High Frequency Stimulation Of Subthalamic Nucleus Research Articles

Towards a computational model for stimulation of the Pedunculopontine nucleus

The pedunculopontine nucleus (PPN) has recently been suggested as a new therapeutic target for deep brain stimulation (DBS) in patients suffering from Parkinson's disease, particularly those with severe gait and postural impairment [1]. Stimulation at this site is typically delivered at low frequencies in contrast to the high frequency stimulation required for therapeutic benefit in the subthalamic nucleus (STN) [1]. Despite real therapeutic successes, the fundamental physiological mechanisms underlying the effect of DBS are still not understood. A hypothesis is that DBS masks the pathological synchronized firing patterns of the basal ganglia that characterize the Parkinsonian state with a regularized firing pattern. It remains unclear why stimulation of PPN should be applied with low frequency in contrast to the high frequency stimulation of STN. To get a better understanding of PPN stimulation we construct a computational model for the PPN Type I neurons in a network.

Bilateral high frequency stimulation of the subthalamic nucleus normalizes COX activity in the substantia nigra of Parkinsonian rats

Part of the mechanism underlying the therapeutic effect of subthalamic nucleus (STN) high frequency stimulation (HFS) involves the activity of the basal ganglia output structures. The general idea is that STN's burst activity leads to an increased activity of the basal ganglia output nuclei and that HFS reverses this. However, the published data sets conflict. Here, we addressed the question which effect STN HFS had on the overall substantia nigra pars reticulata (SNr; one of the basal ganglia output nuclei) activity, in rats rendered Parkinsonian by 6-hydroxydopamine (6-OHDA) injections in the striatum. We used a marker for metabolic activity, cytochrome C oxidase (COX). The expression of COX in the SNr of Parkinsonian rats was significantly higher as compared to sham-operated rats. However, in Parkinsonian rats with STN HFS, expression of COX was significantly lower as compared to non-stimulated Parkinsonian rats, and was comparable to the level of expression in sham-operated rats. These results show that STN HFS decreased the overall activity of the basal ganglia output nucleus in dopamine-depleted rats.

Long term high frequency stimulation of STN increases dopamine in the corpus striatum of hemiparkinsonian rhesus monkey

Long term subthalamic nucleus (STN) high frequency stimulation (HFS) can improve most symptoms of Parkinson's disease (PD) patients and decrease the dosage of antiparkinsonian drug such as Madopar. The mechanism of STN HFS for PD still remains elusive. We hypothesize that the level of dopamine (DA) and its metabolites in the corpus striatum is increased after long term STN HFS. The aim of this study was to examine the DA and its metabolites in the extracellular space of corpus striatum in hemiparkinsonian monkeys during long term STN HFS. Four rhesus monkeys were induced to hemiparkinsonian models by injecting 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) through right internal carotid artery. Then two of them were underwent long term right STN HFS for the subsequent microdialysis sessions. Four microdialysis probe cannulas were implanted into bilateral putamen and caudate nucleus respectively. The microdialysis probe was put into the microdialysis probe cannula of bilateral putamen and caudate nucleus. Dialysates of extracellular space in corpus striatum were collected prior to STN HFS, and subsequently 8 h, 1 week, 1 month, 2 months, 8 months and 10 months after STN HFS. The level of DA and its metabolites were determined by high performance liquid chromatography and subthalamic nucleus electrochemical detection (HPLC-ECD). HFS significantly improved PD symptoms of the monkeys. Rotation evoked by apomorphine (APO) disappeared immediately after HFS pulse generator was turned on. The levels of DA and its metabolites in putamen and caudate nucleus of electrode side increased significantly at different time points after stimulation. Long term STN HFS significantly improved symptoms of hemiparkinsonian rhesus monkey, which might be due to the increase of dopamine and/or its metabolites in corpus striatum.

Deep Brain Stimulation Reduces Neuronal Entropy in the MPTP-Primate Model of Parkinson's Disease

High-frequency stimulation (HFS) of the subthalamic nucleus (STN) or internal segment of the globus pallidus is a clinically successful treatment for the motor symptoms of Parkinson's disease. However, the mechanisms by which HFS alleviates these symptoms are not understood. Whereas initial studies focused on HFS-induced changes in neuronal firing rates, recent studies suggest that changes in patterns of neuronal activity may correlate with symptom alleviation. We hypothesized that effective STN HFS reduces the disorder of neuronal firing patterns in the basal ganglia thalamic circuit, minimizing the pathological activity associated with parkinsonism. Stimulating leads were implanted in the STN of two rhesus monkeys rendered parkinsonian by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Action potentials were recorded from neurons of the internal and external globus pallidus and the motor thalamus (ventralis anterior, ventralis lateralis pars oralis, and ventralis posterior lateralis pars oralis) during HFS that reduced motor symptoms and during clinically ineffective low-frequency stimulation (LFS). Firing pattern entropy was calculated from the recorded spike times to quantify the disorder of the neuronal activity. The firing pattern entropy of neurons within each region of the pallidum and motor thalamus decreased in response to HFS (n > or = 18 and P < or = 0.02 in each region), whereas firing rate changes were specific to pallidal neurons only. In response to LFS, firing rates were unchanged, but firing pattern entropy increased throughout the circuit (n > or = 24 and P < or = 10(-4) in each region). These data suggest that the clinical effectiveness of HFS is correlated with, and potentially mediated by, a regularization of the pattern of neuronal activity throughout the basal ganglia thalamic circuit.

High-Frequency Stimulation of the Subthalamic Nucleus Suppresses Oscillatory Activity in Patients with Parkinson's Disease in Parallel with Improvement in Motor Performance

High-frequency stimulation (HFS) of the subthalamic nucleus (STN) is a well-established therapy for patients with severe Parkinson's disease (PD), but its mechanism of action is unclear. Exaggerated oscillatory synchronization in the beta (13-30 Hz) frequency band has been associated with bradykinesia in patients with PD. Accordingly, we tested the hypothesis that the clinical benefit exerted by STN HFS is accompanied by suppression of local beta activity. To this end, we explored the after effects of STN HFS on the oscillatory local field potential (LFP) activity recorded from the STN immediately after the cessation of HFS in 11 PD patients. Only patients that demonstrated a temporary persistence of clinical benefit after cessation of HFS were analyzed. STN HFS led to a significant reduction in STN LFP beta activity for 12 s after the end of stimulation and a decrease in motor cortical-STN coherence in the beta band over the same time period. The reduction in LFP beta activity correlated with the movement amplitude during a simple motor task, so that a smaller amount of beta activity was associated with better task performance. These features were absent when power in the 5-12 Hz frequency band was considered. Our findings suggest that HFS may act by modulating pathological patterns of synchronized oscillations, specifically by reduction of pathological beta activity in PD.

Effect of short and long term STN stimulation periods on parkinsonian signs

Currently, no study of subthalamic nucleus (STN) stimulation has compared continuous stimulation with a period of short-term stimulation, which is frequently employed in the clinic and in research studies. Therefore, this study examined the effects of STN stimulation over 90 min (short) and greater than 3 months (long) on the cardinal signs of Parkinson's disease. The 90 min time period immediately followed a 12 hour withdrawal from both STN stimulation and medication. Ten PD patients who received STN stimulation were studied. Bradykinesia, rigidity, and tremor were evaluated using the UPDRS and motor control measures which included peak velocity (bradykinesia), work (rigidity), and amplitude (tremor). Results showed no difference between 90 min and greater than 3 months of STN stimulation for the UPDRS or motor control measures. This finding confirms that the treatment efficacy that is derived from a relatively short time course of stimulation generalizes to longer time periods of high frequency STN stimulation that patients experience in their daily lives. As such, it is reasonable to evaluate the effect of DBS after 90 min of stimulation in clinical trials and research studies.

Subthalamic Stimulation and Neuronal Activity in the Substantia Nigra in Parkinson's Disease

High-frequency stimulation of the subthalamic nucleus (STN) is an effective treatment for severe forms of Parkinson's disease (PD). To study the effects of high-frequency STN stimulation on one of the main output pathways of the basal ganglia, single-unit recordings of the neuronal activity of the substantia nigra pars reticulata (SNr) were performed before, during, and after the application of STN electrical stimulation in eight PD patients. During STN stimulation at 14 Hz, no change in either the mean firing rate or the discharge pattern of SNr neurons was observed. STN stimulation at 140 Hz decreased the mean firing rate by 64% and the mean duration of bursting mode activity of SNr neurons by 70%. The SNr residual neuronal activity during 140-Hz STN stimulation was driven by the STN stimulation. How the decrease in rate and modification of firing pattern of SNr-evoked neural activity, during high-frequency STN stimulation, contribute to the improvement of parkinsonian motor disability remains to be elucidated.

High-frequency stimulation of the subthalamic nucleus potentiates L-DOPA-induced neurochemical changes in the striatum in a rat model of Parkinson's disease.

This study examined the cellular changes produced in the striatum by chronic L-DOPA treatment and prolonged subthalamic nucleus high-frequency stimulation (STN-HFS) applied separately, successively, or in association, in the 6-hydroxydopamine-lesioned rat model of Parkinson's disease (PD). Only animals showing severe L-DOPA-induced dyskinesias (LIDs) were included, and STN-HFS was applied for 5 d at an intensity efficient for alleviating akinesia without inducing dyskinesias. L-DOPA treatment alone induced FosB/deltaFosB immunoreactivity, exacerbated the postlesional increase in preproenkephalin, reversed the decrease in preprotachykinin, and markedly increased mRNA levels of preprodynorphin and of the glial glutamate transporter GLT1, which were respectively decreased and unaffected by the dopamine lesion. STN-HFS did not affect per se the postlesion changes in any of these markers. However, when applied in association with L-DOPA treatment, it potentiated the positive modulation exerted by L-DOPA on all of the markers examined and tended to exacerbate LIDs. After 5 d of L-DOPA withdrawal, the only persisting drug-induced responses were an elevation in preprodynorphin mRNA levels and in the number of FosB/deltaFosB-immunoreactive neurons. Selective additional increases in these two markers were measured when STN-HFS was applied subsequently to L-DOPA treatment. These data provide the first evidence that STN-HFS exacerbates the responsiveness of striatal cells to L-DOPA medication and suggest that STN-HFS acts specifically through an L-DOPA-modulated signal transduction pathway associated with LIDs in the striatum. They point to striatal cells as a primary site for the complex interactions between these two therapeutic approaches in PD and argue against a direct anti-dyskinetic action of STN-HFS.

Chronic high‐frequency stimulation of the subthalamic nucleus and L‐DOPA treatment in experimental parkinsonism: effects on motor behaviour and striatal glutamate transmission

Hyperactivity of striatal glutamatergic synaptic transmission in response to dopamine depletion plays a major role in the pathogenesis of parkinsonian motor symptoms. In the present study we investigated the impact, on this hyperactivity, of chronic dyskinesiogenic L-DOPA treatment, combined or not with high-frequency stimulation (HFS) of the subthalamic nucleus (STN). In vitro patch-clamp recordings were performed from striatal spiny neurons of hemiparkinsonian rats (intranigral 6-OHDA injection). Here we show that dyskinesiogenic L-DOPA treatment exacerbated striatal glutamatergic hyperactivity induced by 6-OHDA lesion. Chronic 5-day STN HFS had the opposite effect, reducing striatal glutamatergic transmission in both parkinsonian and dyskinetic animals. Consistently, chronic HFS stimulation could progressively ameliorate motor parkinsonian signs (akinesia) but, conversely, did not improve L-DOPA-induced dyskinesia (LID). Thus, the effects of L-DOPA and HFS on corticostriatal transmission seem to be dissociated. These data show for the first time that dyskinesiogenic L-DOPA treatment and chronic STN HFS with antiakinetic effects induce opposite plastic rearrangements in the striatum. The interaction between these two treatments provides further evidence that striatal glutamatergic hyperactivity is a pathophysiological correlate of akinesia rather than LID.

Reply to: Deep brain stimulation in Parkinson's disease can mimic the 300 Hz subthalamic rhythm Subthalamic high-frequency stimulation drives subthalamic oscillatory activity at stimulation frequency while firing rate is reduced

Neurophysique et Physiologie du Syste`me Moteur, Universite´ Paris V, Paris, FranceCorrespondence to: Dr Wassilios Meissner, CNRS UMR 5543, Universite´ Victor Se´galen, 146 rue Le´o Saignat,33076 Bordeaux Cedex, FranceE-mail: wassilios.meissner@umr5543.u-bordeaux2.frdoi:10.1093/brain/awl210We have read with interest the letter by Foffani and Priorithat will be published online alongside the same issue ofBrain. Foffani and Priori hypothesize that high-frequencystimulation (HFS) of the subthalamic nucleus (STN)might induce oscillatory activity around 250 Hz in thebasal ganglia network. To verify this assumption, we per-formed a new analysis of our entire data set, where wetried to be as close as possible to the analysis described inour recent publication (for details, see Meissner et al., 2005).Accordingly, single-cell oscillations and synchronized oscil-latory activity between pairs of neurons were assessed bycalculating auto-correlograms (AC) and cross-correlograms(CC), respectively (1000 ms offset with a bin width of 1 msinstead of 5 ms to enable the analysis of frequencies up to 350Hz). For each AC and CC the power spectrum was calculatedbetween3and350Hzandtheoscillatoryactivitywasassessedfor three distinct frequency bands: 3–30 Hz as in our recentpublication, 31–200Hz and 201–350Hz.A peak in the powerspectrumwasconsideredtobesignificantifitwashigherthanthe mean power of the entire spectrum [(3–350 Hz) + 5 SD]and if it had an oscillatory index >10%. The standard devia-tion was individually calculated for each frequency bandusing the two other frequency bands (i.e. for the 3–30 Hzband, the standard deviation was calculated in the 31–350 Hzrange). Differences of AC and CC between the experimentalstates were assessed by using z-tests.Total single oscillatory activity was 95.1% in the normalstate and 92.9% in the parkinsonian state (Fig. 1A, z = 0.1,P > 0.5) and was mainly related to oscillatory activity inthe 3–30 Hz frequency band (3–30 Hz: 90.2% versus 83.7%,z = 0.7, P > 0.05; 31–200 Hz: 4.9% versus 5.1%, z = 0.4,P > 0.5; 201–350 Hz: 2.4% versus 4.1%, z = 0.01, P > 0.5).The strong oscillatory activity in the normal state and theabsence of a significant increase in the parkinsonian stateare explained by the observation that the power spectrumin the 31–200 Hz and 201–350 Hz bands were generally flat,but contributed to the calculation of the mean and standarddeviation for the 3–30 Hz band, rendering the analysis verysensitive for that frequency band.Total synchronized oscillatory activity between pairs ofneurons was 40.4% in the normal and 50.0% in the parkin-sonian state (Fig. 1B, z = 1.1, P > 0.05). MPTP treatmentsignificantly increased synchronized oscillatory activity inthe 3–30 Hz frequency band (8.8% versus 23.3%, z = 2.2,P 0.5; 201–350 Hz: 24.6% versus 18.0%, z = 0.9,P > 0.05).STN–HFS in the parkinsonian state induced strong oscil-latory activity in the 31–200 Hz band at the stimulation fre-quency of 130 Hz (Fig. 1C and D, single neuron: 93.0%; pairsof neurons: 100.0%), while STN–HFS decreased the firingrate of subthalamic neurons to 48.9% of baseline values(Meissner et al., 2005). Only 7.3% of single neurons showedsignificant oscillatory activity in the 3–30 Hz band and 2.3%in the 201–350 Hz band. When comparing these values withthe MPTP-treated state, differences were significant for the3–30Hzandthe31–200Hzband(3–30Hz:z=8.4,P 0.5).Synchronizedoscillatoryactivityduring STN–HFSwasexclu-sively present in the 31–200 Hz frequency band. Differencesbetween MPTP and MPTP + HFS states were significant forall frequency bands (3–30 Hz: z = 3.4, P < 0.001; 31–200 Hz:z = 11.7, P < 0.001; 201–350 Hz: z = 2.9, P < 0.5).As shown in our previous paper, the recovery of themean firing probability of STN neurons between two elec-trical stimuli is represented by a sigmoid function: f(t) =F0/(1 + exp ( k(t t0))), where F0 is the baseline firingrate, t the time in seconds, k = 4.5 6 0.6 ms

Addiction in Parkinson's disease: Impact of subthalamic nucleus deep brain stimulation

In Parkinson's disease, dopamine dysregulation syndrome (DDS) is characterized by severe dopamine addiction and behavioral disorders such as manic psychosis, hypersexuality, pathological gambling, and mood swings. Here, we describe the case of 2 young parkinsonian patients suffering from disabling motor fluctuations and dyskinesia associated with severe DDS. In addition to alleviating the motor disability in both patients, subthalamic nucleus (STN) deep brain stimulation greatly reduced the behavioral disorders as well as completely abolished the addiction to dopaminergic treatment. Dopaminergic addiction in patients with Parkinson's disease, therefore, does not constitute an obstacle to high-frequency STN stimulation, and this treatment may even cure the addiction.

High frequency stimulation of the subthalamic nucleus is efficacious in Parkin disease

High frequency stimulation (HFS) of the subthalamic nucleus (STN) is an efficacious symptomatic treatment for Parkinson's disease. We have analysed the genetic status of a series of consecutive parkinsonian patients implanted for STN HFS and compared the outcome of five carrying mutations in the parkin gene with that of the non-parkin group. All patients obtained sustained control of PD symptoms and achieved functional improvement; in the parkin group the UPDRS motor score improved by 56.4%, the levodopa equivalent daily dosage was reduced by 75.5%. Postoperative medications were reduced more in parkin than in non-parkin patients. We confirm that the current inclusion criteria for STN HFS do not exclude patients carrying mutations in the parkin gene; their clinical outcome is comparable to that of the non-parkin group.

Differential effects of prolonged high frequency stimulation and of excitotoxic lesion of the subthalamic nucleus on dopamine denervation‐induced cellular defects in the rat striatum and globus pallidus

This study examined the effects of prolonged (4 days) high frequency stimulation (HFS) of the subthalamic nucleus (STN), in comparison with those of STN lesion, on the dopamine denervation-mediated cellular changes in the basal ganglia in a Wistar rat model of Parkinson's disease. STN HFS counteracted the dopamine lesion-induced increase in GAD67 mRNA expression in the output structures of the basal ganglia, as shown previously after STN lesion, providing cellular support for the similar antiparkinsonian benefits produced by the two surgical procedures. The dopamine denervation-induced increase in GAD67 mRNA levels in the globus pallidus was partially antagonized after HFS and totally reversed after ibotenate-induced STN lesion. The overexpression of striatal enkephalin mRNA tended to be further increased by HFS but was antagonized by STN lesion. The decrease in striatal substance P mRNA levels was affected neither by STN HFS nor lesion. As STN HFS for two hours was previously found not to interfere with the effects of dopamine lesion in the globus pallidus and striatum, the present data provide strong evidence that the effects of STN surgery in these structures involve long-term adaptive processes and that the rearrangements mediated by HFS and lesion are, at least in part, different.

Effect of High-Frequency Stimulation of the Subthalamic Nucleus on Subthalamic Neurons: An Intracellular Study

Background/Aims: The precise mechanism of action of deep brain stimulation in the subthalamic nucleus (STN) for the treatment of Parkinson’s disease and epilepsy is unknown. In the present study, the intracellular effects on STN neurons following high-frequency stimulation (HFS) of STN were examined to test the hypothesis that HFS results in either an increase or a decrease in neuronal action potential generation. Methods: Intracellular electrophysiological recordings were made in the rat STN neurons in in vitro slice preparations. A concentric bipolar stimulating electrode was placed in the STN, and electrical stimulation (duration, 100–2000 ms; amplitude, 10–500 µA, and frequency, 10–200 Hz) was delivered while simultaneously recording intracellularly from a STN neuron using a sharp electrode. Results: HFS of STN resulted in the generation of excitatory postsynaptic potentials and an increase in action potential firing during the stimulation period followed by a period of poststimulation inhibition of firing in STN neurons. The degree of increase in action potentials from HFS was critically dependent on the frequency of electrical stimulation, i.e. at approximately 100–140 Hz, maximal increase was obtained, but at 200 Hz, the activity was blocked. Interestingly, the duration of poststimulation inhibition of firing was dependent on the duration of stimulation, i.e. the longer the HFS, the longer the inhibition. Conclusions: These results suggest that the mechanism of action of deep brain stimulation involves initial excitation followed by later inhibition of STN neurons at a cellular level rather than primary inhibition, as previously hypothesized.

Effects of High-Frequency Stimulation on Subthalamic Neuronal Activity in Parkinsonian Patients

High-frequency stimulation of the subthalamic nucleus (STN) is a neurosurgical alternative to medical treatment in levodopa-responsive forms of Parkinson disease. The mechanism of action of STN stimulation remains controversial, although an inhibition of overactive STN neurons has been postulated. To determine the effects of high-frequency STN stimulation on the neuronal activity of STN neurons in Parkinson disease patients. Single-unit recordings of the neuronal activity of the STN were obtained before, during, and after the application of intra-STN electrical stimulation in 15 Parkinson disease patients. Changes in firing frequency and pattern were analyzed using various combinations of stimulus frequency (range, 14-140 Hz). Stimulation at a frequency greater than 40 Hz applied within the STN significantly decreased the firing frequency and increased the burst-like activity in the firing pattern of STN neurons. An aftereffect was observed in cells that had been totally inhibited during high-frequency stimulation. The beneficial effects of high-frequency stimulation result from a change in the firing pattern of cellular discharge and a blockade of the spontaneous overactivity of STN neurons.

Experimental therapeutics of Parkinson's disease

1. The loss of central dopamine, which characterises Parkinson's disease, led to the main pharmacological strategy for treatment, namely levodopa, a dopamine-replacement therapy. Several years after treatment, the majority of patients experience dose-limiting side-effects and loss of symptom control. There is a resurgence of interest in neurosurgery for treating the Parkinson's disease, particularly in new techniques targeting the subthalamic nucleus (STN), which is overactive in Parkinson's disease and contributes to symptom development. 2. We performed unilateral subthalamotomy (lesioning the subthalamic nucleus via the toxin N-methyl-d-aspartate) in marmosets and rats with experimentally induced parkinsonism (induced using the toxin 6-hydroxydopamine). A range of similar behaviours common to both rodents and primates were evaluated before and after each type of surgery. Post-mortem histology was used to confirm the lesions. We also provide details of a case with Parkinson's disease who underwent high-frequency bilateral stimulation of the STN and in whom we analysed the STN post-mortem. 3. Unilateral subthalamotomy improved akinesia in parkinsonian primates. However, both monkeys and rodents showed postural abnormalities. The patient who underwent bilateral high-frequency stimulation showed improvement of akinesia and other disease symptoms and no postural abnormalities. Post-mortem analysis did not demonstrate substantial damage of the STN as a result of the electrodes. 4. Although unilateral subthalamotomy improves some aspects of parkinsonism, it causes postural abnormalities in animal models of Parkinson's disease. Because bilateral high-frequency STN stimulation improves disease symptoms, is reversible and is not reported to induce postural side-effects, it may be a better surgical therapy for Parkinson's disease than lesioning the STN.

Spontaneous and Evoked Activity of Substantia Nigra Pars Reticulata Neurons during High-Frequency Stimulation of the Subthalamic Nucleus

The subthalamic nucleus (STN), a major component of the basal ganglia, exerts an excitatory influence on the output structures of this system i.e., the substantia nigra pars reticulata (SNR) and the internal segment of the globus pallidus. High-frequency stimulation of the STN is a method currently used to treat parkinsonian symptoms. The aim of the present study was to analyze the effects of STN high-frequency stimulation on the activity of SNR neurons and to investigate its impact on the transfer of information between the cerebral cortex and the SNR. During STN high-frequency stimulation, the activity of SNR cells was decreased at low-intensity stimulation, whereas it was increased at a higher intensity. The decrease in the discharge of SNR cells likely results from the activation of a GABAergic transmission in the SNR because this effect was blocked by local application of bicuculline. The increased activity likely results from the activation of the glutamatergic subthalamonigral projection because the latency of the evoked excitations was consistent with the conduction time of the subthalamonigral neurons. Finally, during STN high-frequency stimulation, the transmission of cortical information along the direct trans-striatal pathway was preserved, whereas the functionality of the trans-subthalamic pathways was partly preserved or completely blocked depending on the stimulation intensity. The present data indicate that STN high-frequency stimulation influences the activity of SNR cells through activation of their excitatory and inhibitory synaptic afferent pathways as well as antidromic activation of the projection neurons.

High frequency stimulation of the subthalamic nucleus has beneficial antiparkinsonian effects on motor functions in rats, but less efficiency in a choice reaction time task.

Chronic subthalamic nucleus high frequency stimulation (STN HFS) improves motor function in Parkinson's disease. However, its efficacy on cognitive function and the mechanisms involved are less known. The aim of this study was to assess the effects of STN HFS in hemiparkinsonian awake rats performing different specific motor tests and a cognitive operant task. Unilateral STN HFS applied in unilaterally DA-depleted rats decreased the apomorphine-induced circling behaviour and reduced catalepsy induced by the neuroleptic haloperidol. DA-depleted rats exhibited severe deficits in the operant task, among which the inability to perform the task was not alleviated by STN HFS. However, in a few animals showing less impairment, STN HFS significantly reduced the contralateral neglect induced by the lesion. These results are the first to demonstrate a beneficial effect of STN HFS applied in awake rats on basic motor functions. However, STN HFS appears to be less effective on impaired cognitive functions.

Bilateral high-frequency stimulation of the subthalamic nucleus in patients with multiple system atrophy--parkinsonism. Report of four cases.

The aim of this study was to investigate the effect of high-frequency stimulation (HFS) of the subthalamic nucleus (STN) in patients with a subtype of multiple system atrophy (MSA) in which levodopa-unresponsive MSA parkinsonism (MSA-P) is predominant. After a local anesthetic was administered, electrodes were stereotactically implanted bilaterally into the STN in four patients with MSA-P and predominantly akinetorigid symptoms. Unified Parkinson's Disease Rating Scale (UPDRS) scores were evaluated preoperatively, at 1 month, and at long-term follow up. At 1 month the median decrease in the UPDRS III motor score was 22 on the 56-point scale (decreases of 16, 13, 29, and 15 points compared with baseline for Cases 1, 2, 3, and 4, respectively). This was mainly due to an improvement in rigidity and akinesia. The median decrease in the UPDRS II score was 11 on the 52-point scale (respective decreases of 5, 7, 13, and 9 points). At 2 years (mean follow up 27 months) there was a median decrease in the UPDRS III score of 12 (respective decreases of 18, 13, 21, and 9 points), and in the UPDRS II score of 5 (with respective decreases of 2, 2, 17, and 2), both compared with the stimulation off state. At long-term follow up there was an increase in the individual Schwab and England scores of 10 to 15% in the stimulation on compared with the stimulation off condition. There was a beneficial effect of STN HFS in these four patients on both a short-term and a long-term basis. A larger prospective study is justified.

High-Frequency Stimulation of the Subthalamic Nucleus Selectively Reverses Dopamine Denervation-Induced Cellular Defects in the Output Structures of the Basal Ganglia in the Rat

High-frequency stimulation (HFS) of the subthalamic nucleus (STN) is now recognized as an effective treatment for advanced Parkinson's disease, but the molecular basis of its effects remains unknown. This study examined the effects of unilateral STN HFS (2 hr of continuous stimulation) in intact and hemiparkinsonian awake rats on STN neuron metabolic activity and on neurotransmitter-related gene expression in the basal ganglia, by means of in situ hybridization histochemistry and immunocytochemistry. In both intact and hemiparkinsonian rats, this stimulation was found to induce c-fos protein expression but to decrease cytochrome oxidase subunit I mRNA levels in STN neurons. STN HFS did not affect the dopamine lesion-mediated overexpression of enkephalin mRNA or the decrease in substance P in the ipsilateral striatum. The lesion-induced increases in intraneuronal glutamate decarboxylase 67 kDa isoform (GAD67) mRNA levels on the lesion side were reversed by STN HFS in the substantia nigra, partially antagonized in the entopeduncular nucleus but unaffected in the globus pallidus. The stimulation did not affect neuropeptide or GAD67 mRNA levels in the side contralateral to the dopamine lesion or in intact animals. These data furnish the first evidence that STN HFS decreases the metabolic activity of STN neurons and antagonizes dopamine lesion-mediated cellular defects in the basal ganglia output structures. They provide molecular substrate to the therapeutic effects of this stimulation consistent with the current hypothesis that HFS blocks STN neuron activity. However, the differential impact of STN HFS on the effects of dopamine lesion among structures receiving direct STN inputs suggests that this stimulation may not cause simply interruption of STN outflow.