Neuromodulation of the posterior subthalamic area influences upper limb function in Parkinson's disease

Muhammad Luqman Bin Abdul Aziz

    Research output: ThesisDoctoral Thesis

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    Abstract

    [Truncated] Parkinson’s disease (PD) is a neuro-degenerative disorder widely believed to be the result of a pathophysiologic loss or degeneration of dopaminergic neurons in the substantia nigra of the basal ganglia system. Tremor, rigidity, and bradykinesia are the three hallmark motor symptoms of PD and are often presented in the upper limb. Whilst a single motor symptom can predominate, it is also common for an individual with PD to display an overlapping of mixed presentation of all these symptoms. As a result, there can be a wide individual differences in the symptomology. The presence of these motor symptoms impairs movement and severely affects the quality of life in individuals with PD.

    Deep brain stimulation targeted at specific basal ganglia structures have been utilised to treat the PD motor symptoms with a high level of success. Researchers have reported that a zone in the posterior subthalamic area (PSA) called the zona incerta (ZI), to be a highly effective target for DBS in alleviating the three main symptoms in PD: tremor, rigidity and bradykinesia. Plaha et al. (2006) targeted the caudal division of the ZI (cZI) and found reductions in the motor symptoms of their PD patients. Hamel et al. (2003) on the other hand stimulated the dorsal division of the ZI (dZI) and reported motor improvements in the patients with PD. Previous studies in this area have utilised semi-quantitative assessments and as such, provide a somewhat limited assessment of the alterations in the PD symptoms following intervention. More importantly, there have been no published studies that have compared the outcome between cZI and dZI stimulation within individuals. Therefore, this research aimed to provide insights into these previously un-answered questions to contribute to the existing research on PSA DBS and its efficacy in treating the motor symptoms in PD. This was performed through quantitatively assessing the effect of acute ZI targeted PSA DBS on the three primary upper limb symptoms in PD. The research problems outlined were addressed through three interrelated studies of the PD symptoms.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Publication statusUnpublished - 2014

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