OBJECTIVE: The authors analyzed the findings of microelectrode recording data and reported the surgical outcomes of movement disorder patients. METHODS: Since February 2000, the authors have used DBS for the movement disorders. We evaluated 4 patients who were followed more than 12 months after operation. One patient with essential tremor was treated with thalamic stimulation and three patients with idiopathic advanced Parkinson's disease with bilateral subthalamic nucleus stimulation. The electrodes were inserted under microelectrode recording. Clinical assessments were performed preoperatively and postoperatively by neurologist. RESULTS: All features of parkinsonian symptoms improved and the greatest benefit occurred in off-time and ADL. Interestingly our three patients with advanced Parkinson's disease did not have off-time after bilateral stimulation of subthalamic nucleus. There were no adverse side effects related to microelectrode recording or DBS procedure in all 4 patients. In our results of microelectrode recording of subthalamic nucleus, subthalamus showed higher firing rate than that of substantia nigra pars reticularis. Mean burst frequency of subthalamic nucleus was much higher than that of substantia nigra pars reticularis. CONCLUSION: The first trials of DBS in Korea also demonstrated favorable outcomes for movement disorders.
Activities of Daily Living ; Deep Brain Stimulation* ; Electrodes ; Essential Tremor ; Fires ; Humans ; Korea ; Microelectrodes* ; Movement Disorders* ; Parkinson Disease ; Substantia Nigra ; Subthalamic Nucleus ; Subthalamus ; Thalamus

Hemichorea is caused by various diseases but stroke is the most common cause. The usual lesions of the stroke related hemichorea are the contralateral subthalamus or basal ganglia. Few cases with cortical lesion have been reported. But hemichorea with primary somatosensory cortical lesion has not yet been reported. We report a case with hemichorea after acute infarction of the contralateral primary somatosensory cortex.
Basal Ganglia ; Cerebral Infarction ; Chorea ; Infarction ; Somatosensory Cortex ; Stroke ; Subthalamus

BACKGROUND: The substantia nigra pars reticulata is a critical site for the control of epileptic seizures. The potentiation of the inhibitory gamma-amino butyric acid (GABA) ergic input from the striatum to the substantia nigra pars reticulata suppresses primary or secondary generalized seizures in rats. Recent data suggests that the projection from the subthala-mus to the substantia nigra pars reticulata plays a critical role in the control of some forms of epileptic seizures. METHODS: We examined the possible involvement of the excitatory glutamatergic input from the subthalamic nucleus (STN) to the substantia nigra in pilocarpine-induced seizures by the direct injection of GABA receptor agonist (muscimol) and n-methyl- D-aspartate (NMDA) receptor antagonist (MK-801) into the substantia nigra pars reticularis (SNr) and the subthalamic nucleus respectively. Sprague-Dawley rats were classified into four groups depending on the pretreatment; the injection of saline (STN sham) or muscimol (STN) into the subthalamic nucleus, and the injection of saline (SNr sham) or MK-801 (SNr) into the substantia nigra. Seizure was induced by the intraperitoneal injection of pilocarpine (400 mg/kg). RESULTS: Mean seizure stages in the STN group (1.5 +/-0.5) and SNr group (1.3 +/-0.5) were significantly lower than STN sham group (4.8 +/-0.4) and SNr sham group (4.8 +/-0.4) (P <0.05). Electroencephlograms showed typical status epilepticus patterns in the sham operation group but only discrete ictal discharges with slowing and intermittent ictal spikes were shown in both STN and SNr group. Viable cell numbers in the CA1 and CA3 in STN and SNr groups were significantly higher than those of the sham group (P <0.05). CONCLUSIONS: These results provide evidence for the role of subthalamo-nigral projections in the modulation of pilocarpine-induced seizures.
Animals ; Butyric Acid ; Cell Count ; D-Aspartic Acid ; Dizocilpine Maleate ; Epilepsy ; GABA Agonists ; Injections, Intraperitoneal ; Muscimol ; Pilocarpine* ; Rats* ; Rats, Sprague-Dawley ; Seizures* ; Status Epilepticus ; Substantia Nigra ; Subthalamic Nucleus ; Subthalamus

BACKGROUNDS: The widespread N18 in the median nerve SEP is a broad negativity following positive far-field potentials and is widely distributed over the scalp. It is suggested that the N18 may be originated from subthalamus or upper brainstem nuclei. But there remains substantial controversy regarding its origin. Recently, it is proposed that the N18 is generated in the medulla. For the evaluation of its origin, we used nasopharyngeal electrode for recording SEP stimulated by median nerve stimulation. METHODS: Standard methods of recording SEP were used in 19 normal adults(36 sides, 19-68 years, 9 males). 11 patients with following locations of the lesions were studied: 2 high cervical cord, 1 ponto-medullary junction, 3 pons, and 5 thalamus. We evaluated the N18 potentials at ventral medulla level, using nasopharyngeal electrode and recorded them at scalp by non-cephalic reference recording. We compared the amplitude and duration of the N18 at scalp with those at nasopharyngeal electrode. RESULTS: The mean amplitude and duration of N18 at scalp showed no significant difference from that at nasopharyngeal electrode(1.76+/-0.4 microvolt, 16.48+/-2.47 msec and 1.75+/-0.4 microvolt, 16.56+/-2.19 msec, p>0.5). The N18 was absent in 2 patients with high cervical cord lesions. The amplitude and duration of the N18 were normal in all other patients with brainstem and thalamic lesions, including a patient with lesion at the ponto-medullary junction. CONCLUSIONS: These results suggested that N18 is generated in the medulla and not more rostrally in the brainstem.
Brain Stem ; Electrodes ; Evoked Potentials, Somatosensory* ; Humans ; Median Nerve ; Pons ; Scalp ; Subthalamus ; Thalamus

Kernicterus is a neurologic syndrome, resulting from the preferential deposition of unconjugated bilirubin in the globus pallidus, subthalamus, hippocampus, and brain stem. The characteristic finding of kernicterus revealed by T2-weighted MR imaging is irreversible, bilaterally symmetrical high signal intensities in the globus pallidus. We report an atypical case of kernicterus, in which follow-up MR imaging of the globus pallidus demonstrated reversible signal intensity.
Bilirubin ; Brain Stem ; Follow-Up Studies ; Globus Pallidus ; Hippocampus ; Humans ; Infant, Newborn ; Kernicterus* ; Magnetic Resonance Imaging* ; Subthalamus

BACKGROUND AND SIGNIFICANCE: Chronic acquired hepatocerebral degeneration(CAHD) is a heterogenous disorder that can occur with a primary neurologic, hepatic, or combined presentation. Characteristic radiologic finding is high signal in globus pallidus on T1WI MRI, and which is associated with increased level of Manganese. We experienced a patient with CAHD presenting various involuntary movements. Our patient had multiple anomalous vessels with a porto-systemic shunt in abdomen in absence of liver cirrhosis. CASE: A 74-years-old female was admitted because of gradually progressive buccal and lingual choreiform movements with moderate generalized chorea. In our patient, T1 weighted MRI of the brain showed symmetric high signal intensity in both globus pallidus and subthalamus. Increased ammonia level(165umol/L) and Manganese level(7.75ug/dl) in whole blood, pancytopopenia in peripheral blood smear and a multiple vessel anomaly with a porto-systemic shunt on abdominal ultrasonography and CT were found. These involuntary movements had a dramatic response to neuroleptics and nearly disappeared within 5 days. CONCLUSION: We report one patient with chronic acquired hepatocerebral degeneration which had a porto-systemic shunt by anomalous vessels and various involuntary movements.
Abdomen ; Ammonia ; Antipsychotic Agents ; Brain ; Chorea ; Dyskinesias ; Female ; Globus Pallidus ; Hepatolenticular Degeneration* ; Humans ; Liver Cirrhosis ; Liver Diseases ; Magnetic Resonance Imaging ; Manganese ; Subthalamus ; Ultrasonography

Hemichorea is usually caused by lesions in the contralateral subthalamus and basal ganglia. Ipsilateral lesions have rarely been reported to be responsible for the abnormal movement. A 27 year-old woman with well-controlled hyper-thyroidism presented with sudden involuntary movements in the right limbs and a mild headache. The movements were random, irregular, repetitive, and most prominent in the right hand and forearm, but also found in the right leg and face. She experienced no weaknesses in the contralateral limbs. A brain magnetic resonance imaging(MRI) taken after 7 days showed early subacute hematoma in the right basal ganglia. There were no lesions in the left hemisphere. In a cerebral angiography, the bilateral major cerebral vessels were narrowed around the circle of Willis. We critically review previous reports of and explanations for the development of ipsilateral hemichorea.
Adult ; Basal Ganglia Hemorrhage* ; Basal Ganglia* ; Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Circle of Willis ; Dyskinesias ; Extremities ; Female ; Forearm ; Hand ; Headache ; Hematoma ; Humans ; Leg ; Subthalamus

The distributions and morphological characteristics of neurons displaying immunoreactivity to the catecholamine synthetic enzymes, tyrosine hydroxylase[TH], dopamine-beta-hydroxylase[DBH], and phenyletha-nolamine-N-methyltransferase[PNMT] were examined in the adjacent sections of the diencephalon of the striped field mouse [Apodemus agrarius coreae].Only TH-, and no DBH- or PNMT-immunoreactive neurons were found in the diencephalon. In the preoptic area, TH-immunoreactive neurons were found in the anterior preoptic nucleus of Loo[APN], periventricular preoptic nucleus, medial preoptic nucleus, lateral preoptic nucleus and suprachiasmatic nucleus. In the hypothalamus, TH-immunoreactive neurons were found in theparaventricular hypothalamic nucleus, periventricular gray, retrochiasmatic area,anterior hypothalamic nucleus of anterior hypothalamic area and retrochiasmatic region of the hypothalamus. In the rostral tuberal region of the hypothalamus, TH-immunoreactive neurons were found in the paraventricular nucleus, periventricular gray and arcuate nucleus. In the midtuberal region of the hypothalamus, TH-immunoreactive neurons were found in the paraventricular nucleus, dorsomedial hypothalamic nucleus, zona incerta and arcuate nucleus. In the caudal tuberal region of the hypothalamus, dorsal hypothalamic nucleus, posterior hypothalamic complex and arcuate nucleus.
Animals ; Anterior Hypothalamic Nucleus ; Arcuate Nucleus ; Diencephalon* ; Dopaminergic Neurons* ; Dorsomedial Hypothalamic Nucleus ; Hypothalamus ; Immunohistochemistry ; Mice ; Neurons ; Paraventricular Hypothalamic Nucleus ; Preoptic Area ; Subthalamus ; Suprachiasmatic Nucleus ; Tyrosine

The zona incerta (ZI) is involved in various functions and may serve as an integrative node of the circuits for global behavioral modulation. However, the long-range connectivity of different sectors in the mouse ZI has not been comprehensively mapped. Here, we obtained whole-brain images of the input and output connections via fluorescence micro-optical sectioning tomography and viral tracing. The principal regions in the input-output circuits of ZI GABAergic neurons were topologically organized. The 3D distribution of cortical inputs showed rostro-caudal correspondence with different ZI sectors, while the projection fibers from ZI sectors were longitudinally organized in the superior colliculus. Clustering results show that the medial and lateral ZI are two different major functional compartments, and they can be further divided into more subdomains based on projection and input connectivity. This study provides a comprehensive anatomical foundation for understanding how the ZI is involved in integrating different information, conveying motivational states, and modulating global behaviors.
Animals ; Mice ; Zona Incerta ; GABAergic Neurons ; Connectome

Zona Incerta ; Prefrontal Cortex ; Fear ; Neural Pathways