title: Limbic and motor function comparison of deep brain stimulation of the zona incerta and subthalamic nucleus.
abstract: BACKGROUND
  Psychiatric and neuropsychological side effects of subthalamic nucleus (STN) stimulation have been increasingly recognized. Most programming regimens focus on contacts 0 and 1, whereas contact 3, which often is located near or in the zona incerta (ZI), is usually not used. The question of whether ZI stimulation may limit limbic effects has not been answered.
  
  
  OBJECTIVE
  To examine the effects of short-term stimulation near or in the ZI (contact 3) compared with stimulation of the STN using standard trajectories and targeting as measured by limbic and motor functions.
  
  
  METHODS
  Motor and limbic functions of 11 patients with STN DBS were assessed with the Unified Parkinson Disease Rating Scale-3, structured gait video analysis, Visual Analog Scale mood scales, task testing of impulsivity, and facial recognition under routine STN programming and under stimulation in or near the ZI. Postoperative magnetic resonance imaging confirmed the location of contact 3 near or in the ZI.
  
  
  RESULTS
  Data analysis with repeated-measures analysis of variance revealed that motor scores remained stable with both stimulation settings, with specific improvements in finger taps (P = .02) and rapid alternating movements (P = .03) in ZI stimulation. Stimulation near or in the ZI led to a decrease in self- reported anxiety and depression (P = .03 for both) and an improvement in fear recognition (P = .02).
  
  
  CONCLUSIONS
  We provide preliminary evidence that stimulation in or near the ZI results in maintained motor function while improving self-reported depression and anxiety in patients with bilateral STN DBS. Stimulation in or near the ZI may provide a useful programming setting for patients prone to psychiatric side effects.
authors.affiliation: Division of Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Burrows
authors.forename: Paula D
authors.initials: PD
authors.lastname: Ravin
authors.forename: Peter
authors.initials: P
authors.lastname: Novak
authors.forename: Mary Linton B
authors.initials: ML
authors.lastname: Peters
authors.forename: Brian
authors.initials: B
authors.lastname: Dessureau
authors.forename: Joan
authors.initials: J
authors.lastname: Swearer
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008032:Limbic System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy; D011183:Postoperative Complications / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy*; D020127:Recovery of Function; D020531:Subthalamic Nucleus / Q000502:physiology*; D020530:Subthalamus / Q000502:physiology*