Abstract
Deep-brain electrical stimulation (DBS) of the subthalamic nucleus (STN) can provide substantial and readily apparent clinical benefit in Parkinson disease (PD).1 However, the underlying neural mechanisms of these effects are currently debated. The debate has focused on fundamental questions: Does STN DBS decrease, increase or regularize STN output?2 If STN DBS exerts one or more of these effects, how might these effects mediate the observed clinical effects? In this issue of Neurology, Grafton et al.3 report the effects of STN DBS on resting and movement-related regional cerebral blood flow (rCBF) changes in the brains of patients with PD as measured by PET. They report that unilateral STN DBS can increase task-related activity in brain regions that were underactive during ineffective stimulation and can decrease task-related activity of regions that were overactive during ineffective stimulation. These complex results imply that STN DBS interacts with PD-related pathophysiology and with task demands to modulate cortical activity. A similar level of complexity has been shown during performance of a cognitive task.4 Whether functional neuroimaging studies can answer mechanistic questions about DBS depends on which physiologic …
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