title: Activation of subthalamic neurons by contralateral subthalamic deep brain stimulation in Parkinson disease.
abstract: Multiple studies have shown bilateral improvement in motor symptoms in Parkinson disease (PD) following unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and internal segment of the globus pallidus, yet the mechanism(s) underlying this phenomenon are poorly understood. We hypothesized that STN neuronal activity is altered by contralateral STN DBS. This hypothesis was tested intraoperatively in humans with advanced PD using microelectrode recordings of the STN during contralateral STN DBS. We demonstrate alterations in the discharge pattern of STN neurons in response to contralateral STN DBS including short latency, temporally precise, stimulation frequency-independent responses consistent with antidromic activation. Furthermore, the total discharge frequency during contralateral high frequency stimulation (160 Hz) was greater than during low frequency stimulation (30 Hz) and the resting state. These findings demonstrate complex responses to DBS and imply that output activation throughout the basal ganglia-thalamic-cortical network rather than local inhibition is a therapeutic mechanism of DBS.
authors.affiliation: Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA. hcwalker@uab.edu
authors.forename: Harrison C
authors.initials: HC
authors.lastname: Walker
authors.forename: Ray L
authors.initials: RL
authors.lastname: Watts
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Schrandt
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Guthrie
authors.forename: Barton L
authors.initials: BL
authors.lastname: Guthrie
authors.forename: Erwin B
authors.initials: EB
authors.lastname: Montgomery
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009433:Neural Inhibition; D009473:Neuronal Plasticity; D009474:Neurons; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome