Does subthalamic nucleus stimulation affect the frontal limbic areas? A single-photon emission computed tomography study using a manual anatomical segmentation method

Haegelen, Claire; Vérin, Marc; Broche, Benjamin; Prigent, F.; Jannin, Pierre; Gibaud, Bernard; Morandi, Xavier

doi:10.1007/s00276-005-0021-8

Cited by 16 publications

(8 citation statements)

References 34 publications

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“…Intraoperative fMRI imaging of PD patients during STN stimulation demonstrated simultaneous activation of limbic regions (cingulate and insular cortices) (Knight et al ., 2015). Similar studies using PET showed increased activation during STN stimulation in the dorsolateral prefrontal cortex bilaterally (Haegelen et al ., 2005) and the anterior cingulate (Sestini et al ., 2002). …”

Section: Stn Involvement In Limbic Functionsupporting

confidence: 67%

The Subthalamic Nucleus, Limbic Function, and Impulse Control

2015

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It has been well documented that deep brain stimulation (DBS) of the subthalamic nucleus (STN) to address some of the disabling motor symptoms of Parkinson’s disease (PD) can evoke unintended effects, especially on non-motor behavior. This observation has catalyzed more than a decade of research concentrated on establishing trends and identifying potential mechanisms for these non-motor effects. While many issues remain unresolved, the collective result of many research studies and clinical observations has been a general recognition of the role of the STN in mediating limbic function. In particular, the STN has been implicated in impulse control and the related construct of valence processing. A better understanding of STN involvement in these phenomena could have important implications for treating impulse control disorders (ICDs). ICDs affect up to 40% of PD patients on dopamine agonist therapy and approximately 15% of PD patients overall. ICDs have been reported to be associated with STN DBS. In this paper we will focus on impulse control and review pre-clinical, clinical, behavioral, imaging, and electrophysiological studies pertaining to the limbic function of the STN.

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Section: Stn Involvement In Limbic Functionsupporting

confidence: 67%

The Subthalamic Nucleus, Limbic Function, and Impulse Control

2015

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“…Schroeder et al [41,42] reported decreased [26] observed decreased rCMb in the right orbitofrontal cortex, correlated with impaired recognition of fear. In a previous SPECT study, we observed activation in the dorsolateral prefrontal cortex bilaterally [20]. STN DBS may impair prefrontal functions via two different mechanisms, either the inhibitory effect of the stimulation on its limbic territory, or more probably, faulty transmission of cortical information to the substantia nigra pars reticulata and nucleus accumbens, structures located within the same limbic circuit as the STN.…”

Section: Discussionmentioning

confidence: 97%

SPECT and PET analysis of subthalamic stimulation in Parkinson’s disease: analysis using a manual segmentation

et al. 2009

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The subthalamic nucleus (STN) has become an effective target of deep-brain stimulation (DBS) in severely disabled patients with advanced Parkinson's disease (PD). Clinical studies have reported DBS-induced adverse effects on cognitive functions, mood, emotion and behavior. STN DBS seems to interfere with the limbic functions of the basal ganglia, but the limbic effects of STN DBS are controversial. We measured prospectively resting regional cerebral metabolism (rCMb) with 18-fluorodeoxyglucose and PET, and resting regional cerebral blood flow (rCBF) with HMPAO and SPECT in six patients with Parkinson's disease. We compared PET and SPECT 1 month before and 3 months after STN DBS. On cerebral MRI, 13 regions of interest (ROI) were manually delineated slice by slice in frontal and limbic lobes. We obtained mean rCBF and rCMb values for each ROI and the whole brain. We normalized rCBF and rCMB values to ones for the whole brain volume, which we compared before and following STN DBS. No significant difference emerged in the SPECT analysis. PET analysis revealed a significant decrease in rCMb following STN DBS in the superior frontal gyri and left and right dorsolateral prefrontal cortex (p < 0.05). A non-significant decrease in rCMb in the left anterior cingulate gyrus appeared following STN DBS (p = 0.075). Our prospective SPECT and PET study revealed significantly decreased glucose metabolism of the two superior frontal gyri without any attendant perfusion changes following STN DBS. These results suggest that STN DBS may change medial prefrontal function and therefore the integration of limbic information, either by disrupting emotional processes within the STN, or by hampering the normal function of a limbic circuit.

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“…Due to the STN’s rich connections with the dorsolateral prefrontal cortex and limbic structures,[25, 26] stimulation of this area could alter cognition. Poor performance on measures of VF (related to mental flexibility in the frontal-striatal circuitry) is related to high frequency stimulation, with a beneficial effect during low frequency stimulation.…”

Section: Discussionmentioning

confidence: 99%

Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation

Williams

Arzola

Strutt

et al. 2011

Parkinsonism & Related Disorders

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Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson’s disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25% to 30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery.

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Does subthalamic nucleus stimulation affect the frontal limbic areas? A single-photon emission computed tomography study using a manual anatomical segmentation method

Cited by 16 publications

References 34 publications

The Subthalamic Nucleus, Limbic Function, and Impulse Control

The Subthalamic Nucleus, Limbic Function, and Impulse Control

SPECT and PET analysis of subthalamic stimulation in Parkinson’s disease: analysis using a manual segmentation

Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation

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