STN Stimulation - Neural Control of Movement and Posture

描述（由申请人提供）：有多个平行回路连接基底神经节与各种运动和认知回路。高频刺激丘脑底核（丘脑底核）和多巴胺能药物显着改善帕金森病的运动症状。然而，最近的证据表明，听觉刺激也会对语言和认知方面产生负面影响。长期目标是确定帕金森氏病患者手术后6个月和长期内，脑电刺激和药物治疗对运动控制选定方面的影响。中心假设是，脑电刺激和药物治疗对帕金森病的症状（主要涉及运动通路）的作用相似。脑电刺激和药物治疗对包括运动控制认知方面的通路在内的任务可能有不同的影响。目标1将确定在增加任务认知复杂性的次级任务期间，脑电刺激和药物对震颤和僵硬的影响。假设是，当使用次要认知任务时，重复刺激将不那么有效。目标2将确定听觉刺激和药物对语言的影响。该假说是，由于涉及多个基底神经节通路，所以脑干刺激将导致言语清晰度恶化。目的3：确定神经刺激和药物治疗对内引导肢体力控制的影响。该假说认为，由于前扣带皮层的激活减少，肘关节的力量将被高估，在存在刺激的情况下。目的4将确定电刺激和药物治疗对运动迟缓和震颤的长期影响。该假设是，神经刺激和药物治疗仍将通过类似的机制发挥作用，但由于疾病进展，绝对益处将减少。这些实验将客观地量化震颤刺激和药物治疗对震颤、僵硬、运动迟缓、言语和记忆引导的力控制的功效。量化不同认知要求的运动任务将增加我们对刺激的积极和消极后果的理解。

DESCRIPTION (provided by applicant): There are multiple parallel loops that connect the basal ganglia with various motor and cognitive circuits. High frequency stimulation of the subthalamic nucleus (STN) and dopaminergic medication dramatically improves the motor symptoms of Parkinson's disease. However, recent evidence suggests that STN stimulation can also have negative effects on speech and aspects of cognition. The long-range goal is to determine the effect of STN stimulation and medication on selected aspects of motor control in patients with Parkinson's disease six months following surgery and over the long term. The central hypothesis is that STN stimulation and medication act similarly for signs of Parkinson's disease that primarily involves motor pathways. STN stimulation and medication can have differential effects for tasks that include pathways involved in cognitive aspects of motor control. Aim 1 will determine the effects of STN stimulation and medication on tremor and rigidity during secondary tasks that increase the cognitive complexity of the task. The hypothesis is that STN stimulation will be less effective when a secondary cognitive task is used. Aim 2 will determine the effects of STN stimulation and medication on speech. The hypothesis is that STN stimulation will cause deterioration in speech intelligibility since multiple basal ganglia pathways are involved. Aim 3 determines the effects of STN stimulation and medication on internally guided limb force control. The hypothesis is that elbow force will be overestimated in the presence of STN stimulation because of a reduction in the activation of the anterior cingulate cortex. Aim 4 will determine the long-term effects of STN stimulation and medication on bradykinesia and tremor. The hypothesis is that STN stimulation and medication will still act through similar mechanisms, but that the absolute benefit will be reduced due to disease progression. These experiments will objectively quantify the efficacy of STN stimulation and medication for tremor, rigidity, bradykinesia, speech, and memory guided force control. Quantifying motor tasks that differ in their cognitive requirements will increase our understanding of both the positive and negative consequences of STN stimulation.