A positron emission tomographic study of subthalamic nucleus stimulation in Parkinson disease -: Enhanced movement-related activity of motor-association cortex and decreased motor cortex resting activity
A positron emission tomographic study of subthalamic nucleus stimulation in Parkinson disease -: Enhanced movement-related activity of motor-association cortex and decreased motor cortex resting activity
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DOI：
10.1001/archneur.56.8.997
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发表时间：
1999-08-01
影响因子：
--
通讯作者：
Alesch, F
中科院分区：
文献类型：
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作者：
Ceballos-Baumann, AO;Boecker, H;Alesch, F
背景：长期高频刺激丘脑底核(STN)可改善帕金森病患者的运动障碍。STN刺激的神经关联还不是很清楚。正电子发射断层扫描可用于脑深部刺激机制的在体研究。目的：研究帕金森病患者在静息和运动时STN有效刺激时局部脑血流的变化，以此作为突触活动的指标。方法：8例帕金森病患者在STN内植入电极，在静息和起搏自由选择操纵杆动作时，用水O 15正电子发射断层扫描12次(每个实验条件扫描3次)。监测运动性能、反应和运动时间。使用统计参数图比较不同状态和不同激活情况下局部脑血流的变化。结果：所有患者在打开刺激器的扫描中反应和运动时间均有改善。正如预测的那样，在对侧运动中，当刺激开启时，观察到与刺激同侧的嘴侧辅助运动区和运动前皮质的激活增加(P<；.001)。不可预测的观察包括刺激STN导致静息状态下初级运动皮质局部脑血流量减少。结论：刺激STN可减轻帕金森病患者额叶运动关联区的运动相关损害和运动皮质不适当的静息活动。
Background: Long-term high-frequency stimulation of the subthalamic nucleus (STN) improves akinesia in Parkinson disease. The neural correlates of STN stimulation are not well understood. Positron emission tomography can be applied to the in vivo study of the mechanisms of deep brain stimulation.Objective: To study changes in regional cerebral blood flow as an index of synaptic activity in patients with Parkinson disease with effective STN stimulation on and off during rest and movement.Methods: Eight patients with Parkinson disease who had electrodes implanted in the STN underwent 12 measurements of regional cerebral blood flow with water O 15 positron emission tomography at rest and during performance of paced freely selected joystick movements, both with and without STN stimulation (3 scans per experimental condition). Motor performance and reaction and movement times were monitored. Statistical parametric mapping was used to compare changes in regional cerebral blood flow between conditions and differences in activation.Results: All patients showed improvement in reaction and movement times during scans with the stimulator on. As predicted, increases in activation of rostral supplementary motor area and premotor cortex ipsilateral to stimulation were observed when stimulation was on during contralateral movement (P < .001). Unpredicted observations included decreases in regional cerebral blood flow in primary motor cortex at rest induced by STN stimulation.Conclusion: Stimulation of the STN reduces the movement-related impairment of frontal motor association areas and the inappropriate motor cortex resting activity in Parkinson disease.