Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule

Weidong Xu; Svjetlana Miocinovic; Jianyu Zhang; Kenneth B Baker; Cameron C McIntyre; Jerrold L Vitek

doi:10.1016/j.expneurol.2010.08.007

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Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule

Journal article

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Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule

Weidong Xu, Svjetlana Miocinovic, Jianyu Zhang, Kenneth B Baker, Cameron C McIntyre and Jerrold L Vitek

Experimental neurology, Vol.228(2), pp.294-297

2011

DOI: 10.1016/j.expneurol.2010.08.007

PMCID: PMC3536485

PMID: 20713049

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https://www.ncbi.nlm.nih.gov/pmc/articles/3536485View

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Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can be an effective treatment for the motor symptoms of Parkinson's disease. The therapeutic benefits are voltage-dependent and, in many cases, limited by the appearance of side effects, including muscle contractions. We have observed a number of clinical cases where improvements in rigidity were accompanied by a worsening of bradykinesia. Considering the anatomic position of STN and current approaches to implantation of the DBS lead, we hypothesized that this dissociation of motor symptoms arises from activation of pyramidal tract fibers in the adjacent internal capsule. The objective of this study was to assess the physiological basis for this dissociation and to test our hypothesis that the underlying etiology of this paradox is activation of fibers of the internal capsule. The effect of STN DBS at 80% of motor threshold for each of the four contacts was evaluated for its effect on rigidity, bradykinesia, and akinesia in a single primate with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism. Consistent with our observations in humans, this near-threshold stimulation was found to improve rigidity while bradykinesia and akinesia worsened. Worsening bradykinesia in the face of improvement of other motor signs in Parkinson's disease (PD) patients is suggestive of activation of pyramidal tract (PT) fibers during stimulation. This phenomenon may occur without overt muscle contraction and improved rigidity. ► STN DBS adjacent to the internal capsule was studied in a parkinsonian monkey. ► STN DBS improved rigidity but worsened akinesia and bradykinesia. ► STN DBS (80% motor threshold) significantly increased task performance time. ► Current spread to the internal capsule during STN DBS may dissociate motor symptoms.

Internal capsule

Subthalamic nucleus

Parkinson's disease

Deep brain stimulation

Details

Title: Subtitle: Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule
Creators: Weidong Xu - Neuromodulation Research Center, Department of Neuroscience, Cleveland, OH, USA
Svjetlana Miocinovic - Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
Jianyu Zhang - Neuromodulation Research Center, Department of Neuroscience, Cleveland, OH, USA
Kenneth B Baker - Neuromodulation Research Center, Department of Neuroscience, Cleveland, OH, USA
Cameron C McIntyre - Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
Jerrold L Vitek - Neuromodulation Research Center, Department of Neuroscience, Cleveland, OH, USA
Resource Type: Journal article
Publication Details: Experimental neurology, Vol.228(2), pp.294-297
DOI: 10.1016/j.expneurol.2010.08.007
PMID: 20713049
PMCID: PMC3536485
NLM abbreviation: Exp Neurol
ISSN: 0014-4886
eISSN: 1090-2430
Publisher: Elsevier Inc
Language: English
Date published: 2011
Academic Unit: Iowa Neuroscience Institute; Anesthesia
Record Identifier: 9984007289102771

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