EFFECTS OF DBS ON POSTURE AND OROMOTOR CONTROL

描述(改编自申请者摘要)：平衡、步态、言语和 吞咽障碍是帕金森氏症患者致残的主要原因 疾病(PD)。在许多患者中，这些“轴性症状”对 左旋多巴疗法。脑深部刺激(DBS)的潜在优势 苍白球内核(GPI)和丘脑底核(STN)可 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 中枢(自愿)和外周(自动)的基底节 启动了轴向运动。我们假设有多个马达输出 基底节对多巴胺和DBS的敏感性不同。目标是 这个项目的目的是区分不同功能的基底节对照 轴向电机系统的独特响应模式 DBS和左旋多巴单独使用和联合使用时。我们 假设DBS将比左旋多巴和STN更有效 刺激将比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对放射学鉴定的影响 一项随机、双盲的人基底节研究。这些研究将 量化两种姿势和运动任务中的力量和运动： 外围触发、对外部提示的自动响应以及 中央发起的志愿运动。 具体目标是：(1)确定星展银行如何影响中央发起和 外周触发的姿势控制。(2)确定星展银行如何影响 集中启动和外围触发的电动马达控制。(3)至 探讨DBS和左旋多巴治疗对体位和体位的影响 机动控制装置。(4)确定星展银行网站(GPI与STN)的影响 关于姿势和运动控制。这些实验将量化疗效 DBS和左旋多巴单独或联合用于平衡和运动 帕金森病患者的缺陷。量化两种姿势和口部运动 对相同科目的控制也将大大增加我们对 基底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.