Deep brain stimulation: eye movements reveal anomalous effects of electrode placement and stimulation.
Deep brain stimulation: eye movements reveal anomalous effects of electrode placement and stimulation.
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DOI：
10.1371/journal.pone.0032830
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Watts C
中科院分区：
文献类型：
--
作者：
Antoniades CA;Buttery P;FitzGerald JJ;Barker RA;Carpenter RH;Watts C
评估脑深部电刺激（DBS）的疗效或了解其机制的主要困难之一是需要区分刺激本身的效果与手术过程中不可避免地产生的病变的效果。最近的研究表明，帕金森病患者丘脑底核的DBS大大减少了眼睛对视觉刺激做出扫视反应所需的时间。由于这种扫视潜伏期可以快速客观地测量，我们用它来比较手术和刺激的效果。我们使用扫视测量仪测量9名DBS患者的扫视次数（1）术前，（2）插入丘脑底核电极后第二天，（3）三周后，打开刺激器前，（4）刺激开始后。患者在整个研究期间服用抗帕金森病药物。它揭示了一个完全出乎意料和令人费解的发现。与之前的研究一样，手术后立即观察到症状的改善，然后在最终打开刺激器时进一步改善，但在扫视潜伏期的情况下，模式不同：手术产生短暂的潜伏期增加，在三周内返回基线，而随后的刺激减少了潜伏期。因此，电极放置和刺激的差异效应对于扫视和更一般的运动症状是完全不同的。这一重要发现排除了对DBS机制的一些过于简单的解释，并且需要在未来DBS神经生理学建模的尝试中加以考虑。
One of the major difficulties in evaluating the efficacy of deep brain stimulation (DBS), or understanding its mechanism, is the need to distinguish the effects of stimulation itself from those of the lesion inevitably created during surgery. Recent work has shown that DBS of the subthalamic nucleus in Parkinson's disease greatly reduces the time it takes the eyes to make a saccade in response to a visual stimulus. Since this saccadic latency can be rapidly and objectively measured, we used it to compare the effects of surgery and of stimulation. We used a saccadometer to measure the saccadic latencies of 9 DBS patients (1) preoperatively, (2) the day after insertion of subthalamic nucleus electrodes, (3) three weeks later, prior to turning on the stimulator, and (4) after commencement of stimulation. Patients were on their anti-Parkinsonian medication throughout the study. It revealed an entirely unexpected and puzzling finding. As in previous studies an amelioration of symptoms is seen immediately after surgery, and then a further improvement when finally the stimulator is turned on, but in the case of saccadic latency the pattern is different: surgery produces a transient increase in latency, returning to baseline within three weeks, while subsequent stimulation reduced latency. Thus the differential effects of electrode placement and stimulation are completely different for saccades and for more general motor symptoms. This important finding rules out some over-simple interpretations of the mechanism of DBS, and needs to be taken into account in future attempts at modelling the neurophysiology of DBS.
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