Site of deep brain stimulation and jaw velocity in Parkinson disease

Clinical article

Restricted access


While deep brain stimulation (DBS) has proven to be an effective treatment for many symptoms of Parkinson disease (PD), a deterioration of axial symptoms frequently occurs, particularly for speech and swallowing. These unfavorable effects of DBS may depend on the site of stimulation. The authors made quantitative measures of jaw velocity to compare the relative effectiveness of DBS in the globus pallidus internus (GPi) or the subthalamic nucleus (STN). This was a randomized, double-blind, and longitudinal study, with matched healthy controls.


The peak velocities of self-scaled and externally scaled jaw movements were studied in 27 patients with PD before and after 6 months of bilateral DBS in the GPi or the STN. A mixed-effects model was used to identify differences in jaw velocity before DBS surgery (baseline) while off and on levodopa therapy, and after 6 months of DBS (postoperative) during 4 treatment conditions (off- and on-levodopa states with and without DBS).


Self-scaled jaw velocity was impaired by the DBS procedure in the STN; velocity was significantly decreased across all postoperative conditions compared with either the off- or on-levodopa baseline conditions. In contrast, the postoperative velocity in the GPi group was generally faster than the baseline off-levodopa state. Turning the DBS off and on had no effect on jaw velocity in either group. Unlike baseline, levodopa therapy postoperatively no longer increased jaw velocity in either group, and this lack of effect was not related to postoperative changes in dose. The externally scaled jaw velocity was little affected by PD, but DBS still slightly affected performance, with the STN group significantly slower than the GPi group for most conditions.


The authors' results suggest that either the electrode implant in STN or the subsequent period of continuous STN stimulation negatively affected voluntary jaw velocity, including the loss of the preoperative levodopa-induced improvement. While the GPi group showed some improvement in voluntary jaw velocity postoperatively, their performance during the combination of DBS and levodopa was not different from their best medical management presurgery. The results have implications for DBS target selection, particularly for those patients with oromotor dysfunctions.

Abbreviations used in this paper: DBS = deep brain stimulation; GPi = globus pallidus internus; LEDD = levodopa equivalent daily dose; PD = Parkinson disease; SNr = substantia nigra pars reticular; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

Article Information

Address correspondence to: Lee T. Robertson, Ph.D., Department of Integrative Biosciences, Oregon Health & Science University, 611 SW Campus Drive, Portland, Oregon 97201. email:

Please include this information when citing this paper: published online August 12, 2011; DOI: 10.3171/2011.7.JNS102173.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Self-scaled opening and closing jaw movements. A: The vertical velocity (upper trace) and vertical position (lower trace) kinematics during a single opening (down) and closing (up) jaw movement for a representative control individual and 2 representative patients with PD, one of whom (PD-25) had jaw tremors. Arrowheads indicate peak velocity. B and C: Histograms of the mean ± standard error of the peak opening (B) and closing (C) velocities for the GPi and STN groups during various treatment conditions before and after DBS implant. The dashed line indicates the control mean (open: 180 ± 8.3; close: 149 ± 9.2 mm/s).

  • View in gallery

    Externally scaled jaw movements during the carrot biting task. A: The vertical velocity (upper trace) and vertical position (lower trace) kinematics elicited by thin and thick carrot stimuli for a representative control individual and a patient with PD. The velocity and vertical amplitude kinematics fluctuate during the positioning of the carrot stimulus on the molar surface prior to the breakage of the carrot piece, which is evident by the last major peak velocity (arrow) preceding the return of vertical position to baseline. B and C: Histograms of the mean ± standard error of the biting velocity for the thin (B) and thick (C) stimuli for the GPi and STN groups during various treatment conditions before and after the DBS electrode implant. Jaw opening: down; jaw closing: up. The dashed line indicates the control mean (thin: 96.7 ± 5.5; thick: 159 ± 6.8 mm/s).


  • 1

    Benabid ALChabardès SSeigneuret E: Deep-brain stimulation in Parkinson's disease: long-term efficacy and safety—What happened this year?. Curr Opin Neurol 18:6236302005

  • 2

    Carlson JDCleary DRCetas JSHeinricher MMBurchiel KJ: Deep brain stimulation does not silence neurons in subthalamic nucleus in Parkinson's patients. J Neurophysiol 103:9629672010

  • 3

    Ciucci MRBarkmeier-Kraemer JMSherman SJ: Subthalamic nucleus deep brain stimulation improves deglutition in Parkinson's disease. Mov Disord 23:6766832008

  • 4

    D'Alatri LPaludetti GContarino MFGalla SMarchese MRBentivoglio AR: Effects of bilateral subthalamic nucleus stimulation and medication on parkinsonian speech impairment. J Voice 22:3653722008

  • 5

    Deuschl GHerzog JKleiner-Fisman GKubu CLozano AMLyons KE: Deep brain stimulation: postoperative issues. Mov Disord 21:Suppl 14S219S2372006

  • 6

    Deuschl GSchade-Brittinger CKrack PVolkmann JSchäfer HBötzel K: A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med 355:8969082006

  • 7

    Fahn SElton RUPDRS Development CommitteeUnified Parkinson's Disease Rating Scale. Fahn SMarsden CDCalne DB: Recent Developments in Parkinson's Disease Florham Park, NJMacmillan1987. 153163

  • 8

    Filali MHutchison WDPalter VNLozano AMDostrovsky JO: Stimulation-induced inhibition of neuronal firing in human subthalamic nucleus. Exp Brain Res 156:2742812004

  • 9

    Follett KAWeaver FMStern MHur KHarris CLLuo P: Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 362:207720912010

  • 10

    Gentil MGarcia-Ruiz PPollak PBenabid AL: Effect of bilateral deep-brain stimulation on oral control of patients with parkinsonism. Eur Neurol 44:1471522000

  • 11

    Haberler CAlesch FMazal PRPilz PJellinger KPinter MM: No tissue damage by chronic deep brain stimulation in Parkinson's disease. Ann Neurol 48:3723762000

  • 12

    Hammond CRouzaire-Dubois BFéger JJackson ACrossman AR: Anatomical and electrophysiological studies on the reciprocal projections between the subthalamic nucleus and nucleus tegmenti pedunculopontinus in the rat. Neuroscience 9:41521983

  • 13

    Hariz MIRehncrona SQuinn NPSpeelman JDWensing C: Multicenter study on deep brain stimulation in Parkinson's disease: an independent assessment of reported adverse events at 4 years. Mov Disord 23:4164212008

  • 14

    Henderson JMPell MO'Sullivan DJMcCusker EAFung VSHedges P: Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease. Mov Disord 17:1331372002

  • 15

    Hoehn MMYahr MD: Parkinsonism: onset, progression and mortality. Neurology 17:4274421967

  • 16

    Jarraya BBonnet AMDuyckaerts CHoueto JLCornu PHauw JJ: Parkinson's disease, subthalamic stimulation, and selection of candidates: a pathological study. Mov Disord 18:151715202003

  • 17

    Karlsson SPersson MJohnels B: Levodopa induced ON-OFF motor fluctuations in Parkinson's disease related to rhythmical masticatory jaw movements. J Neurol Neurosurg Psychiatry 55:3043071992

  • 18

    Klostermann FEhlen FVesper JNubel KGross MMarzinzik F: Effects of subthalamic deep brain stimulation on dysarthrophonia in Parkinson's disease. J Neurol Neurosurg Psychiatry 79:5225292008

  • 19

    Maltête DDerrey SChastan NDebono BGérardin EFréger P: Microsubthalamotomy: an immediate predictor of long-term subthalamic stimulation efficacy in Parkinson disease. Mov Disord 23:104710502008

  • 20

    Maltête DJodoin NKarachi CHoueto JLNavarro SCornu P: Subthalamic stimulation and neuronal activity in the substantia nigra in Parkinson's disease. J Neurophysiol 97:401740222007

  • 21

    Mann JMFoote KDGarvan CWFernandez HHJacobson CE IVRodriguez RL: Brain penetration effects of microelectrodes and DBS leads in STN or GPi. J Neurol Neurosurg Psychiatry 80:7947972009

  • 22

    Mena-Segovia JBolam JPMagill PJ: Pedunculopontine nucleus and basal ganglia: distant relatives or part of the same family?. Trends Neurosci 27:5855882004

  • 23

    Miller AJ: Craniomandibular Muscles: Their Role in Function and Form Boca Raton, FLCRC Press1991

  • 24

    Moro ELozano AMPollak PAgid YRehncrona SVolkmann J: Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease. Mov Disord 25:5785862010

  • 25

    Nutt JGBurchiel KJComella CLJankovic JLang AELaws ER Jr: Randomized, double-blind trial of glial cell line-derived neurotrophic factor (GDNF) in PD. Neurology 60:69732003

  • 26

    Okun MSFernandez HHWu SSKirsch-Darrow LBowers DBova F: Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial. Ann Neurol 65:5865952009

  • 27

    Østergaard KAa Sunde N: Evolution of Parkinson's disease during 4 years of bilateral deep brain stimulation of the subthalamic nucleus. Mov Disord 21:6246312006

  • 28

    Pahapill PALozano AM: The pedunculopontine nucleus and Parkinson's disease. Brain 123:176717832000

  • 29

    Peyron MAMaskawi KWoda ATanguay RLund JP: Effects of food texture and sample thickness on mandibular movement and hardness assessment during biting in man. J Dent Res 76:7897951997

  • 30

    Robertson LTHammerstad JP: Jaw movement dysfunction related to Parkinson's disease and partially modified by levodopa. J Neurol Neurosurg Psychiatry 60:41501996

  • 31

    Robertson LTHorak FBAnderson VCBurchiel KJHammerstad JP: Assessments of axial motor control during deep brain stimulation in parkinsonian patients. Neurosurgery 48:5445522001

  • 32

    Rodriguez-Oroz MCObeso JALang AEHoueto JLPollak PRehncrona S: Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up. Brain 128:224022492005

  • 33

    Rodriguez-Oroz MCRodriguez MGuridi JMewes KChockkman VVitek J: The subthalamic nucleus in Parkinson's disease: somatotopic organization and physiological characteristics. Brain 124:177717902001

  • 34

    Romito LMContarino MFVanacore NBentivoglio ARScerrati MAlbanese A: Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: long-term observation. Mov Disord 24:5575632009

  • 35

    Santens PDe Letter MVan Borsel JDe Reuck JCaemaert J: Lateralized effects of subthalamic nucleus stimulation on different aspects of speech in Parkinson's disease. Brain Lang 87:2532582003

  • 36

    Sapir SPawlas AARamig LO: Voice and speech abnormalities in Parkinson's disease: relation to severity of motor impairment, duration of disease, medication, depression, gender, and age. J Med Speech Lang Pathol 9:2132262001

  • 37

    Semba KFibiger HC: Afferent connections of the laterodorsal and the pedunculopontine tegmental nuclei in the rat: a retroand antero-grade transport and immunohistochemical study. J Comp Neurol 323:3874101992

  • 38

    Shen KZJohnson SW: Complex EPSCs evoked in substantia nigra reticulata neurons are disrupted by repetitive stimulation of the subthalamic nucleus. Synapse 62:2372422008

  • 39

    Temperli PGhika JVillemure JGBurkhard PRBogousslavsky JVingerhoets FJ: How do parkinsonian signs return after discontinuation of subthalamic DBS?. Neurology 60:78812003

  • 40

    Tripoliti EZrinzo LMartinez-Torres ITisch SFrost EBorrell E: Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation. Mov Disord 23:237723832008

  • 41

    Walter BLVitek JL: Surgical treatment for Parkinson's disease. Lancet Neurol 3:7197282004

  • 42

    Weaver FMFollett KStern MHur KHarris CMarks WJ Jr: Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 301:63732009

  • 43

    Welter MLHoueto JLBonnet AMBejjani PBMesnage VDormont D: Effects of high-frequency stimulation on subthalamic neuronal activity in parkinsonian patients. Arch Neurol 61:89962004

  • 44

    West BTWelch KBGałecki AT: Linear Mixed Models: A Practical Guide Using Statistical Software Boca Raton, FLChapman & Hall/CRC Press2007

  • 45

    Williams AGill SVarma TJenkinson CQuinn NMitchell R: Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 9:5815912010

  • 46

    Zahodne LBOkun MSFoote KDFernandez HHRodriguez RLWu SS: Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus. J Neurol 256:132113292009


Cited By



All Time Past Year Past 30 Days
Abstract Views 136 136 43
Full Text Views 116 116 1
PDF Downloads 103 103 1
EPUB Downloads 0 0 0


Google Scholar