Circuitry models of Parkinson's disease (PD) are based on striatal dopamine loss and aberrant striatal inputs into the basal ganglia network. However, extrastriatal mechanisms have increasingly been the focus of attention, whereas the status of striatal discharges in the parkinsonian human brain remains conjectural. We now report the activity pattern of striatal projection neurons (SPNs) in patients with PD undergoing deep brain stimulation surgery, compared with patients with essential tremor (ET) and isolated dystonia (ID). The SPN activity in ET was very low (2.1 ± 0.1 Hz) and reminiscent of that found in normal animals. In contrast, SPNs in PD fired at much higher frequency (30.2 ± 1.2 Hz) and with abundant spike bursts. The difference between PD and ET was reproduced between 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated and normal nonhuman primates. The SPN activity was also increased in ID, but to a lower level compared with the hyperactivity observed in PD. These results provide direct evidence that the striatum contributes significantly altered signals to the network in patients with PD.otor features of Parkinson's disease (PD) are caused by alterations in the corticobasal ganglia-thalamic network, although the role of particular circuits is unclear (1-3). The progressive degeneration of nigral neurons that massively deplete the striatum of dopamine is at center stage. Classic circuitry models of PD are based on the dopamine-depleted striatum sending disrupted commands through medium spiny neurons, the striatal projection neurons (SPNs), into the direct and indirect output pathways (4, 5). However, the role of a dysfunctional striatum has been undermined in recent years in part due to the focus on extrastriatal mechanisms, particularly the direct cortical regulation of the subthalamic nucleus (hyperdirect pathway), and the widespread effects of dopamine depletion over basal ganglia stations (6-8). In addition, the striatal changes predicted by the model lack clear functional correlates in humans. The only available data are provided by neuroimaging and show inconsistent metabolic changes (both increased or normal activity) in the putamen of patients with PD (9). On the other hand, the molecular and physiological impact of dopamine loss on striatal outputs has been difficult to determine, given the complexity of microcircuits regulating the SPN activity. Convergent cortical, nigral, thalamic, and various interneuronal signals could variably exacerbate or compensate for the lack of dopamine modulation on SPN discharges (10).Morphological and physiological studies in animal models of PD, however, have provided significant data supporting abnormal SPN activity in the parkinsonian state. There is a major loss of dendritic spines in SPNs that is accompanied by remodeling and enlargement of postsynaptic densities of the remaining spines (11,12). Although the mechanisms underlying spine pruning and regrowth are yet unclear, ultimately, these morphological changes involve synaptic contacts and thus have ma...