Anatomy and physiology of the basal ganglia: implications for deep brain stimulation for Parkinson's disease.
Central to surgical management of movement disorders is an understanding of the anatomy and physiology of the basal ganglia. The basal ganglia have been a target for neuromodulation surgery since Russell Meyers' pioneering works in the late 1930s. With the development of deep brain stimulation as the gold standard of surgical intervention for movement disorders, there has been a concomitant evolution in the understanding of the role the basal ganglia plays in the genesis of normal and abnormal motor behaviors. The fundamental concept of the cortico-striato-pallido-thalamocortical loop will be explored in the context of deep brain stimulation. The current targets for deep brain stimulation for Parkinson's disease, the subthalamic nucleus, the globus pallidus internus, and the ventral intermediate nucleus, will be discussed in the framework of the current physiological and anatomical models of Parkinson's disease (PD). Finally, the current understandings of the mechanisms underpinning the beneficial effects of deep brain stimulation for PD will be discussed.
Kopell
Brian H
BH
Department of Neurosurgery, Medical College of Wisconsin, and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin 53202, USA. bkopell@neuroscience.mcw.edu
Rezai
Ali R
AR
Chang
Jin Woo
JW
Vitek
Jerrold L
JL
D001479:Basal Ganglia / Q000033:anatomy & histology* / Q000502:physiology*; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000502:physiology; D003342:Corpus Striatum / Q000502:physiology; D046690:Deep Brain Stimulation / Q000379:methods*; D005917:Globus Pallidus / Q000502:physiology; D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*; D013378:Substantia Nigra / Q000502:physiology; D013788:Thalamus / Q000502:physiology