Deep brain stimulation of the subthalamic nucleus modulates reward processing and action selection in Parkinson patients.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for motor impairments in Parkinson's disease (PD) but its effect on the motivational regulation of action control is still not fully understood. We investigated whether DBS of the STN influences the ability of PD patients to act for anticipated reward or loss, or whether DBS improves action execution independent of motivational valence. 16 PD patients (12 male, mean age = 58.5 ± 10.17 years) treated with bilateral STN-DBS and an age- and gender-matched group of healthy controls (HC) performed a go/no-go task whose contingencies explicitly decouple valence and action. Patients were tested with (ON) and without (OFF) active STN stimulation. For HC, there was a benefit in performing rewarded actions when compared to actions that avoided punishment. PD patients showed such a benefit reliably only when STN stimulation was ON. In fact, the relative behavioral benefit for go for reward over go to avoid losing was stronger in the PD patients under DBS ON than in HC. In PD patients, rather than generally improving motor functions independent of motivational valence, modulation of the STN by DBS improves action execution specifically when rewards are anticipated. Thus, STN-DBS establishes a reliable congruency between action and reward ("Pavlovian congruency") and remarkably enhances it over the level observed in HC.
Departments of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany, caroline.wagenbreth@med.ovgu.de.
Caroline
C
Wagenbreth
Tino
T
Zaehle
Imke
I
Galazky
Jürgen
J
Voges
Marc
M
Guitart-Masip
Hans-Jochen
HJ
Heinze
Emrah
E
Düzel
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D002755:Choice Behavior / Q000502:physiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000628:therapy; D011930:Reaction Time / Q000502:physiology; D012201:Reward; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome