High-frequency stimulation in Parkinson's disease: more or less?

Garcia, Liliana, D'Alessandro, Giampaolo, Bioulac, Bernard and Hammond, Constance (2005) High-frequency stimulation in Parkinson's disease: more or less? Trends in Neurosciences, 28 (4), 209-216. (doi:10.1016/j.tins.2005.02.005).

Abstract

Deep-brain stimulation at high frequency is now considered the most effective neurosurgical therapy for movement disorders. An electrode is chronically implanted in a particular area of the brain and, when continuously stimulated, it significantly alleviates motor symptoms. In Parkinson's disease, common target nuclei of high-frequency stimulation (HFS) are ventral thalamic nuclei and basal ganglia nuclei, such as the internal segment of the pallidum and the subthalamic nucleus (STN), with a preference for the STN in recent years. Two fundamental mechanisms have been proposed to underlie the beneficial effects of HFS: silencing or excitation of STN neurons. Relying on recent experimental data, we suggest that both are instrumental: HFS switches off a pathological disrupted activity in the STN (a ‘less’ mechanism) and imposes a new type of discharge in the upper gamma-band frequency that is endowed with beneficial effects (a ‘more’ mechanism). The intrinsic capacity of basal ganglia and particular STN neurons to generate oscillations and shift rapidly from a physiological to a pathogenic pattern is pivotal in the operation of these circuits in health and disease.

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Contributors

Author: Giampaolo D'Alessandro

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