• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.303-306
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• 2015

Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) is a novel therapy developed to treat Parkinson's disease. We report a patient who underwent bilateral DBS of the PPN and subthalamic nucleus (STN). He suffered from freezing of gait (FOG), bradykinesia, rigidity and mild tremors. The patient underwent bilateral DBS of the PPN and STN. We compared the benefits of PPN-DBS and STN-DBS using motor and gait subscores. The PPN-DBS provided modest improvements in the gait disorder and freezing episodes, while the STN-DBS failed to improve the dominant problems. This special case suggests that PPN-DBS may have a unique role in ameliorating the locomotor symptoms and has the potential to provide improvement in FOG.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2013년도 춘계학술대회 논문집
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• pp.1497-1498
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• 2013

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2011년도 춘계학술대회 논문집
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• pp.943-944
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• 2011

• Journal of Acupuncture Research
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• 제25권1호
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• pp.211-219
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• 2008

목적 : 전통적으로 태충($LR_3$)과 양릉천($GB_{34}$)은 운동기능과 관련된 질환에 사용되어 왔다. 우리는 두뇌에 신경독을 주입하여 파킨슨병 쥐모델을 제작하였고, 쥐는 운동기능이 손상되고 도파민성 신경세포가 선택적으로 소멸하였다. 병증 모델 쥐에게 태충과 양릉천에 자침한 결과 운동기능이 개선되고 신경세포보호효과가 나타남을 관찰한 바 있다. 이에 실제로 태충과 양릉천에 자침하여 운동기능과 관련된 추체외로 영역에서 신경의 활성화가 나타나는지를 fMRI를 통하여 관찰하였다. 방법 : 자침은 수기침을 선택하였으며, 혈위는 (1) 태충, (2) 양릉천, (3) 태충+양릉천의 세군데를 설정하였고, 자침에 대한 대조자극으로 피부자극을 채택하였다. fMRI 스캐너는 3T를 사용하였고 뇌신경 활성화의 신호는 BOLD(blood-oxygen-level dependant)를 관찰하였다. 두뇌에서 관찰부위는 중뇌를 중심으로 추체외로로 한정하였다. 결과 : 태충에 자침하였을 때 두뇌의 substantia nigra, subthalamic nucleus, red nucleus, pons 등이 활성화 되었다. 양릉천에 자침하였을 때 substantia nigra, subthalamic nucleus, caudate nucleus, thalamus가 활성화 되었다. 태충과 양릉천에 동시에 자침하였을 때는 substantia nigra, subthalamic nucleus, red nucleus, globus pallidus가 활성화되었다. 대조자극에 의해서는 위의 영역들이 활성화되지 않았다. 결론 : 태충, 양릉천, 태충+양릉천 자극은 대뇌에서 추체외로 영역을 활성화시키며 특히 substantia nigra의 활성화는 파킨슨병과 같은 질환의 조절가능성을 시사한다.

• Journal of Korean Neurosurgical Society
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• 제42권6호
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• pp.455-461
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• 2007

Objective : It was hypothesized that dopamine agonist administration and subthalamic nucleus (STN) lesion in the rat might have a synergistic effect on the neuronal activities of substantia nigra pars reticulata (SNpr) as observed in patients with Parkinson's disease. The effects of SKF38393 (a $D_1$ receptor agonist) and Quinpirole (a $D_2$ receptor agonist) were compared in parkinsonian rat models with 6- hydroxydopamine (6-OHDA) after STN lesion. Methods : SKF38393 and Quinpirole were consecutively injected intrastriatally. SNpr was microrecorded to ascertain the activity of the basal ganglia output structure. The effect of SKF38393 or Quinpirole injection on the firing rate and firing patterns of SNpr was investigated in medial forebrain bundle (MFB) lesioned rats and in MFB+STN lesioned rats. Results : The administration of SKF38393 decreased SNpr neuronal firing rates and the percentage of burst neurons in the MFB lesioned rats, but did not alter them in MFB+STN lesioned rats. The administration of Quinpirole significantly decreased the spontaneous firing rate in the MFB lesioned rats. However, after an additional STN lesion, it increased the percentage of burst neurons. Conclusion : This study demonstrated that dopamine agonists and STN lesion decreased the hyperactive firing rate and the percentage of burst neurons of SNpr neurons in 6-OHDA lesioned rats, respectively. Quinpirole with STN lesion increased a percentage of burst neurons. To clear the exact interactive mechanism of $D_1$ and $D_2$ agonist and the corresponding location, it should be followed a study using a nonselective dopamine agonist and $D_1$, $D_2$ selective antagonist.

• The Korean Journal of Physiology and Pharmacology
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• 제17권4호
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• pp.299-306
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• 2013

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been widely used as a treatment for the movement disturbances caused by Parkinson's disease (PD). Despite successful application of DBS, its mechanism of therapeutic effect is not clearly understood. Because PD results from the degeneration of dopamine neurons that affect the basal ganglia (BG) network, investigation of neuronal responses of BG neurons during STN DBS can provide informative insights for the understanding of the mechanism of therapeutic effect. However, it is difficult to observe neuronal activity during DBS because of large stimulation artifacts. Here, we report the observation of neuronal activities of the globus pallidus (GP) in normal and PD model rats during electrical stimulation of the STN. A custom artifact removal technique was devised to enable monitoring of neural activity during stimulation. We investigated how GP neurons responded to STN stimulation at various stimulation frequencies (10, 50, 90 and 130 Hz). It was observed that activities of GP neurons were modulated by stimulation frequency of the STN and significantly inhibited by high frequency stimulation above 50 Hz. These findings suggest that GP neuronal activity is effectively modulated by STN stimulation and strongly dependent on the frequency of stimulation.

• 재활복지
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• 제18권4호
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• pp.237-255
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• 2014

특발성 파킨슨병(idiopathic Parkinson disease, IPD)은 알 수 없는 원인으로 인해 중뇌의 흑질신경세포가 손실되는 대표적인 퇴행성 신경계 질환이다. IPD 환자는 신체 운동 이상을 주로 호소하지만 이들 중 70~90%가 운동저하형 마비말장애(hypokinetic dysarthria)를 동반하는 것으로 알려져 있다. 진행된 심도의 IPD 환자의 운동 증상 호전에 가장 효과적인 치료 방법으로 알려진 시상밑부핵 심부뇌자극술(subthalamic nucleus deep brain stimulation, STN-DBS)은 말 산출에서는 그 효과가 일관되지 않게 보고된다. 이에 본 연구에서는 STN-DBS가 말 산출에 미치는 영향을 살펴보고, 연구에서 어떠한 말 평가 과제가 사용되었는지를 조사하기 위하여 medline을 통해 2012까지 이루어진 연구 논문을 수집하였다. 총 32편 중, 연구대상자들에서 술 후 말 상태의'호전'이 관찰된 논문은 42%,'악화'는 29%,'엇갈리는 결과'는 26%,'변화 없음'은 3%로 확인되었다. 말 효과 간에는 문맥발화(contextual speech)가 연구에 사용된 비중이 높을수록 술 후 말 상태는 부정적인 결과로 보고되었으며, 말 산출 단계 중 일부 단계(예: 호흡 및 발성만, 혹은 조음만)만이 반영된 평가 과제가 연구마다 선택적으로 사용되었음을 확인하였다. 이에 본 연구는 STN-DBS를 받은 IPD 환자의 말 평가는 말 산출 하부 단계를 모두 반영하는 문맥발화 과제를 통일적으로 사용할 것을 제안한다.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2013년도 춘계학술대회 논문집
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• pp.987-988
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• 2013

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.138-145
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• 2017

Objective : High frequency stimulation (HFS) of the subthalamic nucleus (STN) is recognized as an effective treatment of advanced Parkinson's disease. However, the neurochemical basis of its effects remains unknown. The aim of this study is to investigate the effects of STN HFS in intact and 6-hydroxydopamine (6-OHDA)-lesioned hemiparkinsonian rat model on changes of principal neurotransmitters, glutamate, and gamma-aminobutyric acid (GABA) in the striatum. Methods : The authors examined extracellular glutamate and GABA change in the striatum on sham group, 6-OHDA group, and 6-OHDA plus deep brain stimulation (DBS) group using microdialysis methods. Results : High-pressure liquid chromatography was used to quantify glutamate and GABA. The results show that HFS-STN induces a significant increase of extracellular glutamate and GABA in the striatum of 6-OHDA plus DBS group compared with sham and 6-OHDA group. Conclusion : Therefore, the clinical results of STN-HFS are not restricted to the direct STN targets but involve widespread adaptive changes within the basal ganglia.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.118-124
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• 2013

Objective : Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment of choice for patients with advanced idiopathic Parkinson's disease (PD) who have motor complication with medication. The objectives of this study are to analyze long-term follow-up data of STN DBS cases and to identify the factors related to outcomes. Methods : Fifty-two PD patients who underwent STN DBS were followed-up for more than 3 years. The Unified Parkinson's Disease Rating Scale (UPDRS) and other clinical profiles were assessed preoperatively and during follow-up. A linear regression model was used to analyze whether factors predict the results of STN DBS. We divided the study individuals into subgroups according to several factors and compared subgroups. Results : Preoperative activity of daily living (ADL) and the magnitude of preoperative levodopa response were shown to predict the improvement in UPDRS part II without medication, and preoperative ADL and levodopa equivalent dose (LED) were shown to predict the improvement in UPDRS part II with medication. In UPDRS part III with medication, the magnitude of preoperative levodopa response was a predicting factor. Conclusion : The intensity of preoperative levodopa response was a strong factor for motor outcome. And preoperative ADL and LED were strong factors for ADL improvement. More vigorous studies should be conducted to elucidate how levodopa-induced motor complications are ameliorated after STN DBS.