ABSTRACT
OBJECTIVES: Current models of basal ganglia dysfunction in Parkinson's disease suggest a pivotal role of subthalamic nucleus (STN) hyperactivity. There is a direct excitatory output to the globus pallidus internus (GPi), which in turn hyperinhibits the motor thalamus and leads to a lack of cortical facilitation. The model, however, does not address the reciprocal influence of GPi on STN activity. METHODS: Measurement of immediate changes in STN single cell activity after GPi deep brain stimulation (DBS). RESULTS: An opposite effect of GPi DBS in the dorsal versus ventral STN was found. There was an almost exclusive reduction of firing rate in the dorsal region of the STN, whereas the cells in the ventral region exhibited facilitation similar to the recordings from the substantia nigra pars reticulata. CONCLUSION: Although these findings require confirmation, they suggest that the current theories of GPi DBS action, which do not include a GPi-STN modulation, are most likely incomplete.
Subject(s)
Globus Pallidus/physiopathology , Parkinson Disease/physiopathology , Subthalamic Nucleus/physiopathology , Aged , Brain Mapping , Dominance, Cerebral/physiology , Electric Stimulation , Electric Stimulation Therapy , Electrodes, Implanted , Humans , Male , Neural Inhibition/physiology , Neural Pathways/physiopathology , Neurons/physiology , Parkinson Disease/diagnosis , Parkinson Disease/therapy , Substantia Nigra/physiopathology , Synaptic Transmission/physiologyABSTRACT
In a general ICU with a predominant surgical census, patients with acute respiratory failure can usually be treated on a clinical assessment and a minimum of invasive monitoring. An algorithm was used to manage the ventilatory support and weaning. When it failed (15% of the time), the patients' functional diagnoses were questioned and more advanced monitoring was used. The algorithm led to expeditious weaning of patients who did not need mechanical support and to a reduction of invasive monitoring.
