Haslinger Bernhard, Kalteis Karin, Boecker Henning, Alesch Francois, Ceballos-Baumann Andrés O
Neurologische Klinik, TU-München, Möhlstrasse 28, D-81675 München, Germany.
Neuroimage. 2005 Nov 15;28(3):598-606. doi: 10.1016/j.neuroimage.2005.06.034. Epub 2005 Aug 2.
According to the classical model of basal ganglia organization, deep brain stimulation (DBS) in the subthalamic nucleus (STN) for the treatment of Parkinson's disease (PD) blocks overactive excitatory projections to inhibitory basal ganglia output structures. This would release the break on thalamofrontal neurons alleviating the poverty of movement, the hallmark of PD. Such parallels to a functional lesion certainly simplify the mechanism of STN DBS. Here, we applied parametric analyses of H2(15)O positron emission tomography (PET) scans at rest while systematically varying stimulation frequency in 6 patients with STN DBS for akinetic PD. A strong positive correlation of rCBF to increasing stimulation frequency was detected around the STN bilaterally. More importantly, we show that gradual increases in STN stimulation frequency are tightly correlated with decreases in motor cortex activity. This demonstrates an active modulation of resting activity within the subcortical stimulation target and within motor cortex by STN DBS. Rather than a possible downstream effect, we propose to consider the tight correlations between DBS frequency and motor cortex activity in the context of an upstream modulation of direct efferents to the STN from primary motor and premotor cortices.
根据基底神经节组织的经典模型，用于治疗帕金森病（PD）的丘脑底核（STN）深部脑刺激（DBS）可阻断向抑制性基底神经节输出结构的过度活跃的兴奋性投射。这将解除对丘脑额叶神经元的抑制，减轻运动减少，即PD的标志性症状。这种类似于功能性损伤的情况无疑简化了STN DBS的机制。在此，我们对6例接受STN DBS治疗运动不能型PD的患者在静息状态下进行了H2(15)O正电子发射断层扫描（PET）的参数分析，同时系统地改变刺激频率。在双侧STN周围检测到rCBF与刺激频率增加呈强正相关。更重要的是，我们表明STN刺激频率的逐渐增加与运动皮层活动的减少密切相关。这证明了STN DBS对皮层下刺激靶点和运动皮层内静息活动的主动调节。我们建议在从初级运动皮层和运动前皮层向STN的直接传出纤维的上游调节的背景下，考虑DBS频率与运动皮层活动之间的紧密相关性，而不是可能的下游效应。
