Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can be an effective treatment for the motor symptoms of Parkinson's disease. The therapeutic benefits are voltage-dependent and, in many cases, limited by the appearance of side effects, including muscle contractions. We have observed a number of clinical cases where improvements in rigidity were accompanied by a worsening of bradykinesia. Considering the anatomic position of STN and current approaches to implantation of the DBS lead, we hypothesized that this dissociation of motor symptoms arises from activation of pyramidal tract fibers in the adjacent internal capsule. The objective of this study was to assess the physiological basis for this dissociation and to test our hypothesis that the underlying etiology of this paradox is activation of fibers of the internal capsule. The effect of STN DBS at 80% of motor threshold for each of the four contacts was evaluated for its effect on rigidity, bradykinesia, and akinesia in a single primate with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism. Consistent with our observations in humans, this near-threshold stimulation was found to improve rigidity while bradykinesia and akinesia worsened. Worsening bradykinesia in the face of improvement of other motor signs in Parkinson's disease (PD) patients is suggestive of activation of pyramidal tract (PT) fibers during stimulation. This phenomenon may occur without overt muscle contraction and improved rigidity.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 294-297 |
| Number of pages | 4 |
| Journal | Experimental Neurology |
| Volume | 228 |
| Issue number | 2 |
| DOIs | |
| State | Published - Apr 1 2011 |
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Keywords
- Deep brain stimulation
- Internal capsule
- Parkinson's disease
- Subthalamic nucleus
Cite this
Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule. / Xu, Weidong; Miocinovic, Svjetlana; Zhang, Jianyu; Baker, Kenneth; McIntyre, Cameron C.; Vitek, Jerrold L.
In: Experimental Neurology, Vol. 228, No. 2, 01.04.2011, p. 294-297.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule
AU - Xu, Weidong
AU - Miocinovic, Svjetlana
AU - Zhang, Jianyu
AU - Baker, Kenneth
AU - McIntyre, Cameron C.
AU - Vitek, Jerrold L
PY - 2011/4/1
Y1 - 2011/4/1
N2 - Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can be an effective treatment for the motor symptoms of Parkinson's disease. The therapeutic benefits are voltage-dependent and, in many cases, limited by the appearance of side effects, including muscle contractions. We have observed a number of clinical cases where improvements in rigidity were accompanied by a worsening of bradykinesia. Considering the anatomic position of STN and current approaches to implantation of the DBS lead, we hypothesized that this dissociation of motor symptoms arises from activation of pyramidal tract fibers in the adjacent internal capsule. The objective of this study was to assess the physiological basis for this dissociation and to test our hypothesis that the underlying etiology of this paradox is activation of fibers of the internal capsule. The effect of STN DBS at 80% of motor threshold for each of the four contacts was evaluated for its effect on rigidity, bradykinesia, and akinesia in a single primate with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism. Consistent with our observations in humans, this near-threshold stimulation was found to improve rigidity while bradykinesia and akinesia worsened. Worsening bradykinesia in the face of improvement of other motor signs in Parkinson's disease (PD) patients is suggestive of activation of pyramidal tract (PT) fibers during stimulation. This phenomenon may occur without overt muscle contraction and improved rigidity.
AB - Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can be an effective treatment for the motor symptoms of Parkinson's disease. The therapeutic benefits are voltage-dependent and, in many cases, limited by the appearance of side effects, including muscle contractions. We have observed a number of clinical cases where improvements in rigidity were accompanied by a worsening of bradykinesia. Considering the anatomic position of STN and current approaches to implantation of the DBS lead, we hypothesized that this dissociation of motor symptoms arises from activation of pyramidal tract fibers in the adjacent internal capsule. The objective of this study was to assess the physiological basis for this dissociation and to test our hypothesis that the underlying etiology of this paradox is activation of fibers of the internal capsule. The effect of STN DBS at 80% of motor threshold for each of the four contacts was evaluated for its effect on rigidity, bradykinesia, and akinesia in a single primate with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism. Consistent with our observations in humans, this near-threshold stimulation was found to improve rigidity while bradykinesia and akinesia worsened. Worsening bradykinesia in the face of improvement of other motor signs in Parkinson's disease (PD) patients is suggestive of activation of pyramidal tract (PT) fibers during stimulation. This phenomenon may occur without overt muscle contraction and improved rigidity.
KW - Deep brain stimulation
KW - Internal capsule
KW - Parkinson's disease
KW - Subthalamic nucleus
UR - http://www.scopus.com/inward/record.url?scp=79952708149&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952708149&partnerID=8YFLogxK
U2 - 10.1016/j.expneurol.2010.08.007
DO - 10.1016/j.expneurol.2010.08.007
M3 - Article
C2 - 20713049
AN - SCOPUS:79952708149
VL - 228
SP - 294
EP - 297
JO - Experimental Neurology
JF - Experimental Neurology
SN - 0014-4886
IS - 2
ER -