Language Section, Voice, Speech, and Language Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA.
Brain Stimul. 2012 Oct;5(4):605-15. doi: 10.1016/j.brs.2011.09.002. Epub 2011 Oct 5.
Dopamine agonist therapy and deep brain stimulation (DBS) of the subthalamic nucleus (STN) are antiparkinsonian treatments that act on a different part of the basal ganglia-thalamocortical motor circuitry, yet produce similar symptomatic improvements.
OBJECTIVE/HYPOTHESIS: The purpose of this study was to identify common and unique brain network features of these standard treatments.
We analyzed images produced by H(2)(15)O positron emission tomography (PET) of patients with Parkinson's disease (PD) at rest. Nine patients were scanned before and after injection of apomorphine, and 11 patients were scanned while bilateral stimulators were off and while they were on.
Both treatments produced common deactivations of the neocortical sensorimotor areas, including the supplementary motor area, precentral gyrus, and postcentral gyrus, and in subcortical structures, including the putamen and cerebellum. We observed concomitant activations of the superior parietal lobule and the midbrain in the region of the substantia nigra/STN. We also detected unique, treatment-specific changes with possible motor-related consequences in the basal ganglia, thalamus, neocortical sensorimotor cortex, and posterolateral cerebellum. Unique changes in nonmotor regions may reflect treatment-specific effects on verbal fluency and limbic functions.
Many of the common effects of these treatments are consistent with the standard pathophysiologic model of PD. However, the common effects in the cerebellum are not readily explained by the model. Consistent deactivation of the cerebellum is interesting in light of recent reports of synaptic pathways directly connecting the cerebellum and basal ganglia, and may warrant further consideration for incorporation into the model.
多巴胺激动剂治疗和丘脑底核（STN）的深部脑刺激（DBS）是两种抗帕金森病的治疗方法，它们作用于基底节-丘脑皮质运动回路的不同部位，但产生相似的症状改善。
目的/假设：本研究的目的是确定这些标准治疗方法的共同和独特的大脑网络特征。
我们分析了帕金森病（PD）患者在静息状态下进行 H(2)(15)O 正电子发射断层扫描（PET）时的图像。9 名患者在注射阿扑吗啡前后进行了扫描，11 名患者在双侧刺激器关闭和开启时进行了扫描。
两种治疗方法都导致新皮层感觉运动区（包括辅助运动区、中央前回和中央后回）和皮质下结构（包括壳核和小脑）的共同去激活。我们观察到中脑黑质/STN 区域的上顶叶和中脑的同时激活。我们还检测到基底节、丘脑、新皮层感觉运动皮质和后外侧小脑中具有治疗特异性的独特变化，可能与运动相关。基底节、丘脑和新皮层感觉运动皮质中独特的变化可能反映了治疗对言语流畅性和边缘功能的特定影响。
这些治疗方法的许多共同作用与 PD 的标准病理生理模型一致。然而，小脑的共同作用不能用该模型来解释。鉴于最近有报道称小脑和基底节之间存在直接的突触通路，小脑的持续去激活很有趣，可能需要进一步考虑将其纳入该模型。
