Therapeutic subthalamic nucleus deep brain stimulation reverses cortico-thalamic coupling during voluntary movements in Parkinson's disease.
Therapeutic subthalamic nucleus deep brain stimulation reverses cortico-thalamic coupling during voluntary movements in Parkinson's disease.
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DOI：
10.1371/journal.pone.0050270
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Foltynie T
中科院分区：
文献类型：
--
作者：
Kahan J;Mancini L;Urner M;Friston K;Hariz M;Holl E;White M;Ruge D;Jahanshahi M;Boertien T;Yousry T;Thornton JS;Limousin P;Zrinzo L;Foltynie T
丘脑下核深部脑刺激（STN DBS）已成为帕金森病（PD）运动并发症患者公认的治疗方法。虽然它的成功越来越明显，但其行动背后的机制仍然不清楚。使用放射性示踪成像的多项研究已经调查了dbs引起的神经活动的区域变化。然而，我们对DBS对神经网络连通性的影响知之甚少；换句话说，DBS是否会影响大脑皮层特定区域的功能整合。在这项工作中，我们报告了10名PD患者和完全植入DBS硬件接受有效刺激的fMRI的首次发现。尽管从植入硬体的患者身上安全获取fMRI数据存在技术要求，但在治疗性STN DBS的反应中，在脑岛皮层和丘脑中发现了强大的激活变化。然后，我们量化了DBS的神经调节作用，并比较了两个已识别节点之间有效连接的16个动态因果模型。使用贝叶斯模型比较，我们发现了明确的外部（区域之间）调节的证据，即皮质-丘脑和丘脑-皮质连接。通过贝叶斯模型参数平均，我们发现在自主运动过程中，DBS逆转了皮层和丘脑区域之间的有效连接。这使DBS的治疗效果从根本上有了新的认识，强调了它在改变皮质-皮质下相互作用中的作用。我们的结论是，STN DBS确实通过改变皮层和丘脑对外部传入信号的敏感性来影响皮层和丘脑之间的有效连接。此外，我们确认，在严格的安全措施下，这些患者对功能磁共振成像是可行的，并且耐受性良好。
Deep brain stimulation of the subthalamic nucleus (STN DBS) has become an accepted treatment for patients experiencing the motor complications of Parkinson's disease (PD). While its successes are becoming increasingly apparent, the mechanisms underlying its action remain unclear. Multiple studies using radiotracer-based imaging have investigated DBS-induced regional changes in neural activity. However, little is known about the effect of DBS on connectivity within neural networks; in other words, whether DBS impacts upon functional integration of specialized regions of cortex. In this work, we report the first findings of fMRI in 10 subjects with PD and fully implanted DBS hardware receiving efficacious stimulation. Despite the technical demands associated with the safe acquisition of fMRI data from patients with implanted hardware, robust activation changes were identified in the insula cortex and thalamus in response to therapeutic STN DBS. We then quantified the neuromodulatory effects of DBS and compared sixteen dynamic causal models of effective connectivity between the two identified nodes. Using Bayesian model comparison, we found unequivocal evidence for the modulation of extrinsic (between region), i.e. cortico-thalamic and thalamo-cortical connections. Using Bayesian model parameter averaging we found that during voluntary movements, DBS reversed the effective connectivity between regions of the cortex and thalamus. This casts the therapeutic effects of DBS in a fundamentally new light, emphasising a role in changing distributed cortico-subcortical interactions. We conclude that STN DBS does impact upon the effective connectivity between the cortex and thalamus by changing their sensitivities to extrinsic afferents. Furthermore, we confirm that fMRI is both feasible and is tolerated well by these patients provided strict safety measures are adhered to.
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