Статті в журналах: "Subthalamic nucleu"

1

Barlas, Orhan, Ha?met A. Hana?as?, Murat ?mer, H�seyin A. ?ahin, Serra Sencer, and Murat Emre. "Do unilateral ablative lesions of the subthalamic nucleu in parkinsonian patients lead to hemiballism?" Movement Disorders 16, no. 2 (2001): 306–10. http://dx.doi.org/10.1002/mds.1051.

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2

Nakano, Naoki, Mamoru Taneda, Akira Watanabe, and Amami Kato. "Computed Three-Dimensional Atlas of Subthalamic Nucleus and Its Adjacent Structures for Deep Brain Stimulation in Parkinson's Disease." ISRN Neurology 2012 (January 12, 2012): 1–13. http://dx.doi.org/10.5402/2012/592678.

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Background. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the standard surgical treatments for advanced Parkinson's disease. However, it has been difficult to accurately localize the stimulated contact area of the electrode in the subthalamic nucleus and its adjacent structures using a two-dimensional atlas. The goal of this study is to verify the real and detailed localization of stimulated contact of the DBS electrode therapeutically inserted into the STN and its adjacent structures using a novel computed three-dimensional atlas built by a personal computer. Method. A three-dimensional atlas of the STN and its adjacent structures (3D-Subthalamus atlas) was elaborated on the basis of sagittal slices from the Schaltenbrand and Wahren stereotactic atlas on a personal computer utilizing a commercial software. The electrode inserted into the STN and its adjacent structures was superimposed on our 3D-Subthalamus atlas based on intraoperative third ventriculography in 11 cases. Findings. Accurate localization of the DBS electrode was identified using the 3D-Subthalamus atlas, and its clinical efficacy of the electrode stimulation was investigated in all 11 cases. Conclusion. This study demonstrates that the 3D-Subthalamus atlas is a useful tool for understanding the morphology of deep brain structures and for the precise anatomical position findings of the stimulated contact of a DBS electrode. The clinical analysis using the 3D atlas supports the contention that the stimulation of structures adjacent to the STN, particularly the zona incerta or the field of Forel H, is as effective as the stimulation of the STN itself for the treatment of advanced Parkinson's disease.

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3

Etemadifar, Masoud, Seyed-Hossein Abtahi, Seyed-Mojtaba Abtahi, Motahreh Mirdamadi, Sepideh Sajjadi, Aryan Golabbakhsh, Mohammad-Reza Savoj, Mahboobeh Fereidan-Esfahani, Zahra Nasr, and Nasim Tabrizi. "Hemiballismus, Hyperphagia, and Behavioral Changes following Subthalamic Infarct." Case Reports in Medicine 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/768580.

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The function of subthalamic nucleus (STN) which is a part of the basal ganglia system is not clear, but it is hypothesized that this component might be involved in action selection. Unilateral damage to STN, which can commonly occur due to the small vessel stroke mainly, causes hemiballismus and sometimes hemichorea-hemiballismus. This paper deals with a 60-year-old patient with sudden onset of abnormal movements in his right limbs. He had increased appetite and hyperphagia and also developed mood and behavioral changes (aggressiveness, irritability, anxiety, and sometimes obscene speech). The magnetic resonance imaging revealed infarct area in left subthalamus. In our case, hemiballismus is caused by infarction in left subthalamic area. Occurrence of irritability, anxiety, and some behavioral changes such as aggressiveness and obscene speech can be explained by impairment of STN role in nonmotor behavior and cognitive function as a result of infarct.

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4

Magalhães, Marcelo José Silva de, Claudiojanes dos Reis, Juliana Rabelo da Silva Sousa, Victória Souza Marques, Tayná Cardoso Gonçalves, Iara Cristina Vieira Ribeiro, Leide Daiana Silveira Cardoso, Victor Caribé Crosland Guimarães, Frederico Gustavo de Souza Marques, and Sarah Dias Pereira. "Subthalamic Nucleus: Neuroanatomical Review." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 39, no. 04 (December 18, 2017): 284–88. http://dx.doi.org/10.1055/s-0037-1615268.

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AbstractDiscovered in 1865 by Jules Bernard Luys, the subthalamic nucleus is a set of small nuclei located in the diencephalon, inferior to the thalamus and superior to the substantia nigra, that can be visualized in a posterior coronal section. Histologically, it consists of neurons compactly distributed and filled with a large number of blood vessels and sparse myelinated fibers. This review presents an analysis of this anatomical region, considering what is most recent in the literature. Subthalamic neurons are excitatory and use glutamate as the neurotransmitter. In healthy individuals, these neurons are inhibited by nerve cells located in the side globus pallidus. However, if the fibers that make up the afferent circuit are damaged, the neurons become highly excitable, thus causing motor disturbances that can be classified as hyperkinetic, for example ballism and chorea, or hypokinetic, for example Parkinson disease (PD). The advent of deep brain stimulation has given the subthalamic nucleus great visibility. Studies reveal that the stimulation of this nucleus improves the motor symptoms of PD.

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5

Velíšková, Jana, Libor Velšek, and Solomon L. Moshé. "Subthalamic nucleus." NeuroReport 7, no. 11 (July 1996): 1786–88. http://dx.doi.org/10.1097/00001756-199607290-00019.

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López-Flores, Gerardo, Juan Miguel-Morales, Juan Teijeiro-Amador, Jerold Vitek, Sahily Perez-Parra, Ramsés Fernández-Melo, Carlos Maragoto, et al. "Anatomic and Neurophysiological Methods for the Targeting and Lesioning of the Subthalamic Nucleus: Cuban Experience and Review." Neurosurgery 52, no. 4 (April 1, 2003): 817–31. http://dx.doi.org/10.1227/01.neu.0000053224.16728.7d.

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Abstract OBJECTIVE To develop a method to place a lesion precisely in the subthalamic nucleus (STN) and evaluate its effectiveness. METHODS A retrospective study of targeting data collected during stereotactic planning to lesion the STN in 31 patients with Parkinson's disease and of results in more than 50 procedures was performed. The targeting method was based on computed tomographic imaging together with semimicroelectrode recording digital processing and electrical stimulation. Two statistical methods were used to correlate initial with final target coordinates and assess the efficacy of the targeting procedure. RESULTS The anatomic target based on computed tomographic imaging data showed electrical activity in the subthalamus in the first pass in 82% of the procedures. In the remaining 18%, the STN was an average of 1.93 mm away from the nearest trajectory that recorded the STN (range, 1.41–2.24 mm). The average number of trajectories per procedure was 7.2; the location of the first trajectory relative to the center of the nucleus determined by electrical and physiological means (P< 0.01, analysis of variance, Student's ttest) was as follows: in the lateral direction, 1.25 ± 1.15 mm; in the anteroposterior direction, 1.53 ± 1.31 mm; and in the vertical direction, 0.67 ± 0.51 mm. The average number of tracts necessary to lesion the STN was two. CONCLUSION The combination of computed tomographic imaging, semimicroelectrode recording, and microstimulation provides an effective method to identify the STN lesion in parkinsonian patients. The method used for anatomic localization and electrophysiological mapping of the subthalamus was found to be effective in reaching the sensorimotor region of the nucleus. We carried out an accurate determination of the subthalamus location and its volume in the lesioning.

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Blandini, Fabio, Giuseppe Conti, Emilia Martignoni, Vittorio Colangelo, Giuseppe Nappi, Renato Di Grezia, and Francesco Orzi. "Modifications of Local Cerebral Metabolic Rates for Glucose and Motor Behavior in Rats with Unilateral Lesion of the Subthalamic Nucleus." Journal of Cerebral Blood Flow & Metabolism 19, no. 2 (February 1999): 149–54. http://dx.doi.org/10.1097/00004647-199902000-00006.

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Inactivation of the subthalamic nucleus (STN) has attracted interest as a therapeutic tool in Parkinson's disease. The functional consequences of the inactivation, however, are uncertain. In this study definition of the pattern of changes of cerebral functional activity associated with lesion of the STN and dopaminergic stimulation, by using the [14C]deoxyglucose method, was sought. Six or 7 days following unilateral lesion of the STN, the animals were divided into two groups: One group (n = 10) was administered apomorphine (1 mg/kg) subcutaneously; the second group (n = 10) received saline. The [14C]deoxyglucose procedure was initiated 10 minutes following the drug or saline injection. The results show that systemic administration of apomorphine to rats with unilateral lesion of the STN causes ipsiversive rotational behavior and asymmetries of glucose utilization of defined brain areas, including the substantia nigra reticulata, globus pallidus, and entopeduncular nucleus. These nuclei are the main targets of the subthalamic excitatory projections. Lesion of the nucleus per se (without challenge with apomorphine) has no significant consequences on glucose utilization. The findings indicate that the STN is involved in the activation of the basal ganglia output nuclei induced by systemic dopaminergic stimulation.

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Young, Geoffrey S., Feng Feng, Hao Shen, and Nan-kuei Chen. "SUSCEPTIBILITY-ENHANCED 3-TESLA T1-WEIGHTED SPOILED GRADIENT ECHO OF THE MIDBRAIN NUCLEI FOR GUIDANCE OF DEEP BRAIN STIMULATION IMPLANTATION." Neurosurgery 65, no. 4 (October 1, 2009): 809–15. http://dx.doi.org/10.1227/01.neu.0000345354.21320.d1.

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Abstract SURGICAL PLANNING FOR deep brain stimulation implantation procedures requires T1-weighted imaging (T1WI) for stereotactic navigation. Because the subthalamic nucleus, the main target for deep brain stimulation, and other midbrain nuclei cannot be visualized on the stereotactic guidance T1WI, additional T2-weighted imaging (T2WI) is generally obtained and registered to the T1WI for surgical targeting. Surgical planning based on the registration of the 2 data sets is subject to error resulting from inconsistent geometric distortions and any subject movement between the 2 scans. In this article, we propose a new method to produce susceptibility-enhanced, contrast-optimized T1-weighted 3-dimensional spoiled gradient recalled acquisition in steady state images with enhanced contrast for midbrain nuclei within the volumetric T1WI data set itself, eliminating the need for additional T2WI. The scan parameters of 3-dimensional spoiled gradient recalled acquisition in steady state are chosen in a way that T1WI can be obtained from conventional magnitude reconstruction and images with improved contrast between midbrain nuclei and surrounding tissues can be produced from the same data by performing susceptibility-weighted imaging reconstruction on a chosen region of interest. In addition, our preliminary experience suggests that the resulting contrast between the midbrain nuclei is superior to the current state-of-the-art fast spin echo T2WI in depicting the subthalamic nucleus as distinct from the substantia nigra pars reticulata and clear depiction of the nucleus ventrointermedius externus of thalamus.

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Sañudo-Peña, M. Clara, and J. Michael Walker. "Role of the Subthalamic Nucleus in Cannabinoid Actions in the Substantia Nigra of the Rat." Journal of Neurophysiology 77, no. 3 (March 1, 1997): 1635–38. http://dx.doi.org/10.1152/jn.1997.77.3.1635.

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Sañudo-Peña, M. Clara and J. Michael Walker. Role of the subthalamic nucleus in cannabinoid actions in the substantia nigra of the rat. J. Neurophysiol. 77: 1635–1638, 1997. The effect of cannabinoids on the excitatory input to the substantia nigra reticulata (SNr) from the subthalamic nucleus was explored. For this purpose a knife cut was performed rostral to the subthalamic nucleus to isolate the subthalamic nucleus and the SNr from the striatum, a major source of cannabinoid receptors to the SNr. The data showed that the cannabinoid agonist WIN55,212-2 blocked the increase in the firing rate of SNr neurons induced by stimulation of the subthalamic nucleus with bicuculline. Furthermore, the cannabinoid antagonist SR141716A antagonized the effect of the cannabinoid agonist. This study showed that cannabinoids regulate not only the striatonigral pathway, as previously reported, but also the subthalamonigral pathway. The opposite influences of these two inputs to the SNr, inhibitory and excitatory respectively, suggest that endogenous cannabinoids play a major role in the physiological regulation of the SNr.

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10

Moro, Elena, Yu-Yan W. Poon, Andres M. Lozano, Jean A. Saint-Cyr, and Anthony E. Lang. "Subthalamic Nucleus Stimulation." Archives of Neurology 63, no. 9 (September 1, 2006): 1266. http://dx.doi.org/10.1001/archneur.63.9.1266.

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Schmalbach, Barbara, Veronika Günther, Jan Raethjen, Stefanie Wailke, Daniela Falk, Günther Deuschl, and Karsten Witt. "The Subthalamic Nucleus Influences Visuospatial Attention in Humans." Journal of Cognitive Neuroscience 26, no. 3 (March 2014): 543–50. http://dx.doi.org/10.1162/jocn_a_00502.

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Spatial attention is a lateralized feature of the human brain. Whereas the role of cortical areas of the nondominant hemisphere on spatial attention has been investigated in detail, the impact of the BG, and more precisely the subthalamic nucleus, on signs and symptoms of spatial attention is not well understood. Here we used unilateral deep brain stimulation of the subthalamic nucleus to reversibly, specifically, and intraindividually modify the neuronal BG outflow and its consequences on signs and symptoms of visuospatial attention in patients suffering from Parkinson disease. We tested 13 patients with Parkinson disease and chronic deep brain stimulation in three stimulation settings: unilateral right and left deep brain stimulation of the subthalamic nucleus as well as bilateral deep brain stimulation of the subthalamic nucleus. In all three stimulation settings, the patients viewed a set of pictures while an eye-tracker system recorded eye movements. During the exploration of the visual stimuli, we analyzed the time spent in each visual hemispace, as well as the number, duration, amplitude, peak velocity, acceleration peak, and speed of saccades. In the unilateral left-sided stimulation setting, patients show a shorter ipsilateral exploration time of the extrapersonal space, whereas number, duration, and speed of saccades did not differ between the different stimulation settings. These results demonstrated reduced visuospatial attention toward the side contralateral to the right subthalamic nucleus that was not being stimulated in a unilateral left-sided stimulation. Turning on the right stimulator, the reduced visuospatial attention vanished. These results support the involvement of the subthalamic nucleus in modulating spatial attention. Therefore, the subthalamic nucleus is part of the subcortical network that subserves spatial attention.

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Marmor, Odeya, Dan Valsky, Mati Joshua, Atira S. Bick, David Arkadir, Idit Tamir, Hagai Bergman, Zvi Israel, and Renana Eitan. "Local vs. volume conductance activity of field potentials in the human subthalamic nucleus." Journal of Neurophysiology 117, no. 6 (June 1, 2017): 2140–51. http://dx.doi.org/10.1152/jn.00756.2016.

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Subthalamic nucleus field potentials have attracted growing research and clinical interest over the last few decades. However, it is unclear whether subthalamic field potentials represent locally generated neuronal subthreshold activity or volume conductance of the organized neuronal activity generated in the cortex. This study aimed at understanding of the physiological origin of subthalamic field potentials and determining the most accurate method for recording them. We compared different methods of recordings in the human subthalamic nucleus: spikes (300–9,000 Hz) and field potentials (3–100 Hz) recorded by monopolar micro- and macroelectrodes, as well as by differential-bipolar macroelectrodes. The recordings were done outside and inside the subthalamic nucleus during electrophysiological navigation for deep brain stimulation procedures (150 electrode trajectories) in 41 Parkinson’s disease patients. We modeled the signal and estimated the contribution of nearby/independent vs. remote/common activity in each recording configuration and area. Monopolar micro- and macroelectrode recordings detect field potentials that are considerably affected by common (probably cortical) activity. However, bipolar macroelectrode recordings inside the subthalamic nucleus can detect locally generated potentials. These results are confirmed by high correspondence between the model predictions and actual correlation of neuronal activity recorded by electrode pairs. Differential bipolar macroelectrode subthalamic field potentials can overcome volume conductance effects and reflect locally generated neuronal activity. Bipolar macroelectrode local field potential recordings might be used as a biological marker of normal and pathological brain functions for future electrophysiological studies and navigation systems as well as for closed-loop deep brain stimulation paradigms. NEW & NOTEWORTHY Our results integrate a new method for human subthalamic recordings with a development of an advanced mathematical model. We found that while monopolar microelectrode and macroelectrode recordings detect field potentials that are considerably affected by common (probably cortical) activity, bipolar macroelectrode recordings inside the subthalamic nucleus (STN) detect locally generated potentials that are significantly different than those recorded outside the STN. Differential bipolar subthalamic field potentials can be used in navigation and closed-loop deep brain stimulation paradigms.

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Villadóniga, Marta, Lidia Cabañes-Martínez, Laura López-Viñas, Samira Fanjul, Marta del Álamo, and Ignacio Regidor. "Combined Stimulation of the Substantia Nigra and the Subthalamic Nucleus for the Treatment of Refractory Gait Disturbances in Parkinson’s Disease: A Preliminary Study." Journal of Clinical Medicine 11, no. 8 (April 18, 2022): 2269. http://dx.doi.org/10.3390/jcm11082269.

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Deep brain stimulation of the subthalamic nucleus is efficient for the treatment of motor symptoms (i.e., tremors) in patients with Parkinson’s disease. Gait disorders usually appear during advanced stages of idiopathic Parkinson’s disease in up to 80% of patients and have an important impact on their quality of life. The effects of deep brain stimulation of the subthalamic nucleus on gait and balance are still controversial. For this reason, alternative targets have been considered, such as stimulation of the pedunculopontine nucleus and the pars reticulata of substantia nigra, involved in the integration of the functional connections for gait. Due to the proximity of the subthalamic nucleus to the substantia nigra, their combined stimulation is feasible and may lead to better outcomes, improving axial symptoms. Our objective was to prospectively compare simultaneous stimulation of both structures versus conventional subthalamic stimulation in improving gait disorders. In ten patients with advanced Parkinson’s disease, deep brain stimulation leads (eight linear contacts) were implanted, and gait analysis was performed 6 months after surgery in off-stimulation and after 4 weeks of dual or single subthalamic stimulation. An improvement in gait parameters was confirmed with both stimulation conditions, with better results with combined substantia nigra and subthalamic stimulation compared with conventional subthalamic stimulation. Further studies are needed to determine if this effect remains after long-term dual-target stimulation.

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Lo Buono, Viviana, Marietta Lucà Trombetta, Rosanna Palmeri, Lilla Bonanno, Emanuele Cartella, Giuseppe Di Lorenzo, Placido Bramanti, Silvia Marino, and Francesco Corallo. "Subthalamic nucleus deep brain stimulation and impulsivity in Parkinson’s disease: a descriptive review." Acta Neurologica Belgica 121, no. 4 (May 7, 2021): 837–47. http://dx.doi.org/10.1007/s13760-021-01684-4.

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AbstractStandard treatment of Parkinson’s disease involves the dopaminergic medications. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an important neurosurgical intervention often used as alternative treatment to drug therapy; however, it can be associated with increase of impulsive behaviors. This descriptive review focused on studies investigating the correlation between Deep brain stimulation of the subthalamic nucleus and impulsivity in Parkinson’s disease patients, arguing, the action’s mechanism and the specific role of the subthalamic nucleus. We searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 106 studies, only 15 met the search criteria. Parkinson’s Disease patients with and without Deep Brain Stimulation were compared with healthy controls, through 16 different tasks that assessed some aspects of impulsivity. Both Deep brain stimulation of the subthalamic nucleus and medication were associated with impulsive behavior and influenced decision-making processes. Moreover, findings demonstrated that: Impulse Control Disorders (ICDs) occurred soon after surgery, while, in pharmacological treatment, they appeared mainly after the initiation of treatment or the increase in dosage, especially with dopamine agonists. The subthalamic nucleus plays a part in the fronto-striato-thalamic-cortical loops mediating motor, cognitive, and emotional functions: this could explain the role of the Deep Brain Stimulation in behavior modulation in Parkinson’s Disease patients. Indeed, increase impulsivity has been reported also after deep brain stimulation of the subthalamic nucleus independently by dopaminergic medication status.

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Kuwabara, N., and N. Suga. "Delay lines and amplitude selectivity are created in subthalamic auditory nuclei: the brachium of the inferior colliculus of the mustached bat." Journal of Neurophysiology 69, no. 5 (May 1, 1993): 1713–24. http://dx.doi.org/10.1152/jn.1993.69.5.1713.

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1. The biosonar pulse of the mustached bat, Pteronotus parnellii parnellii, consists of four harmonics of a constant-frequency component (CF1-4) followed by a frequency-modulated component (FM1-4). FM-FM combination-sensitive neurons in the auditory cortex and the medical geniculate body (MGB) show facilitative responses to certain combinations of FM components in a pulse-echo pair. They are tuned to particular delays of echo FMn (EFMn) (n = 2, 3, or 4) from pulse FM1 (PFM1). The neural mechanisms for creating their response properties involve delay lines, coincidence detection, and multiplication. Coincidence detection and multiplication take place in the MGB. It is not yet known where and how delay lines are created. The first aim of the present studies is to examine whether delay lines are created by subthalamic nuclei. FM-FM neurons are tuned to not only echo delays but also echo amplitudes. Therefore, the second aim of the present studies is to examine the extent to which amplitude selectivity is created by subthalamic nuclei. Responses of single nerve fibers to acoustic stimuli were recorded from the brachium of the inferior colliculus (BIC) using tungsten wire microelectrodes, and their response latencies and best amplitudes were measured. 2. All BIC fibers responded strongly to single tone bursts. No FM-FM combination-sensitive neurons were found in the BIC. The best frequencies of BIC fibers were predominantly within the frequency ranges of four harmonics of the species-specific biosonar pulse. 3. The response latencies of BIC fibers tuned to FM1 were more diverse (3.5-15.0 ms) than those of BIC fibers tuned to FMn (3.8-6.5 ms). This difference in latency distribution was independent of stimulus amplitude. These data are consistent with the theory that delay lines utilized by FM-FM neurons are created by neurons tuned to the "FM1 frequency," and indicate that the delay lines are mostly, if not all, created in a subthalamic nucleus or nuclei. 4. The best amplitudes of BIC fibers tuned to FM1 or CF1 were 63.2 +/- 4.5 (SE) dB SPL, and those of BIC fibers tuned to FMn or CFn were 48.2 +/- 10.7 dB SPL. The distribution of the best amplitudes of BIC fibers were very similar to those of FM-FM and CF/CF neurons in the MGB. These data indicate that the amplitude selectivity of thalamic FM-FM and CF/CF neurons is mainly a product of a subthalamic nucleus or nuclei.(ABSTRACT TRUNCATED AT 400 WORDS)

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Ehlen, Felicitas, Bassam Al-Fatly, Andrea A. Kühn, and Fabian Klostermann. "Impact of deep brain stimulation of the subthalamic nucleus on natural language in patients with Parkinson’s disease." PLOS ONE 15, no. 12 (December 29, 2020): e0244148. http://dx.doi.org/10.1371/journal.pone.0244148.

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Background In addition to the typical motor symptoms, a majority of patients suffering from Parkinson’s disease experience language impairments. Deep Brain Stimulation of the subthalamic nucleus robustly reduces motor dysfunction, but its impact on language skills remains ambiguous. Method To elucidate the impact of subthalamic deep brain stimulation on natural language production, we systematically analyzed language samples from fourteen individuals (three female / eleven male, average age 66.43 ± 7.53 years) with Parkinson’s disease in the active (ON) versus inactive (OFF) stimulation condition. Significant ON-OFF differences were considered as stimulation effects. To localize their neuroanatomical origin within the subthalamic nucleus, they were correlated with the volume of tissue activated by therapeutic stimulation. Results Word and clause production speed increased significantly under active stimulation. These enhancements correlated with the volume of tissue activated within the associative part of the subthalamic nucleus, but not with that within the dorsolateral motor part, which again correlated with motor improvement. Language error rates were lower in the ON vs. OFF condition, but did not correlate with electrode localization. No significant changes in further semantic or syntactic language features were detected in the current study. Conclusion The findings point towards a facilitation of executive language functions occurring rather independently from motor improvement. Given the presumed origin of this stimulation effect within the associative part of the subthalamic nucleus, this could be due to co-stimulation of the prefrontal-subthalamic circuit.

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Hyam, Jonathan A., John-Stuart Brittain, David J. Paterson, Robert J. O. Davies, Tipu Z. Aziz, and Alexander L. Green. "Controlling the Lungs Via the Brain: A Novel Neurosurgical Method to Improve Lung Function in Humans." Neurosurgery 70, no. 2 (August 10, 2011): 469–78. http://dx.doi.org/10.1227/neu.0b013e318231d789.

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Abstract BACKGROUND: Deep brain stimulation (DBS) of subcortical brain areas such as the periaqueductal grey and subthalamic nucleus has been shown to alter cardiovascular autonomic performance. The supramedullary circuitry controlling respiratory airways is not well defined and has not been tested in humans. OBJECTIVE: To use direct electric stimulation via DBS macroelectrodes to test whether airway resistance could be manipulated by these areas in awake humans. METHODS: Thirty-seven patients with in-dwelling deep brain electrodes for movement disorders or chronic pain underwent spirometry according to the European Respiratory Society guidelines. Testing was performed randomly 3 times on stimulation and 3 times off stimulation; patients were blinded to the test. Thoracic diameter changes were measured by a circumferential pressure-sensitive thoracic band. Ten periaqueductal grey and 10 subthalamic nucleus patients were tested. To control for confounding pain and movement disorder relief, the sensory thalamus in 7 patients and globus pallidus interna in 10 patients, respectively, were also tested. RESULTS: Peak expiratory flow rate (PEFR) increased significantly with periaqueductal grey and subthalamic nucleus stimulation by up to 14% (P = .02 and .005, respectively, paired-samples Student t tests). Stimulation of control nuclei produced no significant PEFR change. Similarly, changes in thoracic diameter reflecting skeletal activity rather than airway caliber did not correlate with the improvement in PEFR. Forced expiratory volume in 1 second was unchanged by stimulation. CONCLUSION: DBS can improve PEFR in chronic pain and movement disorder patients. This finding provides insights into the neural modulation of respiratory performance and may explain some of the subjective benefits of DBS.

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Ruschel, Leonardo Gilmone, Guilherme Jose Agnoletto, Daniel Benzecry De Almeida, and Murilo De Sousa Meneses. "Image Fusion of 3T and 1.5 T MRI for Parkinson’s Disease Surgery." JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA 25, no. 2 (March 26, 2018): 117–20. http://dx.doi.org/10.22290/jbnc.v25i2.1095.

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Introduction. Anatomical landmarks for stereotactic surgical procedures like deep brain electrodes implantation for Parkinson’s Disease has been performed since a long time ago through low-field magnetic resonance image (MRI) such as 1.5 Tesla (T) apparatus. Methods: We describe a direct method of visualization of subthalamic nucleus. For this purpose, a routine 1.5T MRI images are taken, and undergoes further fusion with 3T MRI pictures. Results. The result of image fusion allows tridimensional reconstructions, and a better differentiation between white matter and gray matter of the brain. A higher resolution also gives better identification of subthalamic nucleus, skull base nucleus, red nucleus, as well as other anatomical landmarks, resulting in higher accuracy of the procedure. Conclusion. A computational platform combining these two MRIs (3T and 1.5T) has reached more accuracy for surgical implantation of electrodes in Deep Brain Stimulation for subthalamic nucleus.

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Petry-Schmelzer, Jan Niklas, Max Krause, Till A. Dembek, Andreas Horn, Julian Evans, Keyoumars Ashkan, Alexandra Rizos, et al. "Non-motor outcomes depend on location of neurostimulation in Parkinson’s disease." Brain 142, no. 11 (September 23, 2019): 3592–604. http://dx.doi.org/10.1093/brain/awz285.

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Deep brain stimulation of the subthalamic nucleus improves non-motor symptoms in Parkinson’s disease, but with considerable inter-individual variability. Petry-Schmelzer et al. show that neurostimulation in specific subregions of the subthalamic nucleus has differential effects on mood/apathy, attention/memory and sleep-related outcomes. Neurostimulation could thus be tailored to patients’ individual non-motor profiles.

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Aziz, T. Z., D. Nandi, S. Parkin, X. Liu, N. Giladi, P. Bain, R. G. Gregory, C. Joint, R. B. Scott, and J. F. Stein. "Targeting the Subthalamic Nucleus." Stereotactic and Functional Neurosurgery 77, no. 1-4 (2001): 87–90. http://dx.doi.org/10.1159/000064602.

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Strecker, Karl, Jürgen Meixensberger, Johannes Schwarz, and Dirk Winkler. "INCREASE OF FREQUENCY IN DEEP BRAIN STIMULATION RELIEVES APRAXIA OF EYELID OPENING IN PATIENTS WITH PARKINSON'S DISEASE." Neurosurgery 63, no. 6 (December 1, 2008): E1204. http://dx.doi.org/10.1227/01.neu.0000335781.27643.5b.

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Abstract OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment in advanced stages of Parkinson's disease. However, approximately 5% of patients might develop apraxia of eyelid opening after DBS of the subthalamic nucleus. We provide data on a new noninvasive treatment approach to this adverse event. CLINICAL PRESENTATION We report 2 patients who acquired apraxia of eyelid opening after DBS. This adverse event was relieved by changing the stimulation parameters. INTERVENTION The stimulation frequency was increased from 100 Hz to 180 Hz in 1 patient and 160 Hz in the other, resulting in a total relief of symptoms. CONCLUSION Increasing stimulation frequency may be beneficial in apraxia of eyelid opening acquired after DBS of the subthalamic nucleus.

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Hamani, Clement, Erich Richter, Jason M. Schwalb, and Andres M. Lozano. "Bilateral Subthalamic Nucleus Stimulation for Parkinson's Disease: A Systematic Review of the Clinical Literature." Neurosurgery 56, no. 6 (June 1, 2005): 1313–24. http://dx.doi.org/10.1227/01.neu.0000159714.28232.c4.

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Abstract OBJECTIVE: To evaluate the benefits and adverse effects of bilateral subthalamic nucleus stimulation in the treatment of Parkinson's disease (PD) by systematically reviewing the published literature. METHODS: A search of the PubMed database using the key words subthalamic, nucleus, and stimulation yielded 624 articles published between 1966 and December 2003. Only articles that included original, nonduplicated descriptions of patients with PD treated with bilateral subthalamic nucleus stimulation were selected for further analysis. RESULTS: A total of 38 studies from 34 neurosurgical centers in 13 countries were identified for critical review. The outcomes for 471 patients with PD treated with bilateral subthalamic nucleus stimulation were assessed according to the Unified Parkinson's Disease Rating Scale in both on-medication and off-medication conditions. With stimulation, Unified Parkinson's Disease Rating Scale motor scores in the off-medication condition improved by 50% after 6 months, 56% after 12 months, 51% after 2 years, and 49% after 5 years compared with preoperative off-medication scores. At 12 months of subthalamic nucleus stimulation, the mean improvement in tremor was 81%, in rigidity was 63%, in bradykinesia was 52%, in gait was 64%, and in postural instability was 69% when compared with preoperative off-medication subscores. On-medication dyskinesias were reduced by 94%, as assessed 12 months after stimulation using the Unified Parkinson's Disease Rating Scale IV complications of therapy score. There was an overall 52% reduction in the l-dopa-equivalent dose intake after 12 months of stimulation. Most adverse effects were mild to moderate. There was a 1 to 2% incidence of severe adverse effects (death or permanent neurological deficits related to intracerebral hemorrhages). Nineteen percent of the patients had adverse effects related to stimulation that could be reversed by changing stimulation parameters. There was a 9% incidence of adverse effects related to the hardware (infections, lead and pulse generator problems). CONCLUSION: Bilateral subthalamic nucleus stimulation is effective in the treatment of PD. Further refinements in patient selection and surgical technique may lessen the incidence of complications associated with this procedure.

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De la Casa-Fages, Beatriz, and Francisco Grandas. "Dopamine Dysregulation Syndrome and Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease." Neurology Research International 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/759895.

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Dopamine dysregulation syndrome is a complication of the dopaminergic treatment in Parkinson's disease that may be very disabling due to the negative impact that compulsive medication use may have on patients' social, psychological, and physical functioning. The relationship between subthalamic nucleus deep brain stimulation and dopamine dysregulation syndrome in patients with Parkinson's disease remains unclear. Deep brain stimulation may improve, worsen, or have no effect on preoperative dopamine dysregulation syndrome. Moreover, dopamine dysregulation syndrome may appear for the first time after deep brain stimulation of the subthalamic nucleus. The outcome of postoperative dopamine dysregulation syndrome is poor despite stimulation and medication adjustments. Here we review the phenomenology and neurobiology of this disorder, discuss possible mechanisms that may underlie the diverse outcomes of dopamine dysregulation syndrome after subthalamic nucleus deep brain stimulation, and propose management strategies.

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Jahanshahi, Marjan, and John C. Rothwell. "Inhibitory dysfunction contributes to some of the motor and non-motor symptoms of movement disorders and psychiatric disorders." Philosophical Transactions of the Royal Society B: Biological Sciences 372, no. 1718 (February 27, 2017): 20160198. http://dx.doi.org/10.1098/rstb.2016.0198.

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Recently, it has been proposed that similar to goal-directed and habitual action mediated by the fronto-striatal circuits, the fronto-striato-subthalamic-pallidal-thalamo-cortical network may also mediate goal-directed and habitual (automatic) inhibition in both the motor and non-motor domains. Within this framework, some of the clinical manifestations of Parkinson's disease, dystonia, Tourette syndrome and obsessive–compulsive disorder can be considered to represent an imbalance between goal-directed and habitual action and inhibition. It is possible that surgical interventions targeting the basal ganglia nuclei, such as deep brain stimulation of the subthalamic nucleus or the internal segment of the globus pallidus, improve these disorders by restoring a functional balance between facilitation and inhibition in the fronto-striatal networks. These proposals require investigation in future studies. This article is part of the themed issue ‘Movement suppression: brain mechanisms for stopping and stillness’.

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Starr, Philip A., Philip V. Theodosopoulos, and Robert Turner. "Surgery of the Subthalamic Nucleus: Use of Movement-related Neuronal Activity for Surgical Navigation." Neurosurgery 53, no. 5 (November 1, 2003): 1146–49. http://dx.doi.org/10.1227/01.neu.0000088803.79153.05.

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Abstract THE BASAL GANGLIA have important roles in somatic motor, oculomotor, limbic, and associative functions. These functions are represented in anatomically distinct territories in each basal ganglion nucleus. During surgery of the subthalamic nucleus for Parkinson's disease, the primary goal is to influence the physiology of the motor territory without affecting nonmotor areas. This article describes the use of movement-related cellular activity during single-unit microelectrode mapping to identify and to navigate within the motor territory of the subthalamic nucleus.

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Shima, Fumio, Takato Morioka, Shozo Tobimatsu, Omiros Kavaklis, Motohiro Kato, and Masashi Fukui. "Localization of Stereotactic Targets by Microrecording of Thalamic Somatosensory Evoked Potentials." Neurosurgery 28, no. 2 (February 1, 1991): 223–30. http://dx.doi.org/10.1227/00006123-199102000-00008.

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Abstract To improve the localization of stereotactic targets, somatosensory evoked potentials (SEPs) were recorded from the thalamus and subthalamic area using a specially designed semimicroelectrode in 61 patients and a conventional “macroclectrode” in 17 patients. By means of the semimicroelectrode, median nerve stimulation evoked two distinct SEPs, consisting of a diphasic wave with a huge positivity restricted to the nucleus ventrocaudalis (Vc) and a triphasic wave of lower amplitude with a major negativity in the ventral part of the nucleus ventrointermedius (Vim) and nucleus ventrooralis posterior (Vop) as well as the subthalamic lemniscal pathway. The Vim-Vc junction could thus be clearly delineated by an abrupt transition of SEPs from one type to the other with a precision of 1 mm. The parvicellular part of the Vc (Vcpc). situated in its basal region, was distinguishable from the Vc proper by a significant reduction of the positivity elicited by stimulation of the median nerve and by a rapid growth of a diphasic SEPs to stimulation of the posterior tibial nerve. In the other thalamic nuclei, stimulation of the median nerve elicited triphasic SEPs of a very small amplitude, suggesting a volume conduction current from the lemniscal pathway. With the macroclectrode, the positivity in the Vc was sensitive to electrode manipulation and the thalamic nuclei could not be distinctly outlined. SEP monitoring using the semimicroelectrode significantly improved the precision of target localization, which allowed minimizing of the volume of the therapeutic lesion without losing surgical effectiveness, while avoiding complications associated with increased penetration of the coagulating electrode. It is suggested that recording serial thalamic SEPs with the semimicroelectrode is a practical method to refine stereotactic targets in the thalamus.

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Moers-Hornikx, Véronique M. P., Johan S. H. Vles, Sonny K. H. Tan, Kimberly Cox, Govert Hoogland, W. M. Harry Steinbusch, and Yasin Temel. "Cerebellar nuclei are activated by high-frequency stimulation of the subthalamic nucleus." Neuroscience Letters 496, no. 2 (June 2011): 111–15. http://dx.doi.org/10.1016/j.neulet.2011.03.094.

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Gillies, A., and D. Willshaw. "Models of the subthalamic nucleus." Medical Engineering & Physics 26, no. 9 (November 2004): 723–32. http://dx.doi.org/10.1016/j.medengphy.2004.06.003.

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Marchand, R. "Histogenesis of the subthalamic nucleus." Neuroscience 21, no. 1 (April 1987): 183–95. http://dx.doi.org/10.1016/0306-4522(87)90332-0.

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Doshi, Paresh, and Mohit Bhatt. "Hemiballism during subthalamic nucleus lesioning." Movement Disorders 17, no. 4 (July 2002): 848–49. http://dx.doi.org/10.1002/mds.10237.

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Guridi, Jorge, Jose A. Obeso, Maria C. Rodriguez-Oroz, Andres M. Lozano, and Miguel Manrique. "L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE." Neurosurgery 62, no. 2 (February 1, 2008): 311–25. http://dx.doi.org/10.1227/01.neu.0000315998.58022.55.

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Abstract OBJECTIVE To assess the impact of different surgical targets and techniques, such as ablation and deep brain stimulation, to treat patients with L-dopa-induced dyskinesia (LID), a major therapeutic complication of Parkinson's disease. METHODS This review analyzes the effects of early surgical procedures to treat hyperkinesia and the current methods and targets used to combat LID in Parkinson's disease, which are mainly thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus internus and the subthalamic nucleus. RESULTS Available information indicates that surgery of the globus pallidus internus and thalamus (the pallidal receiving area) and of the subthalamic nucleus has a pronounced antidyskinetic effect. This effect is associated with a concomitant improvement in the parkinsonian (“off”-medication) state. Although it is more profound with pallidal and subthalamic surgery, such an effect can also be observed to some extent with thalamic surgery. The latter is attributable to the fact that surgery of the ventralis intermedius is primarily effective for treating tremor. An integral pallidothalamic pathway is needed for dyskinesia to be expressed. Thus, LID is less frequent after subthalamotomy or deep brain stimulation of the subthalamic nucleus through a functional effect mediated by the physiological normalization of the motor system and by an indirect effect associated with a reduction in the daily dose of L-dopa. CONCLUSION Surgery is the only treatment available for Parkinson's disease that can predictably improve both the parkinsonian motor syndrome and LID. The exact mechanisms involved in these effects are not well understood. Pallidal and thalamic surgery affecting pallidal relays reduce LID frequency by disrupting the pallidothalamic circuit, probably eliminating the neuronal activity associated with dyskinesia. Alternatively, the antidyskinetic effect of subthalamic nucleus surgery may in part be attributable to a reduction in the L-dopa dose as well as to the stabilization of the basal ganglia circuits after the surgical procedure.

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Blomstedt, Patric, Ulrika Sandvik, Anders Fytagoridis, and Stephen Tisch. "THE POSTERIOR SUBTHALAMIC AREA IN THE TREATMENT OF MOVEMENT DISORDERS." Neurosurgery 64, no. 6 (June 1, 2009): 1029–42. http://dx.doi.org/10.1227/01.neu.0000345643.69486.bc.

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Abstract THE INTRODUCTION OF thalamotomy in 1954 led naturally to exploration of the underlying subthalamic area, with the development of such procedures as campotomy and subthalamotomy in the posterior subthalamic area. The most popular of these procedures was the subthalamotomy, which was performed in thousands of patients for various movement disorders. Today, in the deep brain stimulation (DBS) era, subthalamic nucleus DBS is the treatment of choice for Parkinson's disease, whereas thalamic and pallidal DBS are mainly used for nonparkinsonian tremor and dystonia, respectively. The interest in DBS in the posterior subthalamic area has been quite limited, however, with a total of 95 patients presented in 14 articles. During recent years, interest has increased, and promising results have been published concerning both Parkinson's disease and nonparkinsonian tremor. We reviewed the literature to investigate the development of surgery in the posterior subthalamic area from the lesional era to the present.

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Toshiya, Fukhi, Hasegawa YuKihiro, Seriyama Shinya, Takeuchi Toru, Sugita Koujiro, and Taukagoshi Hiroshi. "Hemiballism-hemichorea Induced by Subcortical Ischemia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 20, no. 4 (November 1993): 324–28. http://dx.doi.org/10.1017/s0317167100048253.

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ABSTRACT:Four patients presented with hemiballism-hemichorea as a clinical manifestation of white matter ischemia. These patients illustrate “positive” motor phenomena rather than limb weakness as a consequence of cerebral ischemia. In each patient, the involuntary movements disappeared following worsening of paresis. Subcortical white matter infarction in three patients and hemodynamic hypo-perfusion in the cerebral hemisphere contralateral to dyskinetic movements were possible causes. Neuroradiologically, none had pathological changes in the vicinity of the subthalamic nucleus. We presume from these observations that ischemia of the subcortical white matter, without involvement of the basal ganglia or the subthalamic nucleus, may cause hemiballism-hemichorea

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DeLong, M. R., M. D. Crutcher, and A. P. Georgopoulos. "Primate globus pallidus and subthalamic nucleus: functional organization." Journal of Neurophysiology 53, no. 2 (February 1, 1985): 530–43. http://dx.doi.org/10.1152/jn.1985.53.2.530.

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Neuronal relations to active movements of individual body parts and neuronal responses to somatosensory stimulation were studied in the external (GPe) and internal (GPi) segments of the globus pallidus (GP) and the subthalamic nucleus (STN) of awake monkeys. In GPe (n = 249), GPi (n = 151), and STN (n = 153), 47, 29, and 28% of the cells, respectively, discharged in relation to active arm movements, 10, 11, and 15% to leg movements, and 22, 22, and 18% to orofacial movements. Of the neurons whose activity was related to arm movements, 26, 16, and 21% in GPe, GPi, and STN, respectively, discharged in relation to movements of distal parts of the limb. Of cells whose discharge was related to active limb movements, 37, 22, and 20% in GPe, GPi, and STN, respectively, also responded to passive joint rotation, which was usually specific in terms of joint and direction of movement. Only a small percentage of cells responded to muscle or joint palpation, tendon taps, or cutaneous stimulation. Short-latency, direction-specific neuronal responses to load perturbations confirmed the existence of proprioceptive driving. In both GPe and GPi, leg movement-related neurons were centrally located in the rostrocaudal and dorsoventral dimensions. In contrast, arm movement-related cells were found throughout the entire rostrocaudal extent of both segments, although in greater numbers caudally. In the central portions they were situated largely inferior and lateral to leg movement-related neurons. Neurons related to orofacial movements were largely confined to the caudal halves of both segments, where they were located largely ventral to arm movement-related cells. The STN cells whose activity was related to leg movements were observed largely in the central portions of the nucleus in the rostrocaudal and mediolateral dimensions. Cells whose activity was related to arm movements were found throughout the rostrocaudal extent of the nucleus, but were most numerous at the rostral and caudal poles. Neurons related to movements of the facial musculature and to licking and chewing movements were distributed over the entire rostrocaudal extent of the nucleus, where they generally occupied the ventrolateral regions. In all three nuclei, neurons with similar functional properties were sometimes clustered together. Within the arm and leg areas, however, there was no clear evidence for a simple organization of clusters related to different parts of the limb. These studies provide further evidence for a role of the basal ganglia in the control of limb movements.(ABSTRACT TRUNCATED AT 400 WORDS)

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Watanabe, Mitsuru, Koichiro Sumi, Toshiki Obuchi, Katsunori Shijo, Toshikazu Kano, Kazutaka Kobayashi, Hideki Oshima, et al. "Application of Diffusion Tensor Imaging (DTI) Tractography as a Targeting Modality for Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN)." Journal of Nihon University Medical Association 74, no. 2 (2015): 63–68. http://dx.doi.org/10.4264/numa.74.63.

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González-Herrero, Belén, Serge Jauma-Classen, Roser Gómez-Llopico, Gerard Plans, and Matilde Calopa. "Intestinal Levodopa/Carbidopa Infusion as a Therapeutic Option for Unresponsive Freezing of Gait after Deep Brain Stimulation in Parkinson’s Disease." Parkinson's Disease 2020 (May 14, 2020): 1–5. http://dx.doi.org/10.1155/2020/1627264.

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Background. Treatment of freezing of gait (FOG) is always challenging because of its unpredictable nature and multifactorial physiopathology. Intestinal levodopa infusion has been proposed in recent years as a valuable option for its improvement. FOG in Parkinson’s disease (PD) can appear after deep brain stimulation in patients who never had gait symptoms. Objective. To study the effects of intestinal levodopa/carbidopa infusion in unresponsive-FOG that appears in PD patients treated with subthalamic nucleus deep brain stimulation. Methods. We retrospectively collected and analyzed demographic, clinical, and therapeutic data from five PD patients treated with subthalamic nucleus stimulation who developed unresponsive-FOG and received intestinal levodopa/carbidopa infusion as an alternative therapy. FOG was measured based on scores in item 14 of the Unified Parkinson’s Disease Rating Scale before and after intestinal levodopa infusion. Results. Administration of intestinal levodopa caused improvement of FOG in the “ON” state in four patients (80%) by 2 or more points in item 14 of the Unified Parkinson’s Disease Rating Scale. The improvement was maintained for at least 12 months. Conclusions. Intestinal levodopa infusion may be a valuable therapeutic option for unresponsive-FOG developed after subthalamic nucleus deep brain stimulation.

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Dvorzhak, Anton, Christoph Gertler, Daniel Harnack, and Rosemarie Grantyn. "High Frequency Stimulation of the Subthalamic Nucleus Leads to Presynaptic GABA(B)-Dependent Depression of Subthalamo-Nigral Afferents." PLoS ONE 8, no. 12 (December 23, 2013): e82191. http://dx.doi.org/10.1371/journal.pone.0082191.

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Santos-Lobato, Bruno Lopes dos, Elaine Aparecida Del-Bel, José Eymard Homem Pittella, and Vitor Tumas. "Effects of aging on nitrergic neurons in human striatum and subthalamic nucleus." Arquivos de Neuro-Psiquiatria 73, no. 9 (September 2015): 779–83. http://dx.doi.org/10.1590/0004-282x20150097.

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Nitric oxide (NO) is a major neurotransmitter associated with motor control in basal ganglia. Movement disorders, as essential tremor and Parkinson’s disease, are more prevalent on aged individuals. We investigated the effects of aging on neuronal density and diameter/area of nitrergic neurons in samples of striatum (caudate and putamen) and subthalamic nucleus of 20 human brains from normal subjects, stained by histochemistry for NADPH-diaphorase and immunohistochemistry for neuronal NO synthase. Our data showed aging does not modify the neuronal density and size of nitrergic neurons in striatum and subthalamic nucleus. These findings suggest a lack of association between aging and morphologic changes on nitrergic neurons.

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Sterio, Djordje, Martin Zonenshayn, Alon Y. Mogilner, Ali R. Rezai, Kiril Kiprovski, Patrick J. Kelly, and Aleksandar Beric. "Neurophysiological Refinement of Subthalamic Nucleus Targeting." Neurosurgery 50, no. 1 (January 2002): 58–69. http://dx.doi.org/10.1227/00006123-200201000-00012.

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40

Parent, Martin, and André Parent. "The microcircuitry of primate subthalamic nucleus." Parkinsonism & Related Disorders 13 (2007): S292—S295. http://dx.doi.org/10.1016/s1353-8020(08)70018-x.

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Marconi, Roberto, Andrea Landi, and Franco Valzania. "Subthalamic nucleus stimulation in Parkinson’s disease." Neurological Sciences 29, S5 (December 2008): 389–91. http://dx.doi.org/10.1007/s10072-008-1055-6.

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Godinho, F., S. Thobois, M. Magnin, M. Guenot, G. Polo, I. Benatru, J. Xie, et al. "Subthalamic nucleus stimulation in Parkinson’s disease." Journal of Neurology 253, no. 10 (June 20, 2006): 1347–55. http://dx.doi.org/10.1007/s00415-006-0222-z.

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43

Sterio, Djordje, Martin Zonenshayn, Alon Y. Mogilner, Ali R. Rezai, Kiril Kiprovski, Patrick J. Kelly, and Aleksandar Beric. "Neurophysiological Refinement of Subthalamic Nucleus Targeting." Neurosurgery 50, no. 1 (January 1, 2002): 58–69. http://dx.doi.org/10.1097/00006123-200201000-00012.

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ABSTRACT OBJECTIVE Advances in image-guided stereotactic surgery, microelectrode recording techniques, and stimulation technology have been the driving forces behind a resurgence in the use of functional neurosurgery for the treatment of movement disorders. Despite the dramatic effects of deep brain stimulation (DBS) techniques in ameliorating the symptoms of Parkinson's disease, many critical questions related to the targeting, effects, and mechanisms of action of DBS remain unanswered. In this report, we describe the methods used to localize the subthalamic nucleus (STN) and we present the characteristics of encountered cells. METHODS Twenty-six patients with idiopathic Parkinson's disease underwent simultaneous, bilateral, microelectrode-refined, DBS electrode implantation into the STN. Direct and indirect magnetic resonance imaging-based anatomic targeting was used. Cellular activity was analyzed for various neurophysiological parameters, including firing rates and interspike intervals. Physiological targeting confirmation was obtained by performing macrostimulation through the final DBS electrode. RESULTS The average microelectrode recording time for each trajectory was 20 minutes, with a mean of 5.2 trajectories/patient. Typical trajectories passed through the anterior thalamus, zona incerta/fields of Forel, STN, and substantia nigra-pars reticulata. Each structure exhibited a characteristic firing pattern. In particular, recordings from the STN exhibited an increase in background activity and an irregular firing pattern, with a mean rate of 47 Hz. The mean cell density was 5.6 cells/mm, with an average maximal trajectory length of 5.3 mm. Macrostimulation via the DBS electrode yielded mean sensory and motor thresholds of 4.2 and 5.7 V, respectively. CONCLUSION The principal objectives of microelectrode recording refinement of anatomic targeting are precise identification of the borders of the STN and thus determination of its maximal length. Microelectrode recording also allows identification of the longest and most lateral segment of the STN, which is our preferred target for STN DBS electrode implantation. Macrostimulation via the final DBS electrode is then used primarily to establish the side effect profile for postoperative stimulation. Microelectrode recording is a helpful targeting adjunct that will continue to facilitate our understanding of basal ganglion physiological features.

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Thobois, S., P. Mertens, M. Guenot, M. Hermier, H. Mollion, M. Bouvard, G. Chazot, E. Broussolle, and M. Sindou. "Subthalamic nucleus stimulation in Parkinson's disease." Journal of Neurology 249, no. 5 (May 1, 2002): 529–34. http://dx.doi.org/10.1007/s004150200059.

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45

Pariwatcharakul, Pornjira, Chris Clough, Paul Shotbolt, Robert Morris, Natasha Hulse, Angela Costello, Michael Samuel, and Keyoumars Ashkan. "Pathological crying after subthalamic nucleus stimulation." Movement Disorders 28, no. 10 (July 18, 2013): 1348–49. http://dx.doi.org/10.1002/mds.25517.

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46

Zavala, Baltazar, Kareem Zaghloul, and Peter Brown. "The subthalamic nucleus, oscillations, and conflict." Movement Disorders 30, no. 3 (February 17, 2015): 328–38. http://dx.doi.org/10.1002/mds.26072.

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Lozano, Andres M. "The subthalamic nucleus: Myth and opportunities." Movement Disorders 16, no. 2 (2001): 183–84. http://dx.doi.org/10.1002/mds.1076.

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Lévesque, Julie-Christine, and André Parent. "GABAergic interneurons in human subthalamic nucleus." Movement Disorders 20, no. 5 (2005): 574–84. http://dx.doi.org/10.1002/mds.20374.

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49

Hasegawa, Harutomo, Petra Fischer, Huiling Tan, Alek Pogosyan, Michael Samuel, Peter Brown, and Keyoumars Ashkan. "The Effect of Unilateral Subthalamic Nucleus Deep Brain Stimulation on Contralateral Subthalamic Nucleus Local Field Potentials." Neuromodulation: Technology at the Neural Interface 23, no. 4 (April 12, 2020): 509–14. http://dx.doi.org/10.1111/ner.13155.

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Chang, Bowen, Chen Ni, Jiaming Mei, Chi Xiong, Peng Chen, Manli Jiang, and Chaoshi Niu. "Nomogram for Predicting Depression Improvement after Deep Brain Stimulation for Parkinson’s Disease." Brain Sciences 12, no. 7 (June 28, 2022): 841. http://dx.doi.org/10.3390/brainsci12070841.

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Background: Parkinson’s disease is a common neurodegenerative disease, with depression being a common non-motor symptom. Bilateral subthalamic nucleus deep brain stimulation is an effective method for the treatment of Parkinson’s disease. Thus, this study aimed to establish a nomogram of the possibility of achieving a better depression improvement rate after subthalamic nucleus deep brain stimulation in patients with Parkinson’s disease. Methods: We retrospectively analyzed 103 patients with Parkinson’s disease who underwent subthalamic nucleus deep brain stimulation and were followed up for the improvement of their Hamilton Depression scale scores 1 year postoperatively. Univariate and multivariate logistic regression analyses were used to select factors affecting the improvement rate of depression. A nomogram was then developed to predict the possibility of achieving better depression improvement. Furthermore, the discrimination and fitting performance was evaluated using a calibration diagram, receiver operating characteristics, and decision curve analysis. Results: The mean and median improvement rates of Hamilton Depression scores were 13.1 and 33.3%, respectively. Among the 103 patients, 70.8% had an improved depression, 23.3% had a worsened depression, and 5.8% remained unchanged. Logistic multivariate regression analysis showed that age, preoperative Parkinson’s Disease Questionnaire, Hamilton Anxiety, and Hamilton Depression scores were independent factors for the possibility of achieving a better depression improvement rate. Based on these results, a nomogram model was developed. The nomogram had a C-index of 0.78 (95% confidence interval: 0.69–0.87) and an area under the receiver operating characteristics of 0.78 (95% confidence interval: 0.69–0.87). The calibration plot and decision curve analysis further demonstrated goodness-of-fit between the nomogram predictions and actual observations. Conclusion: We developed a nomogram to predict the possibility of achieving good depression improvement 1 year after subthalamic nucleus deep brain stimulation in patients with Parkinson’s disease, which showed a certain value in judging the expected depression improvement of these patients.

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