Normalizing motor-related brain activity - Subthalamic nucleus stimulation in Parkinson disease
Normalizing motor-related brain activity - Subthalamic nucleus stimulation in Parkinson disease
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DOI：
10.1212/01.wnl.0000214237.58321.c3
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发表时间：
2006-04-25
期刊：
影响因子：
9.9
通讯作者：
Crutcher, M
中科院分区：
文献类型：
--
作者：
Grafton, ST;Turner, RS;Crutcher, M
目的：测试帕金森病（PD）患者丘脑底核（STN）的单侧深部脑刺激（DBS）是否会导致运动执行和运动程度控制过程中大脑激活模式的正常化。方法：在执行视觉引导跟踪任务期间，通过 PET 对 6 名 PD 患者进行药物成像，DBS 电压编程为治疗（有效）或亚治疗（无效）刺激。将无效刺激期间 PD 患者的数据与 13 名年龄匹配的对照受试者进行比较，以确定激活模式异常的部位。联合分析用于识别 PD 患者在接受有效刺激治疗后活动恢复正常的区域。结果：对于运动执行，有效的 DBS 导致辅助运动区 (SMA)、上顶叶皮层和小脑的激活增加，趋向更正常的模式。休息时，有效的刺激可减少 SMA 的过度活动。与健康受试者相比，治疗性刺激还可以减少前额叶、颞叶和基底神经节回路中与运动相关的“过度活动”，这与许多区域被招募来补偿无效运动启动的观点一致。与运动程度控制相关的活动正常化与初级运动皮层、SMA 和基底神经节活动的减少有关。结论：有效的丘脑底核刺激会导致特定任务的改变，适当地募集运动区以及广泛的、非特异性的补偿性或竞争性皮质活动的减少。
Objective: To test whether therapeutic unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson disease (PD) leads to normalization in the pattern of brain activation during movement execution and control of movement extent. Methods: Six patients with PD were imaged off medication by PET during performance of a visually guided tracking task with the DBS voltage programmed for therapeutic (effective) or subtherapeutic (ineffective) stimulation. Data from patients with PD during ineffective stimulation were compared with a group of 13 age-matched control subjects to identify sites with abnormal patterns of activation. Conjunction analysis was used to identify those areas in patients with PD where activity normalized when they were treated with effective stimulation. Results: For movement execution, effective DBS caused an increase of activation in the supplementary motor area (SMA), superior parietal cortex, and cerebellum toward a more normal pattern. At rest, effective stimulation reduced overactivity of SMA. Therapeutic stimulation also induced reductions of movement related "overactivity" compared with healthy subjects in prefrontal, temporal lobe, and basal ganglia circuits, consistent with the notion that many areas are recruited to compensate for ineffective motor initiation. Normalization of activity related to the control of movement extent was associated with reductions of activity in primary motor cortex, SMA, and basal ganglia. Conclusions: Effective subthalamic nucleus stimulation leads to task-specific modifications with appropriate recruitment of motor areas as well as widespread, nonspecific reductions of compensatory or competing cortical activity.