This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background: Axial symptoms of Parkinson disease (PD) may result from dysfunctional basal ganglia–brainstem connections. In this study, we assessed whether modulation of basal ganglia activity by high-frequency stimulation of the subthalamic nucleus (STN-HFS) in PD had an impact on the brainstem-controlled startle system.
Methods: We assessed auditory startle responses (recorded from right orbicularis oculi, masseter, sternocleidomastoid, biceps brachii, and soleus muscle) and audiospinal facilitation (startle conditioned soleus H-reflexes at interstimulus intervals of 0–250 msec) in 24 patients with PD with chronically implanted, bilateral STN electrodes in the stimulation on (STIM ON) and off condition (STIM OFF) and 20 healthy controls.
Results: The mixed linear analysis of variance model revealed a significant effect for the startle onset latency in the orbicularis oculi muscle for the factors GROUP (patients with PD vs controls; p < 0.0001, F = 44.66) and STIM (nested within GROUP) (p = 0.0034, F = 8.79). Audiospinal facilitation was modulated by STN-HFS as shown by highly significant effects for STIM [GROUP] (p < 0.0001, F = 15.9), ISI [GROUP] (p < 0.0001, F = 3.5), and the interaction of ISI × STIM [GROUP] (p = 0.0085, F = 2.65) in the mixed linear model.
Conclusion: High-frequency stimulation of the subthalamic nucleus alters the excitability of the brainstem startle system in Parkinson disease, most likely by releasing the reticular motor system from abnormal descending input of the basal ganglia via pallidotegmental pathways.
GLOSSARY: ANOVA = analysis of variance; AUC = area under the curve; ISI = interstimulus intervals; LEDD = levodopa equivalent daily dosage; NRGC = nucleus reticularis gigantocellularis; NRPC = nucleus reticularis pontis caudalis; PD = Parkinson disease; PPN = pedunculopontine nucleus; STN-HFS = high-frequency stimulation of the subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.
Footnotes
-
j.volkmann{at}neurologie.uni-kiel.de
Supported by the Sonderforschungsbereich 654 (project A7) of the Deutsche Forschungsgemeinschaft and by a junior grant of the research commission of Christian-Albrechts-University to Dr. Pötter.
Disclosure: The authors report no conflicts of interest.
Received December 10, 2006. Accepted in final form October 22, 2007.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
The effect of subthalamic nucleus stimulation on autogenic inhibition in Parkinson disease
Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation
Subthalamic nucleus stimulation modulates afferent inhibition in Parkinson disease
Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease