EFFECTS OF DBS ON POSTURE AND OROMOTOR CONTROL

描述（改编自申请人的摘要）：平衡、步态、言语和 吞咽障碍是帕金森病患者残疾的主要原因 疾病（PD）。在许多患者中，这些“轴性症状”对药物抵抗。 左旋多巴疗法脑深部电刺激（DBS）的一个潜在优势是， 苍白球内核（GPi）和丘脑底核（BNZ）可能是 这些轴向运动症状的改善。我们的长期目标是确定 DBS对轴向电机控制的影响，以了解 基底神经节在中枢（自愿）和外周（自动） 开始轴向运动。我们假设有多种运动输出 对多巴胺和DBS的敏感性不同目标 本项目的目的是区分功能不同的基底神经节控制 轴向电机系统的机制，通过其独特的模式， DBS和左旋多巴单独使用和联合使用时。我们 假设DBS比左旋多巴和多巴酚丁胺更有效 电刺激比GPi刺激对轴性帕金森病更有效 症状该项目将利用一个独特的机会， 严格量化慢性DBS对放射学鉴定的 在一项随机、双盲研究中，这些研究将 量化两种姿势和姿势任务中的力和运动： 外围触发，对外部线索的自动反应， 中央发起的志愿运动。 具体目标是：（1）确定DBS如何影响中央启动和 外周触发的姿势控制(2)为了确定DBS如何影响 中央启动和外围触发的随机控制。(3)到 研究DBS和左旋多巴治疗对姿势和 或控制。(4)确定DBS部位的影响（GPi与GPi） 关于姿势和口腔运动控制。这些实验将量化 DBS和左旋多巴单独使用以及联合使用时的平衡和平衡 PD患者的缺陷。量化两种类型的姿势和姿势 在相同的科目中控制也将大大增加我们的理解 基底神经节在轴向运动控制中的作用。

DESCRIPTION (Adapted from the Applicant's Abstract): Balance, gait, speech, and swallowing deficits are major causes of disability in patients with Parkinson's disease (PD). In many patients, these "axial symptoms" are resistant to levodopa therapy. A potential advantage of deep brain stimulation (DBS) of globus pallidus internal (GPi) and the subthalamic nucleus (STN) could be improvement of these axial motor symptoms. Our long-term goal is to determine the effects off DBS on axial motor control in order to understand the role of the basal ganglia in centrally (voluntarily) and peripherally (automatically) initiated axial movements. We hypothesize that there are multiple motor outputs from the basal ganglia with differing sensitivity to dopamine and DBS. The goal of this project is to distinguish functionally different basal ganglia control mechanisms for the axial motor system by their unique patterns of response to DBS and levodopa when used separately and when used in combination. We hypothesize that DBS will he more effective than levodopa and that STN stimulation will be more effective than GPi stimulation for axial parkinsonian symptoms. This project will take advantage of a unique opportunity to rigorously quantify the effects of chronic DBS in radiologically-identified human basal ganglia in a randomized, double-blind study. These studies will quantify forces and movements in two types of postural and oromotor tasks: peripherally triggered, automatic responses to external cues and centrally-initiated voluntary movements. The specific aims are: (1) To determine how DBS affects centrally-initiated and peripherally-triggered postural control. (2) To determine how DBS affects centrally-initiated and peripherally-triggered oromotor control. (3) To investigate the interactions of DBS and levodopa treatment on postural and oromotor control. (4) To determine effects of the site (GPi versus STN) of DBS on postural and oromotor control. These experiments will quantify the efficacy of DBS and levodopa both separately and when combined for balance and oromotor deficits in patients with PD. Quantifying two types of postural and oromotor control in the same subjects will also substantially increase our understanding of the role of the basal ganglia in axial motor control.