Deep brain stimulation effect on anterior pallidum reduces motor impulsivity in Parkinson's disease

Khaled Moussawi; Min Jae Kim; Sydney Baybayan; Myles Wood; Kelly A. Mills

Brain Stimulation (Jan 2022)

Deep brain stimulation effect on anterior pallidum reduces motor impulsivity in Parkinson's disease

Khaled Moussawi,
Min Jae Kim,
Sydney Baybayan,
Myles Wood,
Kelly A. Mills

Affiliations

Khaled Moussawi: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Corresponding author.
Min Jae Kim: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
Sydney Baybayan: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
Myles Wood: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
Kelly A. Mills: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Corresponding author. Johns Hopkins University School of Medicine Dept. of Neurology Meyer 6-181D 600 N. Wolfe Street, Baltimore, MD, 21287, USA.

Journal volume & issue: Vol. 15, no. 1
pp. 23 – 31

Abstract

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Background: Deep Brain Stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is used to treat the motor symptoms of Parkinson's disease. The former can worsen impulsive and compulsive behaviors after controlling for the reduction of dopaminergic medications. However, the effect of pallidal DBS on such behaviors in PD patients is less clear.Objective/Hypothesis: We hypothesized that greater stimulation spread to the pallidum with prefrontal connectivity would reduce motor impulsivity. Methods: Seven Parkinson's patients with stable globus pallidus internus DBS settings for 3 months, disease duration of 13 ± 1.3 years, and Montreal Cognitive Assessment of 26.8 ± 1.1 each had two stimulation settings defined based on reconstructions of lead placement and volume of tissue activation targeting either a dorsal or ventral position along the DBS electrode but still within the globus pallidus internus. Subjects performed a stop signal reaction time task with the DBS turned off vs. on in each of the defined stimulation settings, which was correlated with the degree of stimulation effect on pallidal subregions. Results: A shorter distance between the volume of tissue activation and the right prefrontally-connected GPi correlated with less impulsivity on the stop signal reaction time task (r = 0.69, p < 0.05). Greater volume of tissue activation overlap with the non-prefrontally-connected globus pallidus internus was associated with increased impulsivity. Conclusion: These data can be leveraged to optimize DBS programming in PD patients with problematic impulsivity or in other disorders involving impulsive behaviors such as substance use disorders.

Published in Brain Stimulation

ISSN: 1935-861X (Print); 1876-4754 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry
Website: https://www.journals.elsevier.com/brain-stimulation

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