Fejeran Joshua, Salazar Frank, Alvarez Cesia M, Jahangiri Faisal R
Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, USA.
Neurophysiology, Global Innervation LLC, Dallas, USA.
Cureus. 2022 Aug 11;14(8):e27887. doi: 10.7759/cureus.27887. eCollection 2022 Aug.
Parkinson's disease (PD) is a neurological disorder in which nigrostriatal pathways involving the basal ganglia experience a decrease in neural activity regarding dopaminergic neurons. PD symptoms, such as muscle stiffness and involuntary tremors, have an adverse impact on the daily lives of those affected. Current medical treatments seek to decrease the severity of these symptoms. Deep brain stimulation (DBS) has become the preferred safe, and reliable treatment approach. DBS involves implanting microelectrodes into subcortical areas that produce electrical impulses directly to high populations of dopaminergic neurons. The most common targets are the subthalamic nucleus (STN), and the basal ganglia's globus pallidus pars interna (GPi). Research studies suggest that DBS of the STN may cause a significant reduction in the daily dose of L-DOPA compared to DBS of the GPi. DBS of the STN has suggested that there may be sweet spots within the STN that provide hyper-direct cortical connectivity pathways to the primary motor cortex (M1), supplementary motor area (SMA), and prefrontal cortex (PFC). In addition, the pedunculopontine nucleus (PPN) may be a new target for DBS that helps treat locomotion problems associated with gait and posture. Both microelectrode recording (MER) and magnetic resonance imaging (MRI) are used to ensure electrode placement accuracy. Using MER, stimulation of the STN at high frequencies (140<) decreased oscillatory neuronal firing by 67%. This paper investigates methods of intraoperative neuromonitoring during DBS as a form of PD treatment.
帕金森病（PD）是一种神经障碍疾病，其中涉及基底神经节的黑质纹状体通路中多巴胺能神经元的神经活动减少。帕金森病的症状，如肌肉僵硬和不自主震颤，会对患者的日常生活产生不利影响。目前的医学治疗旨在减轻这些症状的严重程度。深部脑刺激（DBS）已成为首选的安全可靠的治疗方法。DBS包括将微电极植入皮质下区域，这些区域直接向大量多巴胺能神经元产生电脉冲。最常见的靶点是丘脑底核（STN）和基底神经节的内侧苍白球（GPi）。研究表明，与GPi的DBS相比，STN的DBS可能会使左旋多巴的每日剂量显著减少。STN的DBS表明，STN内可能存在一些“最佳点”，这些点提供了通向初级运动皮层（M1）、辅助运动区（SMA）和前额叶皮层（PFC）的超直接皮质连接通路。此外，脚桥核（PPN）可能是DBS的一个新靶点，有助于治疗与步态和姿势相关的运动问题。微电极记录（MER）和磁共振成像（MRI）都用于确保电极放置的准确性。使用MER，高频（140<）刺激STN可使振荡神经元放电减少67%。本文研究了在DBS治疗帕金森病过程中作为一种术中神经监测的方法。
