Subthalamic nucleus
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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
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
It has been suggested that slow oscillations in the subthalamic nucleus (STN) reflect top-down inputs from the medial prefrontal cortex, thus implementing behavior control. It is unclear, however, whether the STN oscillations are related to cortical activity in a bottom-up manner. To assess resting-state subcortico-cortical interactions, we recorded simultaneous scalp electroencephalographic activity and local field potentials in the STN (LFP-STN) in 11 patients with Parkinson's disease implanted with deep brain stimulation electrodes in the on-medication state during rest. We assessed the cross-structural phase-amplitude coupling (PAC) between the STN and cortical activity within a wide frequency range of 1 to 100 Hz. The PAC was dominant between the δ/θ STN phase and β/γ cortical amplitude in most investigated scalp regions and between the δ cortical phase and θ/α STN amplitude in the frontal and temporal regions. The cross-frequency linkage between the slow oscillations of the LFP-STN activity and the amplitude of the scalp-recorded cortical activity at rest was demonstrated, and similar involvement of the left and right STNs in the coupling was observed. Our results suggest that the STN plays a role in both bottom-up and top-down processes within the subcortico-cortical circuitries of the human brain during the resting state. A relative left-right symmetry in the STN-cortex functional linkage was suggested. Practical treatment studies would be necessary to assess whether unilateral stimulation of the STN might be sufficient for treatment of Parkinson's disease.
- MeSH
- elektroencefalografie MeSH
- hluboká mozková stimulace * MeSH
- lidé MeSH
- nucleus subthalamicus * MeSH
- Parkinsonova nemoc * terapie MeSH
- skalp MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem 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
Deep brain stimulation (DBS) has become an important tool in the management of a wide spectrum of diseases in neurology and psychiatry. Target selection is a vital aspect of DBS so that only the desired areas are stimulated. Segmented leads and current steering have been shown to be promising additions to DBS technology enabling better control of the stimulating electric field. Recently introduced orientation selective DBS (OS-DBS) is a related development permitting sensitization of the stimulus to axonal pathways with different orientations by freely controlling the primary direction of the electric field using multiple contacts. Here, we used OS-DBS to stimulate the subthalamic nucleus (STN) in healthy rats while simultaneously monitoring the induced brain activity with fMRI. Maximal activation of the sensorimotor and basal ganglia-thalamocortical networks was observed when the electric field was aligned mediolaterally in the STN pointing in the lateral direction, while no cortical activation was observed with the electric field pointing medially to the opposite direction. Such findings are consistent with mediolateral main direction of the STN fibers, as seen with high resolution diffusion imaging and histology. The asymmetry of the OS-DBS dipolar field distribution using three contacts along with the potential stimulation of the internal capsule, are also discussed. We conclude that OS-DBS offers an additional degree of flexibility for optimization of DBS of the STN which may enable a better treatment response.
- MeSH
- hluboká mozková stimulace metody MeSH
- implantované elektrody * MeSH
- krysa rodu rattus MeSH
- magnetická rezonanční tomografie MeSH
- nucleus subthalamicus fyziologie MeSH
- potkani Sprague-Dawley MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH