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Brain Advance Access published online on October 31, 2006
Brain, doi:10.1093/brain/awl302
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© The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received May 19, 2006
Revised August 22, 2006
Accepted September 20, 2006

Article

Subthalamic stimulation modulates cortical control of urinary bladder in Parkinson's disease

Jan Herzog 1, Peter H. Weiss 2, Ann Assmus 3, Björn Wefer 4, Christoph Seif 4, Peter M. Braun 4, Hans Herzog 2, Jens Volkmann 1, Günther Deuschl 1, and Gereon R. Fink 5 *

1 Department of Neurology, Christian Albrechts University Kiel, Kiel, Germany
2 Institute of Medicine, Research Center Jülich Forschungszentrum Jülich, Jülich, Germany; Brain Imaging Centre West (BICW), Research Center Jülich, Jülich, Germany
3 Institute of Medicine, Research Center Jülich Forschungszentrum Jülich, Jülich, Germany; Brain Imaging Centre West (BICW), Research Center Jülich, Jülich, Germany; Department of Neurology-Cognitive Neurology, University Hospital Aachen, RWTH Aachen, Aachen, Germany
4 Department of Urology, Christian Albrechts University Kiel, Kiel, Germany
5 Institute of Medicine, Research Center Jülich Forschungszentrum Jülich, Jülich, Germany; Brain Imaging Centre West (BICW), Research Center Jülich, Jülich, Germany; Department of Neurology, University Hospital, University of Cologne, Köln, Germany

* To whom correspondence should be addressed.
Gereon R. Fink, E-mail: gereon.fink{at}uk-koeln.de


  Abstract

Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective therapy for off-period motor symptoms and dyskinesias in advanced Parkinson's disease. Clinical studies have shown that STN-DBS also ameliorates urinary bladder function in Parkinson's disease patients by delaying the first desire to void and increasing bladder capacity. This study aimed at investigating the effect of STN-DBS on the neural mechanisms underlying cerebral bladder control. Using PET to measure changes in regional cerebral blood flow (rCBF), 11 patients with bilateral STN-DBS were studied during urodynamic bladder filling in STN-DBS ON and OFF condition. A filled bladder led to a significant increase of rCBF in the anterior cingulate cortex, which was further enhanced during STN-DBS OFF. A significant interaction between bladder state and STN-DBS was observed in lateral frontal cortex with increased rCBF when the bladder was filled during STN-DBS OFF. The data suggest that STN-DBS ameliorates bladder dysfunction and that this modulation may result from facilitated processing of afferent bladder information.

Keywords: deep brain stimulation; Parkinson's disease; subthalamic nucleus; urinary bladder.
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