Subthalamic nucleus stimulation improves Parkinsonian gait via brainstem locomotor centers.
BACKGROUND
Subthalamic deep brain stimulation (STN-DBS) can ameliorate gait disturbances in Parkinson's disease (PD). Using motor imagery and positron emission tomography (PET), we investigated how STN-DBS interacts with supraspinal locomotor centers in PD.


METHODS
Ten PD patients with bilateral STN-DBS actually walked or stood still under STN-DBS ON or OFF conditions. Directly thereafter, subjects imagined walking or standing while changes in regional cerebral blood flow were measured by PET.


RESULTS
Independent of STN-DBS, imagined walking distance correlated with imagery duration. Compared with STN-DBS OFF, STN-DBS ON improved actual gait and increased imagined walking distance. Imagery of gait (vs. stance) induced activity in the supplementary motor area and the right superior parietal lobule for both STN-DBS conditions. The improvement of imagined gait during STN-DBS ON led to activity changes in the pedunculopontine nucleus/mesencephalic locomotor region (PPN/MLR).


CONCLUSIONS
Data suggest that STN-DBS improves Parkinsonian gait by modulating PPN/MLR activity.
Department of Neurology, University Hospital, University of Cologne, Köln, Germany.|Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany.
Peter H
PH
Weiss
Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany.
Jan
J
Herzog
Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Monika
M
Pötter-Nerger
Department of Neurosurgery, Christian-Albrechts-University Kiel, Kiel, Germany.
Daniela
D
Falk
Medical Imaging Physics, Institute of Neuroscience and Medicine (INM-4), Research Center Jülich, Jülich, Germany.
Hans
H
Herzog
Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany.
Günther
G
Deuschl
Department of Neurology, University Hospital, University of Würzburg, Würzburg, Germany.
Jens
J
Volkmann
Department of Neurology, University Hospital, University of Cologne, Köln, Germany.|Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany.
Gereon R
GR
Fink
D046690:Deep Brain Stimulation / Q000379:methods*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007092:Imagination / Q000502:physiology; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D045042:Pedunculopontine Tegmental Nucleus / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D020531:Subthalamic Nucleus / Q000601:surgery; D016138:Walking / Q000502:physiology
PET; Parkinson's disease; deep brain stimulation; locomotion; mesencephalic locomotor region; motor imagery; pedunculopontine nucleus