Article

Effects of unilateral subthalamic and pallidal deep brain stimulation on fine motor functions in Parkinson's disease

Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, United States
Movement Disorders (Impact Factor: 5.63). 04/2007; 22(5):619-26. DOI: 10.1002/mds.21300
Source: PubMed

ABSTRACT Deep brain stimulation (DBS) is an effective treatment for selected patients with disabling Parkinson's disease (PD). The two main targets are the subthalamic nucleus (STN) and the globus pallidus internus (GPi), although it has not been established whether stimulation at one target is superior to the other. This prospective randomized study assessed the effects of unilateral DBS of the STN versus GPi on fine motor skills in 33 patients with advanced PD. Stimulation of either the STN (18 subjects) or GPi (15 subjects) in the off medication state significantly improved movement time and dexterity, but had little or no effect on reaction time. Overall, the extent of improvement did not differ between the two targets. The degree of improvement in movement time, but not dexterity, was correlated with the extent of preoperative medication responsiveness. Our findings suggest that DBS of the STN or GPi results in a similar improvement in hand movements at short-term follow-up. Preoperative medication responsiveness predicts improvement in some but not other motor tasks.

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    • "More recently, altered patterns of neuronal activity in the form of increased bursting and greater synchronization (Brown et al., 2004; Brown and Williams, 2005; Gatev et al., 2006; Maurer et al., 2004; Nini et al., 1995; Raz et al., 2000; Wichmann et al., 1994b; Wichmann et al., 2002) as well as a widening of receptive fields to proprioceptive input (Filion et al., 1988; Leblois et al., 2006; Vitek et al., 1998) have been reported to occur in GPi in the parkinsonian state. And while a causal relationship between these changes and the cardinal features of PD has yet to be determined, it is clear that therapeutic benefit can be achieved for patients with PD through exogenous modulation of pallidal activity (Baron et al., 2002; Bergman et al., 1990; Burchiel et al., 1999; Nakamura et al., 2007; Rodriguez-Oroz et al., 2005; Vitek et al., 2003; Weaver et al., 2005). As currently performed, such procedures involve the targeting and, in most centers, the identification of the sensorimotor region of the GPi, followed by either radiofrequency ablation or the implantation of a deep brain stimulation (DBS) lead for chronic electrical stimulation. "
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