MRI EVALUATION OF DBS IN PARKINSON'S DISEASE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 本研究的总体目标是利用功能磁共振成像(FMRI)研究帕金森S病(PD)患者丘脑底核(STN-DBS)深部脑刺激产生的运动通路活性的变化。STN DBS为处于疾病晚期的帕金森病患者提供了极佳的症状缓解，此时药物治疗不再有效或产生太多不想要的副作用。目前对STN DBS治疗帕金森病的机制的了解主要来自动物模型和人类皮损治疗的推论。 本研究的目的是：1)确定帕金森病患者STN DBS期间功能性MRI的激活模式与运动体征的最佳缓解；2)确定PD患者STN DBS中功能性MRI激活与临床疗效的关系；3)确定导致双侧症状缓解的单侧刺激相关的激活模式。假设帕金森病患者STN的DBS将1)在苍白球和丘脑产生一致的激活模式，使这些区域的激活成为症状缓解的敏感和特异的标志，2)产生与帕金森运动症状缓解程度正相关的激活，3)在单侧刺激下双侧症状缓解的受试者将在单侧刺激期间产生双侧激活模式。 GCRC将用于72小时的住院治疗。受试者将在给定的一周的星期二收到治疗帕金森氏病的DBS。安置程序将作为23小时的观察性入场进行。伤者随后会出院，并入住广东启德儿童中心。在术后第2天(星期四)，受试者将接受临床检查，评估在功能磁共振成像评估过程中使用的每种DBS设置的联合帕金森病评定量表运动亚分(UPDRSSS)。然后，受试者将从GCRC前往MRI扫描仪进行功能MRI检查。在功能磁共振检查之后，受试者将返回GCRC。然后，受试者将于周五上午从GCRC出院，并进行最后一次手术，以内化深部脑刺激器，仅旋转并放置内部脉冲发生器。GCRC将用于或推迟住院费用，因为受试者不能在没有外化DBS的情况下离开医院环境。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall goal of this study is to characterize the changes in motor pathway activity produced by deep brain stimulation in the subthalamic nucleus (STN DBS) in patients with Parkinson¿s disease (PD) using functional magnetic resonance imaging (fMRI). STN DBS provides excellent symptom relief for PD patients in the late stages of the disease when medical therapies are no longer effective or produce too many unwanted side effects. Present understanding of the mechanisms of STN DBS for PD is derived primarily from animal models and inferences drawn from lesional therapies in humans. The aims of the study are 1) to determine the pattern of fMRI activation associated with optimal relief in Parkinsonian motor signs during STN DBS, 2) to determine the relationship between functional MRI activation and clinical efficacy in DBS of the STN in PD and 3) to determine the pattern of activation associated with unilateral stimulation which results in bilateral symptom relief. It is hypothesized that DBS of the STN in PD will 1) produce a consistent pattern of activation in the globus pallidus and thalamus with optimal symptom relief such that activation in these regions will be a sensitive and specific marker of symptomatic benefit, 2) produce activation that will positively correlate in degree with the amount of Parkinsonian motor symptom relief, and 3) in subjects with strong bilateral symptom relief from unilateral stimulation will produce a bilateral pattern of activation in during unilateral stimulation. The GCRC will be used for a 72 hour inpatient stay. Subjects will receive a placement of a DBS for treatment of Parkinson's disease on Tuesday of a given week. The placement procedure will be performed as a 23 hour observational admission. Subject will then be discharged from the hospital and admitted to the GCRC. On postoperative day 2 (Thursday) the subject will receive a clinical examination evaluating the United Parkinson's Disease Rating Scale Motor Subscore (UPDRSSS) for each of the DBS settings to be used during the fMRI evaluation. The subject will then go from the GCRC to the MRI scanner for functional MRI examination. Following the functional MRI examination the subject will return to the GCRC. The subject will be then discharged from the GCRC on Friday morning and have a final surgery for internalization of the deep brain stimulator only turns and placement of the internal pulse generator. The GCRC will be utilized in or to defer the expense of hospital admission as the subjects cannot leave the hospital environment with an externalized DBS in place.