Objective-In Parkinson disease (PD) patients, deep brain stimulation (DBS) of the subthalamic nucleus (STN) may contribute to certain impulsive behavior during high-conflict decisions. A neurocomputational model of the basal ganglia has recently been proposed that suggests this behavioral aspect may be related to the role played by the STN in relaying a "hold your horses" signal intended to allow more time to settle on the best option. The aim of the present study was 2-fold: 1) to extend these observations by providing evidence that the STN may influence and prevent the execution of any response even during low-conflict decisions; and 2) to identify the neural correlates of this effect.Methods-We measured regional cerebral blood flow during a Go/NoGo and a control (Go) task to study the motor improvement and response inhibition deficits associated with STN-DBS in patients with PD.Results-Although it improved Unified Parkinson Disease Rating Scale motor ratings and induced a global decrease in reaction time during task performance, STN-DBS impaired response inhibition, as revealed by an increase in commission errors in NoGo trials. These behavioral effects were accompanied by changes in synaptic activity consisting of a reduced activation in the cortical networks responsible for reactive and proactive response inhibition.
CIHR Author Manuscript
CIHR Author Manuscript
CIHR Author ManuscriptInterpretation-The present results suggest that although it improves motor functions in PD patients, modulation of STN hyperactivity with DBS may tend at the same time to favor the appearance of impulsive behavior by acting on the gating mechanism involved in response initiation.Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor functions in patients with Parkinson disease (PD). 1,2 However, growing evidence suggests that STN-DBS also causes executive inhibitory deficits and impulsive behavior under high-conflict conditions. [3][4][5][6][7] Abnormal basal ganglia activity in PD produces a series of downstream effects affecting thalamic and cortical areas. 8 Within the basal ganglia, the STN plays a major role in motor control, and operating as a relay, influences response suppression by inhibiting thalamocortical programs. The fact that a large part of the STN receives motor inputs from the primary motor cortex (M1), the premotor cortex (PMC), the supplementary motor area (SMA), and the pre-SMA strongly supports its important motor contribution. 9,10 However, the STN also receives several projections from the anterior cingulate cortex (ACC) and inferior frontal cortex (IFC), as well as the medial prefrontal cortex (mPFC) and dorsolateral prefrontal cortex, accounting for a more cognitive aspect of motor control. 10,11 Within this framework, Frank and colleagues have proposed a neurocomputational model 7,12 in which the STN provides a dynamic "hold your horses" signal temporarily preventing the execution of any response in face of high-conflict decisions. According to their model, the STN would...