Prior pallidotomy reduces and modifies neuronal activity in the subthalamic nucleus of Parkinson's disease patients (original) (raw)
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Pallidotomy suppresses beta power in the subthalamic nucleus of Parkinson's disease patients
European Journal of …
Parkinsonian patients, who have had a unilateral pallidotomy, may require bilateral deep brain stimulation of the subthalamic nucleus (STN), due to disease progression. The current model of the basal ganglia circuitry does not predict a direct effect of pallidotomy on the neuronal activity of the ipsilateral STN. To date, only three studies have investigated the effect of pallidotomy on overall activity of the STN or neuronal firing rate, but not on the spectral content of the neuronal oscillatory activity. Moreover, none of these studies attempted to differentiate the effects on the dorsal (sensory-motor) and ventral (associative-limbic) parts of the STN. We studied the effect of pallidotomy on spectral power in six frequency bands in the STN ipsilateral and contralateral to pallidotomy from seven patients and in 60 control nuclei of patients without prior functional neurosurgery, and investigated whether this effect is different on the dorsal and ventral STN. The data show that pallidotomy suppresses beta power (13-30 Hz) in the ipsilateral STN. This effect tends predominantly to be present in the dorsal part of the STN. In addition, spectral power in the frequency range 3-30 Hz is significantly higher in the dorsal part than in the ventral part. The effect of pallidotomy on STN neural activity is difficult to explain with the current model of basal ganglia circuitry and should be envisaged in the context of complex modulatory interactions in the basal ganglia.
Movement Disorders, 2004
Subthalamic nucleus deep brain stimulation (STN-DBS) has revolutionized the management of disabling motor complications in Parkinson's disease. The EARLYSTIM trial applied this treatment to patients who had been experiencing motor complications for less than three years. STN-DBS significantly improved all primary and secondary outcome measures while best medical therapy failed to provide any improvement at the two-year follow-up time point. On face value these results strongly favor the application of STN-DBS far earlier than is currently applied, when patients are just beginning to experience problems with motor complications. Here we review the application of early DBS and the EARLYSTIM trial from the perspectives of clinical issues, health economics and study design and patient expectation of benefit. We conclude that the most relevant issue is not when to operate but on whom and that early is not always better. V
Brain and Cognition, 2000
This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional and hemisphere-specific impairments of frontostriatal cognitive functions followed unilateral PVP. ''Frontal'' behavioral dyscontrol was observed in approximately 25% of patients. Three cases of staged bilateral PVP suggest that premorbid factors may predict outcome, although lesion size and location are also critical. Older patients are at risk for significant cognitive and behavioral decline after bilateral STN DBS, while GPi DBS may be safer.
2000
Synchronous unit activity and local field potentials evoked in the subthalamic nucleus by cortical stimulation. . The responses of single subthalamic nucleus (STN) neurons to cortical activation are complex and depend on the relative activation of several neuronal circuits, making theoretical extrapolation of single neuron responses to the population level difficult. To understand better the degree of synchrony imposed on STN neurons and associated neuronal networks by cortical activation, we recorded the responses of single units, pairs of neighboring neurons, and local field potentials (LFPs) in STN to discrete electrical stimulation of the cortex in anesthetized rats. Stimulation of ipsilateral frontal cortex, but not temporal cortex, generated synchronized "multiphasic" responses in neighboring units in rostral STN, usually consisting of a brief, short-latency excitation, a brief inhibition, a second excitation, and a long-duration inhibition. Evoked LFPs in STN consistently mirrored unit responses; brief, negative deflections in the LFP coincided with excitations and brief, positive deflections with inhibitions. This characteristic LFP was dissimilar to potentials evoked in cortex and structures surrounding STN and was resistant to fluctuations in forebrain activity. The short-latency excitation and associated LFP deflection exhibited the highest fidelity to low-intensity cortical stimuli. Unit response failures, which mostly occurred in caudal STN, were not associated with LFPs typical of rostral STN. These data suggest that local populations of STN neurons can be synchronized by both direct and indirect cortical inputs. Synchronized ensemble activity is dependent on topography and input intensity. Finally, the stereotypical, multiphasic profile of the evoked LFP indicates that it might be useful for locating the STN in clinical as well as nonclinical settings.
Subthalamic deep brain stimulation in patients with a previous pallidotomy
Movement Disorders, 2006
The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age-and sex-matched group of 25 DBS patients who had no prior pallidotomy. After their initial pallidotomy (mean age, 51.8 ؎ 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 ؎ 14.3 to 34.9 ؎ 12.8, and the UPDRS dyskinesia score improved from 1.8 ؎ 1.0 to 0.8 ؎ 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 ؎ 10.2 years) improved by 16.0% from 53.1 ؎ 9.7 (range, 42-68) to 44.6 ؎ 11.1 (range, 25-67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 ؎ 11.1 to 25.7 ؎ 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior pallidotomy had less improvement in UP-DRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection.
Functional neuronal activity and connectivity within the subthalamic nucleus in Parkinson’s disease
Clinical Neurophysiology, 2013
h i g h l i g h t s Significantly different firing behavior of single units has been demonstrated in the sensorimotor part of the STN compared to the remaining part in PD patients. This includes increased mean firing rate, more bursty behavior of neurons and increased interneuronal coherences in the beta band. Postoperative evaluation of target stimulation areas in the investigated PD patients with DBS shows a significant preference for the sensorimotor part of the STN. a b s t r a c t Objective: Characterization of the functional neuronal activity and connectivity within the subthalamic nucleus (STN) in patients with Parkinson's disease (PD). Methods: Single units were extracted from micro-electrode recording (MER) of 18 PD patients who underwent STN deep brain stimulation (DBS) surgery. The firing rate and pattern of simultaneously recorded spike trains and their coherence were analyzed. To provide a precise functional assignment of position to the observed activities, for each patient we mapped its classified multichannel STN MERs to a generic atlas representation with a sensorimotor part and a remaining part. Results: Within the sensorimotor part we found significantly higher mean firing rate (P < 0.05) and significantly more burst-like activity (P < 0.05) than within the remaining part. The proportion of significant coherence in the beta band (13-30 Hz) is significantly higher in the sensorimotor part of the STN than elsewhere (P = 0.015). Conclusions: The STN sensorimotor part distinguishes itself from the remaining part with respect to beta coherence, firing rate and burst-like activity and postoperatively was found as the preferred target area. Significance: Our firing behavior analysis may help to discriminate the STN sensorimotor part for the placement of the DBS electrode.
Journal of Neurophysiology, 2009
Competing theories seek to account for the therapeutic effects of high-frequency deep brain stimulation (DBS) of the internal globus pallidus (GPi) for medically intractable Parkinson's disease. To investigate this question, we studied the spontaneous activity of 102 pallidal neurons during GPiDBS in two macaques rendered parkinsonian by administration of MPTP. Stimulation through macroelectrodes in the GPi (≥200 μA at 150 Hz for 30 s) reduced rigidity in one animal and increased spontaneous movement in both. Novel artifact subtraction methods allowed uninterrupted single-unit recording during stimulation. GPiDBS induced phasic (78% of cells) or sustained (22%) peristimulus changes in firing in both pallidal segments. A subset of cells responded at short latency (<2 ms) in a manner consistent with antidromic driving. Later phasic increases clustered at 3- to 5-ms latency. Stimulation-induced decreases were either phasic, clustered at 1–3 ms, or sustained, showing no peristimu...