61 ročnému pacientovi s pokročilou Parkinsonovou chorobou bola krátko po implantácii neurostimulátora spustená bilaterálna hľbková mozgová stimulácia nucleus subthalamicus. Hneď po zapnutí stimulácie u neho došlo k psychotickému stavu, ktorý pozostával z kvalitatívnej poruchy vedomia, paranoidity a verbálnej i brachiálnej agresivity. Vzhľadom na jednoznačnú súvislosť s mozgovou stimuláciou bola psychotická porucha interpretovaná ako postimulačná psychóza, na rozdiel od prípadov, kedy psychotická epizóda nastáva bezprostredne v pooperačnom období alebo keď súvisí priamo s implantáciou elektród. V liečbe závažnej chronickej psychotickej poruchy bola kľúčová okrem úpravy neurostimulačných parametrov aj medikácia klozapínom.

Shortly after implantation of a neurostimulator, bilateral deep brain stimulation of subthalamic nucleus was launched in a 61-year old patient with advanced Parkinsons disease. Immediately after switching on the stimulation, the patient developed psychosis, consisting of a disturbance in the consciousness, paranoid delusions and verbal as well as brachial aggression. Due to the strong association with deep brain stimulation, a psychotic disorder has been interpreted as a post-stimulation psychosis, as opposed to cases where a psychotic episode occurs immediately in the postoperative period or when it is linked directly with the implantation of electrodes. In the treatment of severe chronic psychotic disorder, medication with clozapine was crucial alongside the adjustment of neurostimulation parameters.

• Klíčová slova
• post-DBS syndrom,
• MeSH
• agrese účinky léků   MeSH
• antipsychotika terapeutické užití   MeSH
• hluboká mozková stimulace * škodlivé účinky   MeSH
• klozapin terapeutické užití   MeSH
• kognitivní poruchy farmakoterapie   MeSH
• kombinovaná terapie MeSH
• levodopa škodlivé účinky   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nucleus subthalamicus MeSH
• Parkinsonova nemoc * terapie   MeSH
• psychotické poruchy * etiologie   farmakoterapie   MeSH
• quetiapin fumarát aplikace a dávkování   terapeutické užití   MeSH
• rivastigmin terapeutické užití   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

The involvement of the subthalamic nucleus (STN) in a broad spectrum of various non-motor functions - attention, executive functions, verbal learning and memory, verbal abstract reasoning, conflict resolution, and emotions - has been reported. The STN has an anatomically central position within the basal ganglia(BG)-thalamocortical motor, associative and limbic circuits. The STN might interfere with non-motor functions as an indirect modulator rather than a regulator. Mechanisms modulating the motor and non-motor functions might differ. The STN has been implicated in control of non-motor behaviors via the tuning of specific circuits depending on the task. The STN might modulate selected non-motor functions via contextual modulation of certain cortical areas. Based on intracerebral recordings, we proposed that the non-motor activities in the BG are organized in some way other than the well-known organization of the cortico-BG-thalamocortical circuits. These findings support the hypothesis of a cortico-STN bypass of the BG-thalamocortical circuitry under some circumstances. The exact role of the STN and the BG in non-motor functions remains an important and interesting challenge for future research.

• MeSH
• kognice fyziologie   MeSH
• lidé MeSH
• nucleus subthalamicus fyziologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Both animal studies and studies using deep brain stimulation in humans have demonstrated the involvement of the subthalamic nucleus (STN) in motivational and emotional processes; however, participation of this nucleus in processing human emotion has not been investigated directly at the single-neuron level. We analyzed the relationship between the neuronal firing from intraoperative microrecordings from the STN during affective picture presentation in patients with Parkinson's disease (PD) and the affective ratings of emotional valence and arousal performed subsequently. We observed that 17% of neurons responded to emotional valence and arousal of visual stimuli according to individual ratings. The activity of some neurons was related to emotional valence, whereas different neurons responded to arousal. In addition, 14% of neurons responded to visual stimuli. Our results suggest the existence of neurons involved in processing or transmission of visual and emotional information in the human STN, and provide evidence of separate processing of the affective dimensions of valence and arousal at the level of single neurons as well.

• MeSH
• arousal * MeSH
• emoce * MeSH
• lidé MeSH
• neurony fyziologie   MeSH
• nucleus subthalamicus fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• nucleus subthalamicus anatomie a histologie   MeSH
• savci MeSH

The modifications of electrophysiological activities of subthalamic nucleus (STN) by non-motor tasks, i.e. movement observation, emotional stimuli and impulse control, were reported repeatedly. Despite being a small structure, STN is apparently involved in a variety of functions. Based on our own electrophysiological recordings and results of other groups we believe that it acts as an indirect modulator which may be involved in tuning the functional systems. STN may modulate specific cognitive activities via contextual modulation of certain cortical areas. Our findings support the hypothesis of a cortical-STN bypass (via hyperdirect pathway) of "classical" basal ganglia-thalamocortical circuitry, at least during the processing of certain cognitive functions. The modulation of cognitive functions appears to be selective, probably determined by the involvement of cortical neuronal populations interconnected with STN. There could also exist a spatial overlap of areas within STN regulating various functions. That may explain the fact that some non-motor symptoms of Parkinson's disease may improve after deep brain stimulation of STN. These improvements are likely caused by combination of direct stimulation effect on non-motor function and overall beneficial effect of motor improvement on quality of life.

• MeSH
• hluboká mozková stimulace metody   MeSH
• kognice fyziologie   MeSH
• kvalita života * MeSH
• lidé MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc patofyziologie   terapie   MeSH
• pohyb fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: According to our studies, based on intracerebral recordings of cognitive Event Related Potentials (ERP), the cognitive activities in the the Basal Ganglia (BG) are organized in some way other than the well-known organization of the cortico-BG-thalamocortical circuits. PURPOSE: The cognitive role of the subthalamic nucleus (STN) has been largely unknown. Direct connections with the cortex that bypass the circuitries might underlie the processing of specific cognitive functions in the STN. STN seems to be specifically involved in the processing of some cognitive activities, e.g. of the executive functions. METHODS: A modified protocol with a dual task elicited local field ERP within the STN. Impact of cortical 1 Hz rTMS on STN was tested. ERD/S in was tested in visuomotor tasks with single letters writing. RESULTS: No generators of ERP (P3-like potentials) were elicited by the standard oddball protocol in the STN (at variance with recordings from the putamen, caudate and pallidum). rTMS over the right inferior frontal cortex caused a shortening of latencies of ERP in standard and dual protocols. No changes were observable after the rTMS over the dorzolateral prefrontal cortex and sham stimulation. In the STN, only the tasks with an increased demand on executive functions produced the alpha and beta ERD/S (event-related desynchronization/synchronization). CONCLUSION: Our results indicate a specific, task-related involvement of the STN in the cognitive activities. Cognitive processing in the STN is possibly processed via hyperdirect cortico-STN pathway. Certain effects of DBS surgery on cognitive performance could be explained by a direct effect on 'cognitive' parts of the STN.

• MeSH
• elektrická stimulace metody   MeSH
• elektroencefalografie metody   MeSH
• exekutivní funkce fyziologie   MeSH
• kognice fyziologie   MeSH
• lidé MeSH
• mapování mozku MeSH
• mozková kůra fyziologie   MeSH
• nervové dráhy fyziologie   MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc patofyziologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can induce nonmotor side effects such as behavioral and mood disturbances or body weight gain in Parkinson's disease (PD) patients. We hypothesized that some of these problems could be related to an altered attribution of incentive salience (ie, emotional relevance) to rewarding and aversive stimuli. Twenty PD patients (all men; mean age ± SD, 58.3 ± 6 years) in bilateral STN DBS switched ON and OFF conditions and 18 matched controls rated pictures selected from the International Affective Picture System according to emotional valence (unpleasantness/pleasantness) and arousal on 2 independent visual scales ranging from 1 to 9. Eighty-four pictures depicting primary rewarding (erotica and food) and aversive fearful (victims and threat) and neutral stimuli were selected for this study. In the STN DBS ON condition, the PD patients attributed lower valence scores to the aversive pictures compared with the OFF condition (P < .01) and compared with controls (P < .01). The difference between the OFF condition and controls was less pronounced (P < .05). Furthermore, postoperative weight gain correlated with arousal ratings from the food pictures in the STN DBS ON condition (P < .05 compensated for OFF condition). Our results suggest that STN DBS increases activation of the aversive motivational system so that more relevance is attributed to aversive fearful stimuli. In addition, STN DBS-related sensitivity to food reward stimuli cues might drive DBS-treated patients to higher food intake and subsequent weight gain.

• MeSH
• emoce fyziologie   MeSH
• hluboká mozková stimulace škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• motivace fyziologie   MeSH
• neparametrická statistika MeSH
• neuropsychologické testy MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc psychologie   terapie   MeSH
• poruchy nálady etiologie   MeSH
• senioři MeSH
• statistika jako téma MeSH
• studie případů a kontrol MeSH
• světelná stimulace MeSH
• tělesná hmotnost MeSH
• záznam o duševním stavu MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Temporal interference stimulation (TIS) is a novel noninvasive electrical stimulation technique to focally modulate deep brain regions; a minimum of two high-frequency signals (f1 and f2 > 1 kHz) interfere to create an envelope-modulated signal at a deep brain target with the frequency of modulation equal to the difference frequency: Δf = |f2 - f1|. OBJECTIVE: The goals of this study were to verify the capability of TIS to modulate the subthalamic nucleus (STN) with Δf and to compare the effect of TIS and conventional deep brain stimulation (DBS) on the STN beta oscillations in patients with Parkinson's disease (PD). METHODS: DBS leads remained externalized after implantation, allowing local field potentials (LFPs) recordings in eight patients with PD. TIS was performed initially by two pairs (f1 = 9.00 kHz; f2 = 9.13 kHz, 4 mA peak-peak per pair maximum) of scalp electrodes placed in temporoparietal regions to focus the envelope signal maximum (Δf = 130 Hz) at the motor part of the STN target. RESULTS: The comparison between the baseline LFPs and recordings after TIS and conventional DBS sessions showed substantial suppression of high beta power peak after both types of stimulation in all patients. CONCLUSIONS: TIS has the potential to effectively modulate the STN and reduce the beta oscillatory activity in a completely noninvasive manner, as is traditionally possible only with intracranial DBS. Future studies should confirm the clinical effectiveness of TIS and determine whether TIS could be used to identify optimal DBS candidates and individualize DBS targets. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

• MeSH
• beta rytmus EEG * fyziologie   MeSH
• hluboká mozková stimulace * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nucleus subthalamicus * patofyziologie   MeSH
• Parkinsonova nemoc * terapie   patofyziologie   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

We studied the appearance of broadband oscillatory changes (ranging 2-45 Hz) induced by a cognitive task with two levels of complexity. The event-related de/synchronizations (ERD/S) in the subthalamic nucleus (STN) and in the anterior cingulate cortex (ACC) were evaluated in an executive function test. Four epilepsy surgery candidates with intracerebral electrodes implanted in the ACC and three Parkinson's disease patients with externalized deep brain stimulation electrodes implanted in the STN participated in the study. A Flanker test (FT) with visual stimuli (arrows) was performed. Subjects reacted to four types of stimuli presented on the monitor by pushing the right or left button: congruent arrows to the right or left side (simple task) and incongruent arrows to the right or left side (more difficult complex task). We explored the activation of STN and the activation of the ACC while processing the FT. Both conditions, i.e. congruent and incongruent, induced oscillatory changes in the ACC and also STN with significantly higher activation during incongruent trial. At variance with the ACC, in the STN not only the ERD beta but also the ERD alpha activity was significantly more activated by the incongruent condition. In line with our earlier studies, the STN appears to be involved in activities linked with increased cognitive load. The specificity and complexity of task-related activation of the STN might indicate the involvement of the STN in processes controlling human behaviour, e.g. in the selection and inhibition of competing alternatives.

• MeSH
• cingulární gyrus fyziologie   MeSH
• dospělí MeSH
• elektroencefalografie MeSH
• epilepsie patofyziologie   MeSH
• exekutivní funkce fyziologie   MeSH
• hluboká mozková stimulace MeSH
• implantované elektrody MeSH
• kognice fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• neuropsychologické testy MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc patofyziologie   terapie   MeSH
• počítačové zpracování signálu MeSH
• psychomotorický výkon fyziologie   MeSH
• světelná stimulace MeSH
• zraková percepce fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIM: Advances in neuroradiological planning techniques in deep brain stimulation have put the need for intraoperative electrophysiological monitoring into doubt. Moreover intraoperative monitoring prolongs surgical time and there is potential association between the use of microelectrodes and increased incidence of hemorrhagic complications. The aim of this study was to analyze the correlation between the anatomically planned trajectory and the final subthalamic electrode placement after electrophysiological monitoring in patients with Parkinson"s disease and its change with the increasing experience of the surgical team. MATERIAL AND METHODS: The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). RESULTS: In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. CONCLUSION: The correlation between anatomically planned trajectory and final electrode placement markedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.

• MeSH
• hluboká mozková stimulace metody   MeSH
• implantované elektrody MeSH
• intraoperační neurofyziologická monitorace * MeSH
• klinické kompetence MeSH
• křivka učení * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikroelektrody MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc chirurgie   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH