The Interdisciplinary Centre for Neural Computation, The Hebrew University of Jerusalem, and Centre for Functional & Restorative Neurosurgery, Department of Neurosurgery, Hadassah University Hospital, P.O. Box 12272, Jerusalem 91120, Israel.
Brain. 2010 Jul;133(Pt 7):2007-21. doi: 10.1093/brain/awq144. Epub 2010 Jun 9.
The significance of oscillations that characterize the subthalamic nucleus in Parkinson's disease is still under debate. Here, we analysed the spectral and spatial characteristics of 314 microelectrode trajectories from 128 patients undergoing subthalamic nucleus deep brain stimulation surgery for Parkinson's disease. We correlated the subthalamic nucleus pathophysiology with the outcome of surgery, as evaluated by the third section of the Unified Parkinson's Disease Rating Scale (motor score), which was subdivided into tremor, rigidity, limb-bradykinesia and axial-bradykinesia subscores. beta-oscillatory activity (13-30 Hz) comprised a continuous stretch within the subthalamic nucleus, and was limited to a distinctly-bounded dorsolateral oscillatory region. Although less consistent and more sporadic, low-frequency (3-7 Hz) power was also increased in the dorsolateral oscillatory region. In contrast, the more ventral subthalamic nucleus was characterized by consistently reduced beta and increased gamma (30-100 Hz) activity. Neuronal responses to passive arm movement (analysed by their alignment to goniometer tracing of the joints' angular displacement) were significantly more common in the dorsolateral oscillatory region than the ventral subthalamic nucleus region (62 versus 25% of sites tested respectively, P<0.01). The length of the dorsolateral oscillatory region recorded in the macroelectrode-implanted trajectory predicted a favourable response to subthalamic nucleus deep brain stimulation (R=0.67, P<0.0001). This correlation was also evident for improvement in the specific symptom subscores of rigidity, limb-bradykinesia and axial-bradykinesia (P<0.05). Similarly, increased subthalamic nucleus beta power was associated with postoperative improvement. In contrast, the preoperative response to levodopa did not correlate with dorsolateral oscillatory region length (P=0.33), however, it did tend to be associated with increased beta (and decreased low frequency) subthalamic nucleus power. Finally, the active macroelectrode contact, independently selected by optimal clinical outcome, coincided with the dorsolateral oscillatory region centre. On average, the location of the active contact was not significantly different from the dorsolateral oscillatory region centre (P=0.10), but was significantly different from the subthalamic nucleus centre (P<0.0001). We conclude that the spatial extent of the dorsolateral oscillatory region, which overlaps the motor territories of the subthalamic nucleus, predicts the outcome of subthalamic nucleus deep brain stimulation. Thus the frequency and spatial characteristics of the subthalamic nucleus trajectory may be used for deep brain stimulation outcome optimization.
底丘脑核中特征性振荡的意义仍存在争议。在此，我们分析了 128 名帕金森病患者接受底丘脑核深部脑刺激手术的 314 个微电极轨迹的频谱和空间特征。我们将底丘脑核病理生理学与手术结果相关联，该结果通过第三部分统一帕金森病评定量表（运动评分）评估，该评分分为震颤、僵直、肢体运动迟缓以及轴性运动迟缓亚评分。β-振荡活动（13-30 Hz）构成了底丘脑核内的连续伸展，仅限于明显限定的背外侧振荡区域。尽管不太一致且更分散，但低频（3-7 Hz）功率也在背外侧振荡区域中增加。相比之下，更腹侧的底丘脑核以一致降低的β和增加的γ（30-100 Hz）活动为特征。对被动手臂运动的神经元反应（通过它们与关节角度位移的量角器轨迹的对准来分析）在背外侧振荡区域中明显比腹侧底丘脑核区域更为常见（分别为 62%和 25%的测试部位，P<0.01）。在宏观电极植入轨迹中记录的背外侧振荡区域的长度可预测底丘脑核深部脑刺激的良好反应（R=0.67，P<0.0001）。这种相关性也体现在僵直、肢体运动迟缓以及轴性运动迟缓的特定症状亚评分的改善中（P<0.05）。同样，增加的底丘脑核β功率与术后改善相关。相比之下，术前对左旋多巴的反应与背外侧振荡区域长度无关（P=0.33），但是，它确实与增加的β（和减少的低频）底丘脑核功率相关。最后，通过最佳临床结果独立选择的主动宏观电极接触点与背外侧振荡区域中心重合。平均而言，主动接触点的位置与背外侧振荡区域中心没有显著差异（P=0.10），但与底丘脑核中心有显著差异（P<0.0001）。我们得出结论，背外侧振荡区域的空间范围与底丘脑核的运动区域重叠，可预测底丘脑核深部脑刺激的结果。因此，底丘脑核轨迹的频率和空间特征可用于深部脑刺激结果的优化。
