Functional anatomy of subthalamic nucleus stimulation in Parkinson disease.
Objective: We developed a novel method to map behavioral effects of deep brain stimulation (DBS) across a 3-dimensional brain region and to assign statistical significance after stringent type I error correction. This method was applied to behavioral changes in Parkinson disease (PD) induced by subt...
| Publicado en: | Annals of Neurology Vol. 76; no. 2; pp. 279 - 296 |
|---|---|
| Autores principales: | , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2014
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103841453&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103841453 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03645134 1WM jtl: Annals of Neurology issn: 03645134 maglogo: Y pubinfo: dt: Aug2014 vid: 76 iid: 2 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 103841453 NLM24953991 2012692616 10.1002/ana.24204 NLM24953991 PMC4172323 103841453 ppf: 279 ppct: 17 formats: tig: atl: Functional anatomy of subthalamic nucleus stimulation in Parkinson disease. aug: au: Eisenstein, Sarah A Koller, Jonathan M Black, Kathleen D Campbell, Meghan C Lugar, Heather M Ushe, Mwiza Tabbal, Samer D Karimi, Morvarid Hershey, Tamara Perlmutter, Joel S Black, Kevin J affil: Department of Psychiatry, Washington University in St Louis, St Louis, MO. sug: subj: Brain Mapping Methods Deep Brain Stimulation Methods Parkinson Disease Therapy Diencephalon Anatomy and Histology Diencephalon Physiology Aged Female Human Male Middle Age Parkinson Disease Physiopathology Treatment Outcomes Scales Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Objective: We developed a novel method to map behavioral effects of deep brain stimulation (DBS) across a 3-dimensional brain region and to assign statistical significance after stringent type I error correction. This method was applied to behavioral changes in Parkinson disease (PD) induced by subthalamic nucleus (STN) DBS to determine whether these responses depended on anatomical location of DBS.Methods: Fifty-one PD participants with STN DBS were evaluated off medication, with DBS off and during unilateral STN DBS with clinically optimized settings. Dependent variables included DBS-induced changes in Unified Parkinson Disease Rating Scale (UPDRS) subscores, kinematic measures of bradykinesia and rigidity, working memory, response inhibition, mood, anxiety, and akathisia. Weighted t tests at each voxel produced p images showing where DBS most significantly affected each dependent variable based on outcomes of participants with nearby DBS. Finally, a permutation test computed the probability that this p image indicated significantly different responses based on stimulation site.Results: Most motor variables improved with DBS anywhere in the STN region, but several motor, cognitive, and affective responses significantly depended on precise location stimulated, with peak p values in superior STN/zona incerta (quantified bradykinesia), dorsal STN (mood, anxiety), and inferior STN/substantia nigra (UPDRS tremor, working memory).Interpretation: Our method identified DBS-induced behavioral changes that depended significantly on DBS site. These results do not support complete functional segregation within STN, because movement improved with DBS throughout, and mood improved with dorsal STN DBS. Rather, findings support functional convergence of motor, cognitive, and limbic information in STN. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|