Subthalamic nucleus stimulation modulates motor cortex oscillatory activity in Parkinson's disease
Subthalamic nucleus stimulation modulates motor cortex oscillatory activity in Parkinson's disease
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DOI：
10.1093/brain/awh053
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发表时间：
2004-02-01
期刊：
影响因子：
14.5
通讯作者：
Defebvre, L
中科院分区：
文献类型：
--
作者：
Devos, D;Labyt, E;Defebvre, L
在帕金森病中，运动准备受损与整个对侧初级感觉运动(PSM)皮质出现运动相关去同步(MRD)的潜伏期延长有关。在运动执行过程中，内侧苍白球(GPI)刺激改善了PSM皮质上的运动去同步化，但未能改善受损的运动准备。PET研究表明，刺激丘脑底核(STN)可以部分逆转运动时大脑激活的异常运动前模式。通过对MRD的监测，我们旨在评估刺激双侧STN引起的运动前和PSM皮层振荡活动的变化，并将这些变化与L-多巴诱发的变化进行比较。10名帕金森病患者和一组年龄匹配的健康对照组分别在四种状态下进行自定速屈腕运动：无刺激或L-多巴(关闭状态)，有刺激但无L-多巴(在STIM上)，有L-多巴和不刺激(在药物上)，同时有刺激和L-多巴(在两种情况下)。与关闭状态相比，在开状态和开药物状态下，统一帕金森病评定量表(UPDRS)III评分下降了约60%，在两种状态下都下降了80%。刺激和L多巴可显著延长运动对侧中心区的去同步化潜伏期和双侧中央区的运动去同步化潜伏期，两者联合作用最大。此外，与关闭状态相比，三种处理条件下双侧额叶中央区域的去同步化潜伏期显著缩短。在帕金森病患者中，电刺激短臂旁核可能通过减少去同步化在额中央区的异常扩散，增加PSM皮层在动作准备和执行过程中的活动，从而导致异常皮层振荡活动模式的改变(与L-多巴所产生的类似)，并相应地改善运动迟缓。接受治疗的帕金森病患者表现出一种与年龄匹配的健康对照组接近的去同步化模式，尽管中枢潜伏期仍然较短。这项研究表明，它可能影响与计划和执行通过基底节的自愿运动有关的皮质反应性，此外，PSM皮质的振荡活动(除了运动前区)在控制帕金森氏病运动相关的神经活动方面可能具有重要意义。
In Parkinson's disease, impaired motor preparation has been related to an increased latency in the appearance of movement-related desynchronization (MRD) throughout the contralateral primary sensorimotor (PSM) cortex. Internal globus pallidus (GPi) stimulation improved movement desynchronization over the PSM cortex during movement execution but failed to improve impaired motor preparation. PET studies indicate that subthalamic nucleus (STN) stimulation partly reverses the abnormal premotor pattern of brain activation during movement. By monitoring MRD, we aimed to assess changes in premotor and PSM cortex oscillatory activity induced by bilateral STN stimulation and to compare these changes with those induced by l-dopa. Ten Parkinson's disease patients and a group of healthy, age-matched controls performed self-paced wrist flexions in each of four conditions: without either stimulation or l-dopa (the 'off' condition), with stimulation and without l-dopa (On Stim), with l-dopa and without stimulation ('on drug'), and with both stimulation and l-dopa (On Both). Compared with the Off condition, in both the On Stim and the On Drug condition the Unified Parkinson's Disease Rating Scale (UPDRS) III score decreased by about 60% and in the On Both condition it decreased by 80%. The desynchronization latency over central regions contralateral to movement and the movement desynchronization over bilateral central regions were significantly increased by stimulation and by l-dopa, with a maximal effect when the two were associated. Furthermore, desynchronization latency significantly decreased over bilateral frontocentral regions in the three treatment conditions compared with the Off condition. In Parkinson's disease, STN stimulation may induce a change in abnormal cortical oscillatory activity patterns (similar to that produced by l-dopa) by decreasing the abnormal spreading of desynchronization over frontocentral regions and increasing PSM cortex activity during movement preparation and execution, with a correlated improvement in bradykinesia. Parkinsonians under treatment displayed a desynchronization pattern close to that seen in healthy, age-matched controls, although central latencies remained shorter. The study indicates that it is possible to influence cortical reactivity related to the planning and execution of voluntary movement through the basal ganglia, and furthermore that the oscillatory activity of the PSM cortex (in addition to that of premotor areas) could be of major importance in the control of movement-associated, neural activity in Parkinson's disease.