Brain Advance Access originally published online on October 30, 2007
Brain 2008 131(1):132-145; doi:10.1093/brain/awm254
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Improved sensory gating of urinary bladder afferents in Parkinson's disease following subthalamic stimulation
1Department of Neurology, Christian-Albrechts-University Kiel, Schittenhelmstrasse 10, 24105 Kiel, 2Institute of Neurosciences and Biophysics, Research Center Jülich, 3Brain Imaging Centre West (BICW), Research Center Jülich, Leo- Brandt- Str. 5, 52425 Jülich, 4Department of Urology, Christian-Albrechts-University Kiel, Arnold- Heller- Street 7, 5Department of Neurosurgery, Christian-Albrechts-University Kiel, Schittenhelmstr. 10, 24105 Kiel and 6Department of Neurology, University Hospital, University of Cologne, Kerpener Straße 62, 50924 Köln, Germany
Correspondence to: Prof. Gereon R. Fink, MD, Department of Neurology, University Hospital, University of Cologne, Kerpener Straße 62, 50924 Köln, Germany E-mail: gereon.fink{at}uk-koeln.de
In addition to motor symptoms, patients with Parkinson's disease (PD) show deficits in sensory processing. These deficits are thought to result from deficient gating of sensory information due to basal ganglia dysfunction in PD. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been shown to improve sensory deficits in PD, e.g. STN-DBS normalizes the perception of urinary bladder filling in patients with PD. This study aimed at investigating how STN-DBS modulates the processing of urinary bladder information to elucidate the (patho-)physiology of sensory gating mechanisms in PD.
Nine PD patients with bilateral STN-DBS switched on (STN-DBS ON) or off (STN-DBS OFF) were studied during dynamic bladder filling and an empty bladder condition (for control), while changes in regional cerebral blood flow (rCBF) were measured by PET. Urinary bladder filling led to an increased rCBF in the periaqueductal grey (PAG), the posterior thalamus, the insular cortex as well as in the right frontal cortex and the cerebellum bilaterally. A significant interaction between bladder condition and STN-DBS was observed in the posterior thalamus and the insular cortex, with enhanced modulation of these areas during STN-DBS ON compared to STN-DBS OFF. Furthermore, regression analyses revealed a modulation of the neural activity in the thalamus and the insular cortex by the PAG activity during STN-DBS ON only. Thus, STN-DBS led to a significant enhancement of afferent urinary bladder information processing. The data suggest that STN-DBS facilitates the discrimination of different bodily states by supporting sensory perception and the underlying neural mechanisms. Furthermore, this is the first imaging study, which shows an effect of STN-DBS on sensory gating in PD patients and its neural basis.
Key Words: deep brain stimulation; subthalamic nucleus; periaqueductal grey; visceral sensory processing; PET
Abbreviations: ACC, anterior cingulate cortex; DBS, deep brain stimulation; DLPFC, dorsolateral prefrontal cortex; GPi, internal globus pallidus; LFC, lateral frontal cortex; PAG, periaqueductal grey; PD, Parkinson's disease; rCBF, regional cerebral blood flow; ROI, region of interest; RT, reticular thalamus; SMA, supplementary motor area; SNr, substantia nigra pars reticulata; SPECT, single photon emission computerized tomography; SPM, statistical parametric mapping; STN, subthalamic nucleus; VA, ventral anterior nucleus; VL, ventral lateral nucleus
Received March 28, 2007. Revised September 18, 2007. Accepted September 24, 2007.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. C. Helmich, L. C. Derikx, M. Bakker, R. Scheeringa, B. R. Bloem, and I. Toni Spatial Remapping of Cortico-striatal Connectivity in Parkinson's Disease Cereb Cortex, August 26, 2009; (2009) bhp178v1. [Abstract] [Full Text] [PDF]
|
|