title: Functional imaging of subthalamic nucleus deep brain stimulation in Parkinson's disease.
abstract: Deep brain stimulation of the subthalamic nucleus is an accepted treatment for the motor complications of Parkinson's disease. The therapeutic mechanism of action remains incompletely understood. Although the results of deep brain stimulation are similar to the results that can be obtained by lesional surgery, accumulating evidence from functional imaging and clinical neurophysiology suggests that the effects of subthalamic nucleus-deep brain stimulation are not simply the result of inhibition of subthalamic nucleus activity. Positron emission tomography/single-photon emission computed tomography has consistently demonstrated changes in cortical activation in response to subthalamic nucleus-deep brain stimulation. However, the technique has limited spatial and temporal resolution, and therefore the changes in activity of subcortical projection sites of the subthalamic nucleus (such as the globus pallidus, substantia nigra, and thalamus) are not as clear. Clarifying whether clinically relevant effects from subthalamic nucleus-deep brain stimulation in humans are mediated through inhibition or excitation of orthodromic or antidromic pathways (or both) would contribute to our understanding of the precise mechanism of action of deep brain stimulation and may allow improvements in safety and efficacy of the technique. In this review we discuss the published evidence from functional imaging studies of patients with subthalamic nucleus-deep brain stimulation to date, together with how these data inform the mechanism of action of deep brain stimulation.
authors.affiliation: Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, United Kingdom.
authors.forename: Tessel
authors.initials: T
authors.lastname: Boertien
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
authors.forename: Joshua
authors.initials: J
authors.lastname: Kahan
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahanshahi
authors.forename: Marwan
authors.initials: M
authors.lastname: Hariz
authors.forename: Laura
authors.initials: L
authors.lastname: Mancini
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
mesh_terms: D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D059906:Neuroimaging; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000473:pathology / Q000628:therapy*; D011877:Radionuclide Imaging; D012146:Rest / Q000502:physiology; D020531:Subthalamic Nucleus / Q000502:physiology*