Anatomical targets associated with abrupt versus gradual washout of subthalamic deep brain stimulation effects on bradykinesia.
Anatomical targets associated with abrupt versus gradual washout of subthalamic deep brain stimulation effects on bradykinesia.
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DOI：
10.1371/journal.pone.0099663
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Butson CR
中科院分区：
文献类型：
--
作者：
Cooper SE;Driesslein KG;Noecker AM;McIntyre CC;Machado AM;Butson CR
丘脑底核（Subthalamic nucleus，DBS）是脑深部电刺激（Deep Brain Stimulation，DBS）治疗帕金森病的常见解剖靶点。然而，刺激的影响可能会扩散到大脑以外。正在进行的研究旨在确定附近的解剖结构，其中DBS诱导的效应可能与治疗改善或副作用相关。我们之前发现，DBS电极导线位置决定了刺激停止后治疗效果消退的速率-突然与逐渐。这些结果表明，电流从电极传播到与不同洗脱率相关的两个空间上不同的刺激目标。为了确定这些目标，我们使用计算模型来预测DBS期间在该研究中的14名帕金森病患者中激活的组织体积。然后，我们将每个患者与立体定位图谱进行配准，并生成概率刺激图谱，以获得刺激与突然与逐渐洗脱相关的区域的三维表示。我们发现，逐渐消退的治疗效果与刺激齿状回和Forel区有关，而逐渐消失的治疗效果与刺激齿状回本身有关。这支持存在多个DBS目标的想法，并且来自一个电极的电流传播可能激活给定患者中的多个DBS目标，产生根据电极位置和刺激设置而变化的效应组合。
The subthalamic nucleus (STN) is a common anatomical target for deep brain stimulation (DBS) for the treatment of Parkinson’s disease. However, the effects of stimulation may spread beyond the STN. Ongoing research aims to identify nearby anatomical structures where DBS-induced effects could be associated with therapeutic improvement or side effects. We previously found that DBS lead location determines the rate – abrupt vs. gradual – with which therapeutic effect washes out after stimulation is stopped. Those results suggested that electrical current spreads from the electrodes to two spatially distinct stimulation targets associated with different washout rates. In order to identify these targets we used computational models to predict the volumes of tissue activated during DBS in 14 Parkinson’s patients from that study. We then coregistered each patient with a stereotaxic atlas and generated a probabilistic stimulation atlas to obtain a 3-dimensional representation of regions where stimulation was associated with abrupt vs. gradual washout. We found that the therapeutic effect which washed out gradually was associated with stimulation of the zona incerta and fields of Forel, whereas abruptly-disappearing therapeutic effect was associated with stimulation of STN itself. This supports the idea that multiple DBS targets exist and that current spread from one electrode may activate more than one of them in a given patient, producing a combination of effects which vary according to electrode location and stimulation settings.
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