Brain, Vol. 122, No. 12, 2365-2373,
December 1999
© 1999 Oxford University Press
Review article |
Bilateral subthalamic nucleus stimulation improves frontal cortex function in Parkinson's disease
An electrophysiological study of the contingent negative variation
1 Departments of Neurology and 2 Neurosurgery, University of Vienna, Austria and 3 MRC Human Movement and Balance Unit, Institute of Neurology, London, UK
Correspondence to:
Dr Wilfried Lang, Department of Neurology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
Parkinson's disease involves impaired activation of frontal cortical areas, including the supplementary motor area and prefrontal cortex, resulting from impaired thalamocortical output of the basal ganglia. Electrophysiologically, such impaired cortical activation may be seen as a reduced amplitude of the contingent negative variation (CNV), a slow negative potential shift reflecting cognitive processes associated with the preparation and/or anticipation of a response. Surgical interventions aimed at increasing basal ganglia–thalamic outflow to the cortex, such as electrical stimulation of the subthalamic nucleus with chronically implanted electrodes, have been shown to be effective in improving the clinical symptoms of Parkinson's disease. This study examined changes in cortical activity, as reflected in the CNV, associated with bilateral subthalamic nucleus stimulation in Parkinson's disease. The CNV was recorded from 10 patients with Parkinson's disease when on and off bilateral subthalamic nucleus stimulation, and was compared with the CNV of 10 healthy control subjects. Without subthalamic nucleus stimulation, Parkinson's disease patients showed reduced CNV amplitudes over the frontal and frontocentral regions compared with control subjects. With bilateral subthalamic nucleus stimulation, however, CNV amplitudes over the frontal and frontocentral regions were significantly increased. Results therefore suggest that impaired cortical functioning in Parkinson's disease, particularly within the frontal and premotor areas, is improved by subthalamic nucleus stimulation.
Parkinson's disease; subthalamic nucleus stimulation; contingent negative variation
CNV = contingent negative variation; GPi = globus pallidus internus; SNr = substantia nigra pars reticulata; UPDRS = Unified Parkinson's Disease Rating Scale
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