Dokument: Anterolaterale subthalamische Theta Stimulation verbessert die Wortflüssigkeit bei Morbus Parkinson

Titel:	Anterolaterale subthalamische Theta Stimulation verbessert die Wortflüssigkeit bei Morbus Parkinson
Weiterer Titel:	Antero-Lateral Subthalamic Nucleus Theta Stimulation Improves Verbal Fluency in Parkinson's Disease
URL für Lesezeichen:	https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=70549
URN (NBN):	urn:nbn:de:hbz:061-20250827-115734-8
Kollektion:	Dissertationen
Sprache:	Deutsch
Dokumententyp:	Wissenschaftliche Abschlussarbeiten » Dissertation
Medientyp:	Text
Autor:	Schönwald, Hannah Vivian [Autor]
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Beitragende:	Prof. Dr. med. Schnitzler, Alfons [Gutachter] Prof. Dr. med. Vesper, Jan [Gutachter]
Stichwörter:	Morbus Parkinson, tiefe Hirnstimulation, Wortflüssigkeit
Dokumententyp (erweitert):	Dissertation
Dewey Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit
Beschreibungen:	Die hochfrequente tiefe Hirnstimulation des Nucleus subthalamicus verbessert die motorischen Symptome bei Parkinson Patient*innen. Während die therapeutische hochfrequente Stimulation mit einer Verschlechterung der Wortflüssigkeit assoziiert wird, hat die niedrigfrequente Stimulation positive Auswirkungen auf die Wortflüssigkeit. Die anatomischen Erkenntnisse über den optimalen Stimulationsort, der diesem positiven Effekt zugrunde liegt, sind jedoch widersprüchlich und frühere Studien waren häufig durch mangelnde Verblindung und Kontrolle von Medikamentenwirkungen begrenzt. Diese Arbeit untersucht die richtungsabhängigen und ortsspezifischen Effekte der niedrigfrequenten tiefen Hirnstimulation (Theta-Frequenz) auf die Wortflüssigkeit. In einem doppelt verblindeten Cross-over-Design wurde die Wortflüssigkeit bei 20 Parkinson Patient:innen unter linkshemisphärischer tiefer Hirnstimulation getestet. Um die Richtungsspezifität der Theta-Stimulation auf die Wortflüssigkeit zu untersuchen, wurden fünf Stimulationsbedingungen getestet: Omnidirektionale Stimulation, die drei direktionalen Stimulationsmöglichkeiten und das Stimulations-Off. Die Ergebnisse wurden in einem linear gemischten Modell statistisch untersucht. In einem zweiten Schritt wurden die Stimulationselektroden mithilfe von prä- und postoperativen CT und MRT-Bildern lokalisiert und die elektrischen Felder für jede Stimulationsbedingung berechnet. Mithilfe des probabilistischen Sweet-Spot-Mappings konnten Voxel mit signifikanten Veränderungen der Wortflüssigkeit identifiziert werden. Diese Arbeit liefert erste Belege dafür, dass sich unter direktionaler tiefer Hirnstimulation der individuell besten Orientierung mit Theta-Frequenz die Leistung der Wortflüssigkeit im Vergleich zu omnidirektionaler Stimulation und dem Stimulations-Off verbessert. Der Stimulationseffekt folgt dabei einem Gradienten von medial nach antero-lateral, wobei eine stärkere Verbesserung der Wortflüssigkeit an der Grenze zwischen motorischem und assoziativem Teil des Nucleus subthalamicus beobachtet wurde. Die Ergebnisse unterstützen die Vorstellung von stimulationsortspezifischen Effekten der tiefen Hirnstimulation im anterolateralen Nucleus subthalamicus und könnten wertvoll sein, um negative Effekte der hochfrequenten Stimulation auf die Wortflüssigkeit auszugleichen. High-frequency deep brain stimulation of the subthalamic nucleus improves motor symptoms in patients with Parkinson9s Disease. While therapeutic high frequency stimulation has been associated with a deterioration of verbal fluency, low frequency stimulation has positive effects on verbal fluency performance. Yet, anatomical findings on the optimal stimulation site underlying these beneficial effects are inconsistent and prior protocols were often limited due to a lack of blinding and control for medication effects. In this prospective single-center study we aimed to investigate stimulation directiondependent and site-specific effects of theta frequency deep brain stimulation on verbal fluency performance. In a double-blinded cross-over design we tested the effects of left subthalamic theta stimulation on verbal fluency in 20 patients with Parkinson9s disease. Patients were tested during omnidirectional and each of the three directional stimulation conditions as well as off stimulation to explore the directional specificity of theta stimulation on verbal fluency outcomes using linear mixed effects models. In a second step, the deep brain stimulation leads were localized using pre- and postoperative CT and MRI images and electric fields for each stimulation condition were calculated. We employed probabilistic sweet spot mapping to identify voxels with significant change in verbal fluency. Our findings demonstrate that with the best directional stimulation setting, verbal fluency improved significantly in comparison to the stimulation off and omnidirectional stimulation conditions. The stimulation effect on verbal fluency follows a medial to antero-lateral gradient with higher verbal fluency improvement observed on the border between motor and associative subparts of the subthalamic nucleus. We provide first evidence that directional theta frequency deep brain stimulation improves verbal fluency performance compared to omnidirectional and off conditions. Our results support the notion of stimulation site specific effects of deep brain stimulation within the antero-lateral subthalamic nucleus and may be valuable to counterbalance negative effects of high frequency stimulation on verbal fluency outcomes.
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Fachbereich / Einrichtung:	Medizinische Fakultät » Institute » Institut für Medizinische Psychologie
Dokument erstellt am:	27.08.2025
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