Functional imaging of subthalamic nucleus deep brain stimulation in Parkinson's disease

• Published in: Movement disorders 2011-08, Vol.26 (10), p.1835-1843
• Main Authors: Boertien, Tessel, Zrinzo, Ludvic, Kahan, Joshua, Jahanshahi, Marjan, Hariz, Marwan, Mancini, Laura, Limousin, Patricia, Foltynie, Thomas
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Brain - blood supply; Brain - diagnostic imaging; Brain - metabolism; Brain - pathology; deep brain stimulation; Deep Brain Stimulation - methods; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; functional imaging; functional magnetic resonance imaging; functional magnetic resonance imaging; deep brain stimulation; subthalamic nucleus; Humans; Medical sciences; Neuroimaging; Neurology; Neuropsychological Tests; Parkinson Disease - pathology; Parkinson Disease - therapy; Parkinson's disease; Radionuclide Imaging; Rest - physiology; subthalamic nucleus; Subthalamic Nucleus - physiology
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.23788

Deep brain stimulation of the subthalamic nucleus is an accepted treatment for the motor complications of Parkinson's disease. The therapeutic mechanism of action remains incompletely understood. Although the results of deep brain stimulation are similar to the results that can be obtained by lesional surgery, accumulating evidence from functional imaging and clinical neurophysiology suggests that the effects of subthalamic nucleus‐deep brain stimulation are not simply the result of inhibition of subthalamic nucleus activity. Positron emission tomography/single‐photon emission computed tomography has consistently demonstrated changes in cortical activation in response to subthalamic nucleus‐deep brain stimulation. However, the technique has limited spatial and temporal resolution, and therefore the changes in activity of subcortical projection sites of the subthalamic nucleus (such as the globus pallidus, substantia nigra, and thalamus) are not as clear. Clarifying whether clinically relevant effects from subthalamic nucleus‐deep brain stimulation in humans are mediated through inhibition or excitation of orthodromic or antidromic pathways (or both) would contribute to our understanding of the precise mechanism of action of deep brain stimulation and may allow improvements in safety and efficacy of the technique. In this review we discuss the published evidence from functional imaging studies of patients with subthalamic nucleus‐deep brain stimulation to date, together with how these data inform the mechanism of action of deep brain stimulation. © 2011 Movement Disorder Society