Subthalamic nucleus stimulation reduces abnormal motor cortical overactivity in Parkinson disease
Subthalamic nucleus stimulation reduces abnormal motor cortical overactivity in Parkinson disease
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DOI：
10.1001/archneur.61.8.1307
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发表时间：
2004-08-01
影响因子：
--
通讯作者：
Agid, Y
中科院分区：
文献类型：
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作者：
Payoux, P;Remy, P;Agid, Y
工作背景：基于基底神经节模型，已经假设高频刺激丘脑底核（subthalamic nucleus，简称丘脑底核）对抗帕金森病症状的功效依赖于皮层运动前区的激活。在以往的正电子发射断层扫描激活研究中，高频刺激与手运动时中线运动前区的选择性激活有关，但主要减少运动相关区域的局部脑血流量，特别是在静息状态下。目的：用正电子发射断层扫描研究局部脑血流量减少在高频刺激提供的临床改善中的作用。7例晚期帕金森病患者，通过双侧双极高频刺激明显改善，在关闭右侧双极电极的情况下，使用（H2O）-O-15进行正电子发射断层扫描。患者进行了研究，在休息和右手运动中的3个电极条件：没有刺激，效率低下的低频刺激，有效的高频stimulation.Results：高频刺激的主要影响是减少区域脑血流量在左侧初级感觉运动皮层，外侧运动前皮层，右侧小脑，和中线运动前区。前扣带皮层和左侧初级感觉运动皮层在高频刺激下手部运动过程中的选择性激活归因于静息时局部脑血流量减少，而不是高频刺激引起的激活增加。运动不能与对侧初级感觉运动皮层和同侧小脑的异常过度活动相关。结论：高频刺激的小脑行为通过减少运动系统的异常静息过度活动，允许运动过程中选择性皮层激活。
Background: Based on the basal ganglia model, it has been hypothesized that the efficacy of high-frequency stimulation of the subthalamic nucleus (STN) against parkinsonian symptoms relies on the activation of cortical premotor regions. In previous positron emission tomography activation studies, STN high-frequency stimulation was associated with selective activation of midline premotor areas during hand movements but mainly reduced the regional cerebral blood flow in movement-related areas, peculiarly at rest.Objective: To investigate with positron emission tomography the role of regional cerebral blood flow reduction in the clinical improvement provided by STN high-frequency stimulation.Methods: Seven patients with advanced Parkinson disease, who were markedly improved by bilateral STN high-frequency stimulation, under-went positron emission tomography with (H2O)-O-15 while the right STN electrode was turned off. The patients were studied at rest and during right-hand movements in 3 electrode conditions: no stimulation, inefficient low-frequency stimulation, and efficient high-frequency stimulation.Results: The main effect of high-frequency stimulation was to reduce regional cerebral blood flow in the left primary sensorimotor cortex, the lateral premotor cortex, the right cerebellum, and the midline premotor areas. The selective activation of the anterior cingulate cortex and the left primary sensorimotor cortex during hand movement under STN high-frequency stimulation was attributed to decreased regional cerebral blood flow at rest, rather than increased activation induced by STN high-frequency stimulation. Akinesia was correlated with the abnormal overactivity in the contralateral primary sensorimotor cortex and the ipsilateral cerebellum.Conclusion: High-frequency stimulation of the STN acts through the reduction of abnormal resting overactivity in the motor system, allowing selective cortical activation during movement.