Editors' ChoiceNeuroscience

Brain Stimulation and Decision-Making

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Science Translational Medicine  16 Nov 2011:
Vol. 3, Issue 109, pp. 109ec187
DOI: 10.1126/scitranslmed.3003417

During daily living, we constantly manage competing thoughts to come up with an action plan, not necessarily to meet immediate impulsive needs but to pursue more substantial, often long-term goals. The neural substrates for such high-level brain functions might involve the prefrontal cortex (PFC) and several subcortical structures, most notably the subthalamic nucleus (STN). Recently, Cavanagh et al. sought to explore the neurophysiological evidence for the involvement of the STN and its relation to PFC activity, making use of the fact that a subset of Parkinson’s disease patients are treated with deep brain stimulation (DBS) via an implanted device that disrupts STN function.

The researchers first actively perturbed STN activity through DBS in such patients, who performed simple decision-making tasks twice, once with DBS on and once with it off. The most interesting finding is that when DBS was on, the participants had the tendency to rush to a suboptimal decision as compared with taking the time to contemplate the choices and arrive at a better decision when DBS was off. This finding suggests that STN plays an important role in inhibiting premature decisions. Next, the researchers recorded electrical activity from the STN during DBS implantation surgeries. When the participants had to make hard decisions, there was clear modulation of such activity, mostly in two frequency ranges, the beta and theta bands. Because those frequency bands have been thought to mediate cortico-subcortical communication, their power modulation suggests that the STN plays an active role during decision-making with a close interaction between the STN and PFC.

In addition to providing insight into the neural mechanism of decision-making, this study shows that stimulation parameters (such as stimulation frequencies) used in DBS treatments can be further optimized in order to reduce potential side effects related to decision-making functions while maintaining the primary effect in treating movement disorders. Furthermore, this study also demonstrates the possibility of future neurostimulation treatment paradigms in which electrodes would be implanted over the STN and/or PFC to modulate brain activities to resolve or alleviate neurological and psychiatric disorders related to impulsive behaviors and decision-making.

J. F. Cavanagh et al., Subthalamic nucleus stimulation reverses mediofrontal influence over decision threshold. Nat. Neurosci. 14, 1462–1467 (2011). [Abstract]

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