively,each P＜ 0.05).In addition,PD patients' connectivity strength between RSTN and the bilateral precuneus was positively correlated with MoCA scores(t =0.58 and 0.57,respectively,each P＜0.05).Conclusions Compared with HC,PD patients exhibit decreased FC between RSTN and the precuneus,with FC strength positively correlated with MOCA scores.The cognitive decline caused by deep brain stimulation in STN may be related to injuries of the precuneus.
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Objective To investigate the changed brain areas of functional connectivity ( FC ) patterns of subthalamic nucleus ( STN) between different subtypes of Parkinson′s disease ( PD) and healthy controls and their clinical significance .Methods Twenty-three PD patients and 12 health controls were enrolled, and PD patients were divided into 11 tremor dominant PD patients and 12 postural instability and gait disorder (PIGD) dominant PD patients.The difference of whole-brain resting-state FC with STN among the three groups was investigated and the relationship between the changed areas and clinical symptoms was calculated.Results Compared with healthy controls , PIGD dominant group showed increased FC between STN and right calcarine and decreased FC between STN and right precuneus , and tremor dominant PD patients showed decreased FC between STN and precuneus , right angular gyrus and left middle frontal gyrus , while the FC strength between the STN and left middle frontal gyrus showed positive relationship with MMSE scores ( r=0.64, P=0.034 ) .Compared with tremor dominant PD patients , PIGD dominant patients showed increased FC in the area of left calcarine .Conclusions Decreased FC between STN and precuneus was gained in different subtypes of PD , and PIGD dominant patients showed increased FC between STN and calcarine.Changed areas based on the FC of STN in different subtypes of PD were found related with cognition and mood control .
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OBJECTIVE: High frequency stimulation (HFS) of the subthalamic nucleus (STN) is recognized as an effective treatment of advanced Parkinson’s disease. However, the neurochemical basis of its effects remains unknown. The aim of this study is to investigate the effects of STN HFS in intact and 6-hydroxydopamine (6-OHDA)-lesioned hemiparkinsonian rat model on changes of principal neurotransmitters, glutamate, and gamma-aminobutyric acid (GABA) in the striatum. METHODS: The authors examined extracellular glutamate and GABA change in the striatum on sham group, 6-OHDA group, and 6-OHDA plus deep brain stimulation (DBS) group using microdialysis methods. RESULTS: High-pressure liquid chromatography was used to quantify glutamate and GABA. The results show that HFS-STN induces a significant increase of extracellular glutamate and GABA in the striatum of 6-OHDA plus DBS group compared with sham and 6-OHDA group. CONCLUSION: Therefore, the clinical results of STN-HFS are not restricted to the direct STN targets but involve widespread adaptive changes within the basal ganglia.
Subject(s)
Animals , Rats , Basal Ganglia , Chromatography, Liquid , Deep Brain Stimulation , gamma-Aminobutyric Acid , Glutamic Acid , Microdialysis , Models, Animal , Neurotransmitter Agents , Oxidopamine , Parkinson Disease , Subthalamic NucleusABSTRACT
Objective To explore the significance of multiple microelectrode guided technique in determining the sensory?motor area of the sub?thalamic nucleus(STN)in deep brain stimulation(DBS)surgeries. Methods A total of 22 electrophysiological recording data of STNs recorded by multiple microelectrode was retrospectively analyzed ,while another 20 electrophysiological recording data of STNs recorded by a single micro?electrode was recruited as the control group. Results A total of 64 microelectrodes were used in 22 STNs guided by multiple electrophysiological recording electrodes. Sensory or motor activated potentials were recorded in 21 sides(95.5%),while regular discharge was recorded in one side. The average length of typical STN activity on the optimal channel of multiple electrophysiological recording electrodes was 5.58±0.53 mm,and the average length of sensory or motor activated potentials was 3.27±1.54 mm. In contrast,the average length of typical STN activity recorded by single microelectrode was 5.02±1.01 mm. However,sensory or motor activated potentials were recorded in 13 sides(65.0%)with the average length of 1.36±0.98 mm. Among the 22 STNs guided by multiple electrophysiological recording electrodes,the final implanted target was consistent with the initially selected anatomic target in 13 sides(coincidence rate,59.1%). In 9 sides,the electrophysiological target was inconsistent with the initially selected anatomic target. Conclusion STN DBS performed with multiple electrophysiological recording electrodes resulted in better outcomes of recording of the average length of typical STN activity or the average length of sensory or motor activated potentials of STN ,final confirmation of STN sensory motor area and determination of the optimal channel of implantation. Application of multiple electrophysiological recording electrodes provides a premise for the precise electrode placement in STN DBS surgeries.