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Cited by 52Deep Brain Stimulation and Movement DisordersObsessive-Compulsive Spectrum DisordersTranscranial Magnetic Stimulation Studies

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Cerebral blood flow responses to dorsal and ventral STN DBS correlate with gait and balance responses in Parkinson's disease

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Hill, K.K., Campbell, M.C., McNeely, M.E., Karimi, M., Ushe, M., Tabbal, S.D., Hershey, T., Flores, H.P., Hartlein, J.M., Lugar, H.M., Revilla, F.J., Videen, T.O., Earhart, G.M., Perlmutter, J.S.·2013·Experimental Neurology
DOI 10.1016/j.expneurol.2012.12.003PMC PMC3570746
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Abstract

Objectives The effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on gait and balance vary and the underlying mechanisms remain unclear. DBS location may alter motor benefit due to anatomical heterogeneity in STN. The purposes of this study were to (1) compare the effects of DBS of dorsal (D-STN) versus ventral (V-STN) regions on gait, balance and regional cerebral blood flow (rCBF) and (2) examine the relationships between changes in rCBF and changes in gait and balance induced by D-STN or V-STN DBS. Methods We used a validated atlas registration to locate and stimulate through electrode contacts in D-STN and V-STN regions of 37 people with Parkinson's disease. In a within-subjects, double-blind and counterbalanced design controlled for DBS settings, we measured PET rCBF responses in a priori regions of interest and quantified gait and balance during DBS Off, unilateral D-STN DBS and unilateral V-STN DBS. Results DBS of either site increased stride length without producing significant group-level changes in gait velocity, cadence or balance. Both sites increased rCBF in subcortical regions and produced variable changes in cortical and cerebellar regions. DBS-induced changes in gait velocity are related to premotor cortex rCBF changes during V-STN DBS (r=-0.40, p=0.03) and to rCBF changes in the cerebellum anterior lobe during D-STN DBS (r=-0.43, p=0.02). Conclusions DBS-induced changes in gait corresponded to rCBF responses in selected cortical and cerebellar regions. These relationships differed during D-STN versus V-STN DBS, suggesting DBS acts through distinct neuronal pathways dependent on DBS location.

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  • Resting cerebral blood flow increases in the premotor cortex following deep brain stimulation treatment, correlated with improved gait velocity and cadence.

    “Additionally, resting CBF increases in the premotor cortex following DBS treatment, which correlated with improved gait velocity and cadence (250).”

    From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [250]

    The Results (Correlation analyses of rCBF with gait and balance; page not provided) report negative, not positive, correlations between premotor blood-flow changes during ventral STN DBS and changes in gait velocity and cadence; these correlations did not remain significant after correction for multiple comparisons. The Discussion states that patients with decreased premotor blood flow tended to show the greatest gait-velocity improvements, contrary to the claimed increase. (LLM, conf=0.90)

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  • Deep brain stimulation effectiveness in improving Parkinson's disease motor symptoms is credited to microvascular improvements.

    “Deep brain stimulation (DBS) is commonly used to improve PD-related motor symptoms, and its effectiveness is credited to microvascular improvements (250, 473).”

    From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [250]

    The Introduction says STN DBS improves gait and balance in some people with Parkinson’s disease, and the Results report improved motor scores during stimulation. But the Introduction says its mechanisms remain unclear. The Results describe regional blood-flow changes, not microvascular improvements causing the motor benefit; the reported gait correlations did not remain significant after correction for multiple comparisons. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Metadata

Authors
Hill, K. K., Campbell, M. C., McNeely, M. E., Karimi, M., Ushe, M., Tabbal, S. D., Hershey, T., Flores, H. P., Hartlein, J. M., Lugar, H. M., Revilla, F. J., Videen, T. O., Earhart, G. M., & Perlmutter, J. S.
Affiliations
  • Washington University in St. Louis (US)
  • University of Cincinnati (US)
Corresponding author
Perlmutter, J.S.
ORCID
Venue
Experimental Neurology
Publisher
Elsevier BV
Published
2013-03
Volume
241
Pages
105-112
ISSN
0014-4886 (ISSN-L)
DOI
10.1016/j.expneurol.2012.12.003
PMC
PMC3570746
OpenAlex
W1981810463
Cited by
52
References
3
Citations by year
2026: 1 · 2025: 7 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 1 · 2020: 4 · 2019: 5 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 8 · 2013: 4
FWCI
2.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Experimental Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
  • eSpace (Curtin University) (submittedVersion)
Funders
  • American Parkinson Disease Association
  • Foundation for Barnes-Jewish Hospital
  • University of Washington (P30 NS057105, UL1 TR000448)
  • National Institutes of Health (CO6 RR020092, F31 NS071639, NS41248, NS58797, R01 NS41509)
  • National Alliance for Research on Schizophrenia and Depression
  • American Academy of Neurology
  • Medtronic
Topics
  • Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
Parkinson's disease, subthalamic nucleus, deep brain stimulation, regional cerebral blood flow, gait, balance, stride length, walking speed, premotor cortex, cerebellum, positron emission tomography
MeSH terms
Aged, Cerebral Cortex, Postural Balance, Female, Humans, Functional Laterality, Male, Middle Aged, Parkinson Disease, Regional Blood Flow, Sensation Disorders, Severity of Illness Index, Statistics as Topic, Gait Disorders, Neurologic, Subthalamic Nucleus, Deep Brain Stimulation, Positron-Emission Tomography

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