Subthalamic suppression defines therapeutic threshold of deep brain stimulation in Parkinson's disease.
Parkinson’s disease
deep brain stimulation
subthalamic nucleus
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN: 1468-330X
Titre abrégé: J Neurol Neurosurg Psychiatry
Pays: England
ID NLM: 2985191R
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
06
05
2019
revised:
08
08
2019
accepted:
08
08
2019
pubmed:
20
8
2019
medline:
19
6
2020
entrez:
19
8
2019
Statut:
ppublish
Résumé
Subthalamic deep brain stimulation (DBS) is beneficial when delivered at a high frequency. However, the effects of current amplitude and pulse width on subthalamic neuronal activity during high-frequency stimulation have not been investigated. In 20 patients with Parkinson's disease each undergoing subthalamic DBS, we recorded single-unit subthalamic activity using one microelectrode, while a separate microelectrode was used to deliver 5-10 s trains of stimulation at 100 Hz using varying current amplitudes and pulse widths (44 neurons investigated). Analysis of variance tests confirmed significant (p<0.001) main effects of both current amplitude and pulse width on subthalamic neuronal firing during stimulation and on poststimulus inhibitory silent periods. Prolonged silent periods were often followed by postinhibitory rebound burst excitations. Additionally, a significant (p<0.0001) correlation was found between neuronal firing and total electrical energy delivered (TEED). With TEED values≤31.2 µJ/s (associated with DBS parameters of ≤2.0 mA, 130 Hz stimulation frequency and 60 µs pulse width, assuming 1 kΩ impedance), neuronal firing was sustained at a rate of 32.4%±3.3% (mean±SE), while with values>31.2 µJ/s, neurons fired at only 4.3%±1.2%. Neuronal suppression is likely an important mechanism of action of therapeutically beneficial subthalamic DBS, which may underlie clinically relevant behavioural changes.
Identifiants
pubmed: 31422369
pii: jnnp-2019-321140
doi: 10.1136/jnnp-2019-321140
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1105-1108Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: SKK, MH and WH have received honoraria, travel funds and/or grant support from Medtronic (not related to this work). AL has received honoraria, travel funds and/or grant support from Medtronic, Boston Scientific, St. Jude-Abbott and Insightec (not related to this work). MRP is a shareholder in MyndTec. AL is a co-founder of Functional Neuromodulation. LM has no competing interests.