title: Subthalamic nucleus stimulation modulates audiospinal reactions in Parkinson disease.
abstract: BACKGROUND
  Axial symptoms of Parkinson disease (PD) may result from dysfunctional basal ganglia-brainstem connections. In this study, we assessed whether modulation of basal ganglia activity by high-frequency stimulation of the subthalamic nucleus (STN-HFS) in PD had an impact on the brainstem-controlled startle system.
  
  
  METHODS
  We assessed auditory startle responses (recorded from right orbicularis oculi, masseter, sternocleidomastoid, biceps brachii, and soleus muscle) and audiospinal facilitation (startle conditioned soleus H-reflexes at interstimulus intervals of 0-250 msec) in 24 patients with PD with chronically implanted, bilateral STN electrodes in the stimulation on (STIM ON) and off condition (STIM OFF) and 20 healthy controls.
  
  
  RESULTS
  The mixed linear analysis of variance model revealed a significant effect for the startle onset latency in the orbicularis oculi muscle for the factors GROUP (patients with PD vs controls; p < 0.0001, F = 44.66) and STIM (nested within GROUP) (p = 0.0034, F = 8.79). Audiospinal facilitation was modulated by STN-HFS as shown by highly significant effects for STIM [GROUP] (p < 0.0001, F = 15.9), ISI [GROUP] (p < 0.0001, F = 3.5), and the interaction of ISI x STIM [GROUP] (p = 0.0085, F = 2.65) in the mixed linear model.
  
  
  CONCLUSIONS
  High-frequency stimulation of the subthalamic nucleus alters the excitability of the brainstem startle system in Parkinson disease, most likely by releasing the reticular motor system from abnormal descending input of the basal ganglia via pallidotegmental pathways.
authors.affiliation: Department of Neurology, Christian-Albrechts-University, Schittenhelmstr. 10 m D-24105 Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Pötter
authors.forename: J
authors.initials: J
authors.lastname: Herzog
authors.forename: H R
authors.initials: HR
authors.lastname: Siebner
authors.forename: F
authors.initials: F
authors.lastname: Kopper
authors.forename: F
authors.initials: F
authors.lastname: Steigerwald
authors.forename: G
authors.initials: G
authors.lastname: Deuschl
authors.forename: J
authors.initials: J
authors.lastname: Volkmann
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods*; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006181:H-Reflex / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D010300:Parkinson Disease / Q000503:physiopathology*; D013216:Reflex, Startle / Q000502:physiology*; D013116:Spinal Cord / Q000502:physiology*; D020531:Subthalamic Nucleus / Q000502:physiology*