STN Stimulation - Neural Control of Movement and Posture

描述(申请人提供)：有多个平行环路连接基底节和各种运动和认知回路。高频刺激丘脑底核(STN)和多巴胺能药物显著改善帕金森病的运动症状。然而，最近的证据表明，刺激STN也会对言语和认知方面产生负面影响。长期目标是确定STN刺激和药物治疗对帕金森病患者术后6个月和长期运动控制的特定方面的影响。中心假设是刺激STN和药物对主要涉及运动通路的帕金森氏症症状的作用相似。STN刺激和药物治疗可以对包括运动控制认知方面的通路的任务产生不同的影响。目标1将确定STN刺激和药物在增加任务认知复杂性的次要任务中对震颤和僵直的影响。假说是，当使用次级认知任务时，STN刺激的效果会较差。目的2将确定STN刺激和药物对语音的影响。假设刺激STN会导致语言清晰度下降，因为它涉及多条基底节通路。目的3确定STN刺激和药物对内导肢体力量控制的影响。假设在刺激STN的情况下，肘力会被高估，因为前扣带回皮质的激活减少。目的4将确定STN刺激和药物治疗对运动迟缓和震颤的长期影响。假设STN刺激和药物治疗仍将通过类似的机制发挥作用，但绝对益处将因疾病进展而减少。这些实验将客观地量化STN刺激和药物对震颤、僵硬、运动迟缓、语音和记忆引导的力量控制的疗效。量化认知需求不同的运动任务将增加我们对STN刺激的积极和消极影响的理解。

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.