Funding agencies: This work was undertaken at UCL/UCLH and was partly funded by the Department of Health NIHR Biomedical Research Centres funding scheme. The Unit of Functional Neurosurgery, Queen Square, London, is supported by the Parkinson's Appeal.
Version of Record online: 14 JUN 2011
Copyright © 2011 Movement Disorder Society
Volume 26, Issue 10, pages 1835–1843, 15 August 2011
How to Cite
Boertien, T., Zrinzo, L., Kahan, J., Jahanshahi, M., Hariz, M., Mancini, L., Limousin, P. and Foltynie, T. (2011), Functional imaging of subthalamic nucleus deep brain stimulation in Parkinson's disease. Mov. Disord., 26: 1835–1843. doi: 10.1002/mds.23788
Relevant conflicts of interest/financial disclosures: Nothing to report.
Full financial disclosures and author roles may be found in the online version of this article.
- Issue online: 26 AUG 2011
- Version of Record online: 14 JUN 2011
- Manuscript Accepted: 17 APR 2011
- Manuscript Revised: 7 APR 2011
- Manuscript Received: 17 NOV 2010
- Parkinson's disease;
- functional imaging;
- functional magnetic resonance imaging; deep brain stimulation; subthalamic nucleus
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