A Positron Emission Tomographic Study of Subthalamic Nucleus Stimulation in Parkinson Disease

Abstract

Stimulation of the STN reduces the movement-related impairment of frontal motor association areas and the inappropriate motor cortex resting activity in Parkinson disease.

Effects of subthalamic nucleus stimulation on actual and imagined movement in Parkinson's disease : a PET study

“…This finding underlines the restoration of a more physiological frontal-striatal-thalamic circuit by STN stimulation although the precise mechanims of such stimulation remains debated [4]. This effect may be explained by an improved functioning of the thalamocortical excitatory pathway and is in accordance with recent studies [7,27].…”

“…Interestingly the overactivation observed in the right DLPFC (i. e. controlateral to the stimulation and ispilateral to the movement) has also been found by Ceballos-Baumann et al [7]. In a recent PET study, the right DLPFC, and not the left one, appeared hypoactivated, compared with controls, while PD patients performed a joystick motor task in freely selected directions with the right hand [40].…”

“…Apomorphine challenge or stereotactic surgical procedures achieve their efficacy in alleviating parkinsonian symptoms by reducing the inhibitory output of these structures on the thalamocortical pathway as suggested by electrophysiological recordings [3,22,25,26,41]. This is supported by results from recent PET studies during actual execution of a motor task showing that hypoactivation of the rostral SMA and of the DLPFC may be corrected by subthalamic nucleus (STN) stimulation or by pallidotomy [7,17,19,27,32,39].…”

Modified Fluorodeoxyglucose Metabolism in Motor Circuitry by Subthalamic Deep Brain Stimulation

“…The decrease in cerebral blood flow in the supplementary motor area has been correlated with the improvement of rigidity [13]. However, some investigations indicated that during motor execution, STN DBS induced an increased activation of the supplementary motor area [14,15,16]. The inconsistency might originate from the heterogeneity of patients enrolled in different studies.…”

Combining functional imaging with brain stimulation in Parkinson's disease

“…Further, studies assessing the neural changes induced by DBS during a motor task have revealed an activation of the areas involved in kinesis, i.e. supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPFC) and anterior-cingulate cortex (ACC) and a deactivation of the so-called ' accessory ' pathways (Ceballos-Baumann et al, 1999;Grafton et al, 2006;Limousin et al, 1997;Strafella et al, 2003;Thobois et al, 2002).…”