Deep brain stimulation for Parkinson's disease: disrupting the disruption

Many people are disabled by Parkinson's disease (PD) despite the drug treatments that are currently available. For these patients, neurosurgery has the potential to help restore their function. The most effective neurosurgical procedures to date use electrical stimulation--deep brain stimulation (DBS)--of small targets in the brain by use of a pacemaker-like device to deliver constant stimulation. Although these operations can produce striking results, the mechanism by which delivery of electrical stimulation to targets deep in the brain can restore function in the motor system is not clear. This type of surgery probably works by interfering with and shutting down abnormal brain activity in areas where the current is delivered, such as the thalamus, globus pallidus, or the subthalamic nucleus. With this abnormal neuronal activity neutralised, motor areas of the brain can resume their function and normal movements are reinstated. Current research is aimed at elucidating how DBS works and using this information to develop better treatments for patients with PD and other neurological disorders.

[1]  Reinhard Dengler,et al.  Effects of subthalamic nucleus (STN) stimulation on motor cortex excitability , 2002, Neurology.

[2]  W Lang,et al.  Bilateral subthalamic nucleus stimulation improves frontal cortex function in Parkinson's disease. An electrophysiological study of the contingent negative variation. , 1999, Brain : a journal of neurology.

[3]  C. Hammond,et al.  High-frequency stimulation produces a transient blockade of voltage-gated currents in subthalamic neurons. , 2001, Journal of neurophysiology.

[4]  B. Steinhoff,et al.  Effects of antiepileptic drugs on motor cortex excitability in humans: A transcranial magnetic stimulation study , 1996, Annals of neurology.

[5]  Sylvain Houle,et al.  Globus pallidus stimulation activates the cortical motor system during alleviation of parkinsonian symptoms , 1997, Nature Medicine.

[6]  Hiroshi Asanuma,et al.  Noxious effects of excessive currents used for intracortical microstimulation , 1975, Brain Research.

[7]  M. Honda,et al.  Dissociation between contingent negative variation (CNV) and Bereitschaftspotential (BP) in patients with parkinsonism. , 1997, Electroencephalography and clinical neurophysiology.

[8]  M. Hallett Transcranial magnetic stimulation and the human brain , 2000, Nature.

[9]  P Ashby,et al.  Neurophysiological effects of stimulation through electrodes in the human subthalamic nucleus. , 1999, Brain : a journal of neurology.

[10]  G. Pozzessere,et al.  Parkinson disease: electrophysiological (CNV) analysis related to pharmacological treatment. , 1986, Electroencephalography and clinical neurophysiology.

[11]  A. Lozano,et al.  Effects of subthalamic nucleus stimulation on motor cortex excitability in Parkinson’s disease , 2002, Neurology.

[12]  J. Hunter,et al.  Segmental effects of epidural spinal cord stimulation in humans. , 1994, The Journal of physiology.

[13]  D M Durand,et al.  Suppression of epileptiform activity by high frequency sinusoidal fields in rat hippocampal slices , 2001, The Journal of physiology.

[14]  F. Windels,et al.  Effects of high frequency stimulation of subthalamic nucleus on extracellular glutamate and GABA in substantia nigra and globus pallidus in the normal rat , 2000, The European journal of neuroscience.

[15]  J. Rothwell,et al.  Impact of deep brain stimulation on upper limb akinesia in Parkinson's disease , 1999, Annals of neurology.

[16]  M. Hallett,et al.  The relative metabolic demand of inhibition and excitation , 2000, Nature.

[17]  Richard S. J. Frackowiak,et al.  Thalamic stimulation and suppression of parkinsonian tremor. Evidence of a cerebellar deactivation using positron emission tomography. , 1993, Brain : a journal of neurology.

[18]  L. Tremblay,et al.  Abnormal influences of passive limb movement on the activity of globus pallidus neurons in parkinsonian monkeys , 1988, Brain Research.

[19]  A. Benabid,et al.  Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. , 1996, Journal of neurosurgery.

[20]  J C Rothwell,et al.  The Bereitschaftspotential is abnormal in Parkinson's disease. , 1989, Brain : a journal of neurology.

[21]  C. Finch,et al.  Parkinson’s Disease—II , 1978, Advances in Experimental Medicine and Biology.

[22]  A. Lang,et al.  Effects of internal globus pallidus stimulation on motor cortex excitability , 2001, Neurology.

[23]  Bart Nuttin,et al.  Chronaxie calculated from current–duration and voltage–duration data , 2000, Journal of Neuroscience Methods.

[24]  C. L. Kwan,et al.  Thalamic stimulation and functional magnetic resonance imaging: localization of cortical and subcortical activation with implanted electrodes. Technical note. , 1999 .

[25]  E. Růžička,et al.  Functional magnetic resonance imaging during deep brain stimulation: A pilot study in four patients with Parkinson's disease , 2001, Movement disorders : official journal of the Movement Disorder Society.

[26]  L. Tremblay,et al.  Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism , 1991, Brain Research.

[27]  E. Vaadia,et al.  Physiological aspects of information processing in the basal ganglia of normal and parkinsonian primates , 1998, Trends in Neurosciences.

[28]  E. Bézard,et al.  High frequency stimulation of the internal Globus Pallidus (GPi) simultaneously improves parkinsonian symptoms and reduces the firing frequency of GPi neurons in the MPTP-treated monkey , 1996, Neuroscience Letters.

[29]  N Accornero,et al.  Motor cortical inhibition and the dopaminergic system. Pharmacological changes in the silent period after transcranial brain stimulation in normal subjects, patients with Parkinson's disease and drug-induced parkinsonism. , 1994, Brain : a journal of neurology.

[30]  S. Hemm,et al.  Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus , 2000, The Lancet.

[31]  Abdelhamid Benazzouz,et al.  Responses of substantia nigra pars reticulata and globus pallidus complex to high frequency stimulation of the subthalamic nucleus in rats: electrophysiological data , 1995, Neuroscience Letters.

[32]  P Ashby,et al.  Potentials recorded at the scalp by stimulation near the human subthalamic nucleus , 2001, Clinical Neurophysiology.

[33]  J. Dostrovsky,et al.  Microstimulation-induced inhibition of neuronal firing in human globus pallidus. , 2000, Journal of neurophysiology.

[34]  A. Lang,et al.  Parkinson's disease. First of two parts. , 1998, The New England journal of medicine.

[35]  J Holsheimer,et al.  Identification of the target neuronal elements in electrical deep brain stimulation , 2000, The European journal of neuroscience.

[36]  Y. Smith,et al.  Anatomy of the dopamine system in the basal ganglia , 2000, Trends in Neurosciences.

[37]  Thomas Boraud,et al.  Electrical Stimulation of the Subthalamic Nucleus in Fully Parkinsonian (MPTP) Monkeys , 1996 .

[38]  M. Rizzone,et al.  Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: effects of variation in stimulation parameters , 2001, Journal of neurology, neurosurgery, and psychiatry.

[39]  Y. Agid,et al.  Levodopa‐induced dyskinesias in Parkinson's disease: Is sensitization reversible? , 2000 .

[40]  A. Lozano,et al.  Globus pallidus deep brain stimulation for generalized dystonia: Clinical and PET investigation , 1999, Neurology.

[41]  J R Moeller,et al.  Networks mediating the clinical effects of pallidal brain stimulation for Parkinson's disease: a PET study of resting-state glucose metabolism. , 2001, Brain : a journal of neurology.

[42]  A. Benabid,et al.  Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. , 1998, The New England journal of medicine.

[43]  J. Dostrovsky,et al.  Effects of High Frequency Stimulation in the Subthalamic Nucleus on Neuronal Firing in Parkinson’s Disease Patients , 2002 .

[44]  Richard S. J. Frackowiak,et al.  Changes in cerebral activity pattern due to subthalamic nucleus or internal pallidum stimulation in Parkinson's disease , 1997, Annals of neurology.

[45]  B Conrad,et al.  Continuous intrathecal baclofen infusions induced a marked increase of the transcranially evoked silent period in a patient with generalized dystonia , 1998, Muscle & nerve.

[46]  R. Inzelberg,et al.  Changes in excitability of motor cortical circuitry in patients with parkinson's disease , 1995, Annals of neurology.

[47]  A L Benabid,et al.  Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease. , 1998, Brain : a journal of neurology.

[48]  A. Lang,et al.  Parkinson's disease. Second of two parts. , 1998, The New England journal of medicine.

[49]  J. Dostrovsky,et al.  Does stimulation of the GPi control dyskinesia by activating inhibitory axons? , 2001, Movement disorders : official journal of the Movement Disorder Society.

[50]  A. Benabid,et al.  Effect of high-frequency stimulation of the subthalamic nucleus on the neuronal activities of the substantia nigra pars reticulata and ventrolateral nucleus of the thalamus in the rat , 2000, Neuroscience.

[51]  C Ghez,et al.  Functional correlates of pallidal stimulation for Parkinson's disease , 2001, Annals of neurology.