Subthalamic nucleus deep brain stimulation improves saccades in Parkinson's disease

Objectives. The clinical efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) for major motor symptoms of Parkinson's disease (PD) is well established, but its effects on visually guided vs. internally generated eye movements in the medication off state need to be studied further. Since the basal ganglia are thought to be involved in the generation of voluntary movements under internal control, we hypothesized that voluntary saccades would show improvements with STN DBS. Materials and Methods. Seven PD patients with STN DBS performed visually guided and internally generated (anti- and memory-guided) saccades with STN DBS on and off following 12 hours of levodopa withdrawal. The change in saccade reaction time, first saccade gain, and final saccade gain with STN DBS were measured. Results. STN DBS improved the reaction time of visually guided saccades but not of anti- or memory-guided saccades. STN DBS also improved the first saccade gain of the anti- and memory-guided saccades, but not of the visually guided saccades. Conclusions. These results demonstrate that STN DBS has differential effects on the parameters of visually guided and internally generated saccades. These effects may be mediated by the influence of STN DBS on cortical ocular motor areas, the basal ganglia, ocular motor loop, or downstream structures such as the brainstem saccade generating circuits.