Deep brain stimulation of the corpus luysi (subthalamic nucleus) and other targets in Parkinson's disease. Extension to new indications such as dystonia and epilepsy.

Chronic high frequency (130 Hz) stimulation (HFS) of the thalamic target Vim, first used in our group in 1987 as a treatment of tremor of various origins, has been used over the last ten years in 137 patients. Since 1993, this method has been extended to two other targets (subthalamic nucleus (STN): 137 patients and the medial pallidum (GPi): 12 patients), based on recent experimental data in rats and monkeys. STN appears to be a target of major interest, able to control the three cardinal symptoms and to allow the decrease or suppression of levodopa treatment, which then also suppresses levodopa induced dyskinesias. The stereotactic technique is based on the determination of the target using ventriculography, MRI and electrophysiology, with both microrecording of single neuron activity and microstimulation inducing therapeutic symptom suppression and side effects. Chronic electrodes are then placed bilaterally at the best physiologically defined location and then connected to implantable stimulators (either 2 Itrel II or the new double channel Kinetra), operated at 130-185 Hz, 60 ms pulse width, 2.5 to 3.5 volts. There was no operative mortality and permanent morbidity was observed in 3 patients. The mechanisms of action of HFS are not fully understood, but are definitely related to high frequency and are probably different depending on the target. Inhibition of cellular activity or of neural network functions could be induced, by jamming of a retroactive loop for tremor, or by shutdown of neurotransmitter release in STN. Mechanisms within an individual target are also probably different for tremor or for other symptom alleviation. All cardinal symptoms are alleviated from tremor to akinesia and rigidity. This strong improvement allows the decrease of the drug dosage to approximately 30% of the preoperative level, which suppresses the levodopa-induced dyskinesias. The off period dystonias are also suppressed as well as freezings and falls. The effects remain stable over more than 5 years and in the same period, the off stimulation-off medication UPDRS remains stable and does not increase at the usual rate The low rate of permanent complications, the minor side effects and their immediate reversibility, the possibility of bilateral implantation in one session and the long-term persistence of symptom relief are strong arguments which support chronic HFS of STN as the method of choice when a surgical procedure is indicated for the treatment of Parkinson's disease and even more when a bilateral procedure is necessary. Recent data show that STN stimulation could be useful in the treatment of dystonia as well as some forms of epilepsy. It is therefore possible that DBS in STN as well as in other targets could become a potent therapeutic tool in the near future for neurological disorders.

Discrimination between cross-country and downhill skiers by pulmonary and local 31PNMR evaluations.

The purpose of the present study was to correlate data on calf muscle metabolism using 31P nuclear magnetic resonance spectroscopy with measurements of whole body maximal oxygen consumption and maximal power output, and to determine whether the combination of these data could be used to predict athletic ability. Experiments were performed in a 2.35 Tesla, 35 cm diameter electromagnet on the leg muscle of sedentary human subjects (N = 6) and groups of athletes trained for endurance (cross-country skiers, N = 7) or strength performance (downhill skiers, N = 5). The exercise protocol consisted of successive plantar flexions performed at graded fractions of the maximal voluntary contraction (MVC). The results obtained from NMR investigation (changes in content of inorganic phosphate: Pi, phosphocreatine: PC and muscle ATP, and intracellular pH) were then compared with those of maximal O2 consumption (VO2max) and maximal power (MP). When the data on athletes were compared with those obtained on sedentary subjects, the curves illustrating the relationship between the imposed load and the Pi/PC ratio were significantly shifted toward high output power for a given Pi/PC value. It also appeared from this study that specific training in force development (downhill skiing) induced a slighter decrease in PC level than for endurance (cross-country skiers) despite improvement in physical performance. A slight but significant intracellular acidification was observed in the muscles of sedentary subjects and downhill skiers for contraction at, respectively, 50% and 80% of MVC, but not in the skeletal muscles of cross-country skiers.(ABSTRACT TRUNCATED AT 250 WORDS)

Muscle bioenergetics in skiers: studies using NMR spectroscopy.

Sedentary human subjects (n = 6) and two homogeneous groups of athletes, trained for down-hill skiing (n = 5) and cross-country skiing (n = 7), were subjected to cardiorespiratory testing and to evaluation of the bioenergetics of calf muscles by means of Phosphorus Nuclear Magnetic Resonance Spectroscopy. The exercise consisted of successive plantar flexions performed at graded fractions of the maximal voluntary contraction force. It appears from this study that the decrease in phosphocreatine level induced by exercise at 80% of maximal voluntary contraction, was smaller in the muscles of athletes who trained for cross-country skiing, than in the muscles of down-hill skiers and control subjects. Intracellular acidosis was virtually absent in cross-country athletes. The rate of restitution of phosphocreatine, after the exercise, was higher in both groups of skiers, compared to sedentary subjects. The maximal oxygen consumption and the maximal alactic power were higher in athletes than in sedentary subjects. NMR data and mechanical measurements are used in consideration with functional systemic indexes to characterize the capabilities of skiers.