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Functional imaging of subthalamic nucleus deep brain stimulation in Parkinson's disease§

Authors

  • Tessel Boertien,

    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
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  • Ludvic Zrinzo MD, FRCS,

    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
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  • Joshua Kahan,

    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Marjan Jahanshahi PhD,

    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Marwan Hariz MD, PhD,

    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
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  • Laura Mancini PhD,

    1. Lysholm Department of Neuroradiology, National Hospital for Neurology & Neurosurgery, UCLH NHS Foundation Trust, Queen Square, London, United Kingdom
    2. Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, United Kingdom
    3. Queen Square Imaging Centre, Queen Square, London, United Kingdom
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  • Patricia Limousin MD, PhD,

    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Thomas Foltynie MRCP, PhD

    Corresponding author
    1. Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom
    • Box 146, National Hospital for Neurology & Neurosurgery, Queen Square, London, WC1N 3BG, UK
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  • 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.

  • 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.

Abstract

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

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