Original Article

Stimulation of the subthalamic nucleus and impulsivity: Release your horses†

  1. Benedicte Ballanger PhD1,2,
  2. Thilo van Eimeren MD1,2,
  3. Elena Moro MD, PhD3,
  4. Andres M. Lozano MD, PhD1,4,
  5. Clement Hamani MD1,4,
  6. Philippe Boulinguez PhD5,
  7. Giovanna Pellecchia PhD2,
  8. Sylvain Houle MD, PhD2,
  9. Yu Yan Poon RN3,
  10. Anthony E. Lang MD1,3,
  11. Antonio P. Strafella MD, PhD1,2,3,*

Article first published online: 2 JUL 2009

DOI: 10.1002/ana.21795

Issue

Annals of Neurology

Annals of Neurology

Volume 66, Issue 6, pages 817–824, December 2009

Additional Information

How to Cite

Ballanger, B., van Eimeren, T., Moro, E., Lozano, A. M., Hamani, C., Boulinguez, P., Pellecchia, G., Houle, S., Poon, Y. Y., Lang, A. E. and Strafella, A. P. (2009), Stimulation of the subthalamic nucleus and impulsivity: Release your horses. Annals of Neurology, 66: 817–824. doi: 10.1002/ana.21795

Author Information

  1. 1

    Division of Brain, Imaging and Behaviour–Systems Neuroscience, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

  2. 2

    PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

  3. 3

    Movement Disorders Center, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

  4. 4

    Department of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

  5. 5

    Center for Cognitive Neuroscience, Claude Bernard University, Lyon, France

*Toronto Western Hospital & Institute, UHN, CAMH-PET Imaging Centre, University of Toronto, Toronto, ON, Canada

  1. †

    Potential conflict of interest: Nothing to report.

Publication History

  1. Issue published online: 23 DEC 2009
  2. Article first published online: 2 JUL 2009
  3. Accepted manuscript online: 2 JUL 2009 12:00AM EST
  4. Manuscript Accepted: 22 JUN 2009
  5. Manuscript Revised: 28 MAY 2009
  6. Manuscript Received: 19 JAN 2009

Funded by

  • Canadian Institutes of Health Research (CIHR). Grant Number: MOP-64423
  • CIHR New Investigator Research Award
  • Canada Research Chair (tier 1) in Neuroscience

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Abstract

Objective

In Parkinson disease (PD) patients, deep brain stimulation (DBS) of the subthalamic nucleus (STN) may contribute to certain impulsive behavior during high-conflict decisions. A neurocomputational model of the basal ganglia has recently been proposed that suggests this behavioral aspect may be related to the role played by the STN in relaying a “hold your horses” signal intended to allow more time to settle on the best option. The aim of the present study was 2-fold: 1) to extend these observations by providing evidence that the STN may influence and prevent the execution of any response even during low-conflict decisions; and 2) to identify the neural correlates of this effect.

Methods

We measured regional cerebral blood flow during a Go/NoGo and a control (Go) task to study the motor improvement and response inhibition deficits associated with STN-DBS in patients with PD.

Results

Although it improved Unified Parkinson Disease Rating Scale motor ratings and induced a global decrease in reaction time during task performance, STN-DBS impaired response inhibition, as revealed by an increase in commission errors in NoGo trials. These behavioral effects were accompanied by changes in synaptic activity consisting of a reduced activation in the cortical networks responsible for reactive and proactive response inhibition.

Interpretation

The present results suggest that although it improves motor functions in PD patients, modulation of STN hyperactivity with DBS may tend at the same time to favor the appearance of impulsive behavior by acting on the gating mechanism involved in response initiation. Ann Neurol 2009;66:817–824

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