Cortical and subcortical blood flow effects of subthalamic nucleus stimulation in PD
Cortical and subcortical blood flow effects of subthalamic nucleus stimulation in PD
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DOI：
10.1212/01.wnl.0000083991.81859.73
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发表时间：
2003-09-23
期刊：
影响因子：
9.9
通讯作者：
Perlmutter, JS
中科院分区：
文献类型：
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作者：
Hershey, T;Revilla, FJ;Perlmutter, JS
目的：探讨刺激丘脑底核（subthalamic nucleus，简称丘脑底核）的主要作用机制是驱动还是抑制输出神经元。方法：应用PET技术检测13例帕金森病患者的脑血流反应。患者在刺激器关闭和打开的情况下进行扫描（每种情况下扫描六次）。在每次扫描时获得临床评级、EMG和运动录像。从分析中排除具有可观察到的震颤或运动的扫描。确定了脑电刺激显著改变血流的脑区。结果如下：丘脑刺激增加了中脑（包括中脑）、苍白球和丘脑（主要在左侧）的血流量，但减少了双侧额叶、顶叶和颞叶皮质的血流量。结论：这些数据表明，丘脑刺激增加了丘脑输出神经元的放电，这增加了对丘脑皮质投射的抑制，最终减少了皮质靶点的血流。电刺激似乎是驱动而不是抑制电刺激输出神经元。
Objective: To assess whether subthalamic nuclei (STN) stimulation's primary mechanism of action is to drive or inhibit output neurons. Methods: Cerebral blood flow responses to STN stimulation were measured using PET in 13 patients with Parkinson disease. Patients were scanned with stimulators off and on (six scans each condition). Clinical ratings, EMG, and videotaping of movements were obtained at each scan. Scans with observable tremor or movement were eliminated from analysis. Brain regions where STN stimulation significantly altered blood flow were identified. Results: STN stimulation increased blood flow in midbrain (including STN), globus pallidus, and thalamus, primarily on the left side, but reduced blood flow bilaterally in frontal, parietal, and temporal cortex. Conclusions: These data suggest that STN stimulation increases firing of STN output neurons, which increases inhibition of thalamocortical projections, ultimately decreasing blood flow in cortical targets. STN stimulation appears to drive, rather than inhibit, STN output neurons.