Journal
JOURNAL OF NEUROSCIENCE
Volume 38, Issue 43, Pages 9129-9141Publisher
SOC NEUROSCIENCE
DOI: 10.1523/JNEUROSCI.1327-18.2018
Keywords
cortical projections; DBS; deep-brain stimulation; electrocorticography; globus pallidus; hyperdirect pathway
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Funding
- American Brain Foundation Clinical Research Training Fellowship
- National Institutes of Health and National Institute of Neurological Disorders and Stroke [K23NS097576, R01NS090913]
- NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE [K23NS097576, R01NS090913] Funding Source: NIH RePORTER
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A monosynaptic projection from the cortex to the subthalamic nucleus is thought to have an important role in basal ganglia function and in the mechanism of therapeutic subthalamic deep-brain stimulation, but in humans the evidence for its existence is limited. We sought physiological confirmation of the cortico-subthalamic hyperdirect pathway using invasive recording techniques in patients with Parkinson's disease (9 men, 1 woman). We measured sensorimotor cortical evoked potentials using a temporary subdural strip electrode in response to low-frequency deep-brain stimulation in patients undergoing awake subthalamic or pallidal lead implantations. Evoked potentials were grouped into very short latency (< 2 ms), short latency (2-10 ms), and long latency (10-100 ms) from the onset of the stimulus pulse. Subthalamic and pallidal stimulation resulted in very short-latency evoked potentials at 1.5 ms in the primary motor cortex accompanied by EMG-evoked potentials consistent with corticospinal tract activation. Subthalamic, but not pallidal stimulation, resulted in three short-latency evoked potentials at 2.8, 5.8, and 7.7 ms in a widespread cortical distribution, consistent with antidromic activation of the hyperdirect pathway. Long-latency potentials were evoked by both targets, with subthalamic responses lagging pallidal responses by 10-20 ms, consistent with orthodromic activation of the thalamocortical pathway. The amplitude of the first short-latency evoked potential was predictive of the chronic therapeutic stimulation contact.
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