High frequency deep brain stimulation: what are the therapeutic mechanisms?

High frequency deep brain stimulation (HFS) used to treat the symptoms of Parkinson's disease (PD) was first assumed to act by reducing an excessive tonic GABAergic inhibitory output from the internal globus pallidus (GPi). Stimulation in GPi might produce this directly by mechanisms such as depolarization block or activation of presynaptic inhibitory fibers, and the same mechanisms evoked by HFS in the subthalamic nucleus (STN) could reduce the excitatory action of STN on GPi neurons. Although somatic recordings from neurons near the stimulation site may appear to support this potential mechanism, the action downstream from the site of stimulation often is not consistent with this interpretation. A more parsimonious explanation for the similar effects of HFS in STN or GPi and a lesion of either of these structures is that both HFS and pallidotomy interrupt an abnormal pattern of firing in cortico-basal ganglia-thalamocortical loops that is responsible for the symptoms of PD.

Context-dependent modulation of movement-related discharge in the primate globus pallidus.

A selective contribution of the basal ganglia (BG) to memory-contingent motor control has long been hypothesized. The importance of memory context remains an open question, however, for the BG skeletomotor circuit. To investigate this question, we studied the perimovement discharge of a carefully selected group of 74 "arm-related" pallidal cells in two rhesus monkeys. The animals performed three tasks designed to dissociate multiple independent aspects of memory-contingent reaching while controlling movement kinematics. The activity of most neurons (88%) was influenced strongly by the memory demands of a task (remembering "where" or "when" to move), but the population as a whole showed no systematic preference for memory- or sensory-contingent conditions. The effects of memory context were primarily additive with those of movement kinematics (particularly movement direction). Considered separately, decreases and increases in firing had very different context preferences: decreases were nearly always larger for sensory-triggered movements, whereas increases were enhanced most often under memory-contingent conditions (i.e., self-initiated or self-guided movements). A similar pattern of preferences was found for both pallidal segments. The distinct context-specific enhancements of decreases and increases could not be explained as simple sensory responses or as interactions with preparatory or anticipatory processes present before movement initiation. Rather, they appear related to movement execution under specific contexts. Our results lead to the conclusion that movement facilitatory decreases in internal pallidal (GPi) activity are primarily greater under sensory-triggered conditions. GPi increases and their suppressive effects, perhaps on competing activity in pallidal-recipient centers, have increased prevalence under memory-contingent conditions.

Effects of high-frequency stimulation in the internal globus pallidus on the activity of thalamic neurons in the awake monkey.

The reduction in symptoms of Parkinson's disease produced by high-frequency stimulation (HFS) in the internal globus pallidus (GPi) has been proposed to be due to stimulus-induced inactivation of pallidal neurons and resulting disinhibition of thalamic neurons. We tested this in awake Macaca fascicularis by stimulating between pairs of electrodes inserted into GPi under electrophysiological control and recording the responses evoked in thalamic neurons. HFS produced a reduction, not an increase, in discharge frequency during the stimulus train in 77% of the responsive thalamic neurons. Only 16% of the responsive cells showed an increase in discharge during stimulation and, for some of these, stimulation at a similar intensity produced contralateral muscle contraction, a probable sign of current spread to the internal capsule. The few thalamic neurons studied during bursting had a reduction in burst frequency and duration during HFS. We conclude that high-frequency stimulation within GPi does not necessarily facilitate thalamic discharge, and it may act, instead, to interrupt abnormal patterns of thalamic discharge associated with parkinsonian symptoms.