深部脑刺激对苍白球前核的影响可降低帕金森病的运动冲动性。
Deep brain stimulation effect on anterior pallidum reduces motor impulsivity in Parkinson's disease.
机构信息
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
出版信息
Brain Stimul. 2022 Jan-Feb;15(1):23-31. doi: 10.1016/j.brs.2021.11.006. Epub 2021 Nov 5.
BACKGROUND
Deep Brain Stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is used to treat the motor symptoms of Parkinson's disease. The former can worsen impulsive and compulsive behaviors after controlling for the reduction of dopaminergic medications. However, the effect of pallidal DBS on such behaviors in PD patients is less clear.
OBJECTIVE/HYPOTHESIS: We hypothesized that greater stimulation spread to the pallidum with prefrontal connectivity would reduce motor impulsivity.
METHODS
Seven Parkinson's patients with stable globus pallidus internus DBS settings for 3 months, disease duration of 13 ± 1.3 years, and Montreal Cognitive Assessment of 26.8 ± 1.1 each had two stimulation settings defined based on reconstructions of lead placement and volume of tissue activation targeting either a dorsal or ventral position along the DBS electrode but still within the globus pallidus internus. Subjects performed a stop signal reaction time task with the DBS turned off vs. on in each of the defined stimulation settings, which was correlated with the degree of stimulation effect on pallidal subregions.
RESULTS
A shorter distance between the volume of tissue activation and the right prefrontally-connected GPi correlated with less impulsivity on the stop signal reaction time task (r = 0.69, p < 0.05). Greater volume of tissue activation overlap with the non-prefrontally-connected globus pallidus internus was associated with increased impulsivity.
CONCLUSION
These data can be leveraged to optimize DBS programming in PD patients with problematic impulsivity or in other disorders involving impulsive behaviors such as substance use disorders.
背景
深部脑刺激（DBS）于丘脑底核或苍白球 internus 内进行，用于治疗帕金森病的运动症状。在控制多巴胺能药物减少的情况下，前者可能会加重冲动和强迫行为。然而，苍白球 internus DBS 对 PD 患者此类行为的影响尚不清楚。
目的/假设：我们假设与前额叶连接的苍白球内刺激扩散越大，运动冲动性越低。
方法
7 名帕金森病患者，稳定的苍白球 internus DBS 设置 3 个月，疾病持续时间为 13±1.3 年，蒙特利尔认知评估为 26.8±1.1，每个患者都有两种刺激设置，基于对铅放置位置和组织激活体积的重建，针对沿 DBS 电极的背侧或腹侧位置，但仍在苍白球 internus 内。在 DBS 关闭与开启的情况下，每位患者都在每个定义的刺激设置下进行停止信号反应时间任务，该任务与刺激对苍白球亚区的影响程度相关。
结果
组织激活体积与右侧与前额叶相连的苍白球 internus 之间的距离越短，停止信号反应时间任务中的冲动性越低（r=0.69，p<0.05）。与非前额叶相连的苍白球 internus 之间的组织激活体积重叠越大，冲动性越高。
结论
这些数据可用于优化 PD 患者有问题的冲动性或涉及冲动行为（如物质使用障碍）的其他疾病的 DBS 编程。
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