zona_incerta

La Zona Incerta (ZI) es una banda de sustancia gris ubicada entre el tálamo y el fascículo lenticular.

La estimulación cerebral profunda de la zona incerta caudal, es un tratamiento relativamente inexplorado y prometedor en pacientes con temblor esencial severo, aunque los datos preliminares indican, que la fluidez verbal puede quedar afectada (Fytagoridis y col., 2012).

Esta estructura, se sabe que recibe conexiones de la corteza cerebral motora primaria, sin embargo, sus eferencias son aún desconocidas.

- Sus principales aferencias provienen del segmento lateral del globus pallidus (fibras gabaérgicas), vía fascículo subtalámico.

- Por otro lado, sus principales eferencias son numerosas fibras excitadoras, que liberan glutamato al segmento medial del globo pálido.

- Lesiones en el núcleo subtalámico producen alteraciones motoras consistentes en movimientos involuntarios violentos y mantenidos de extremidades, y a veces de cuello y cara.

- La enfermedad llamada Hemibalismo se relaciona con este núcleo.

En la zona incerta y alrededores, las células descargan a baja frecuencia (<15 Hz) y presentan un potencial de acción de larga duración (>2 milisegundos; normalmente el potencial de acción varía de 1.1 a 1.6 milisegundos), en algunos casos con una muesca en una de sus ramas. Se distinguen en el altavoz ya que dan un típico tono, más grave que el de las células normales. Si bien las diferencias en la duración del potencial de acción de una neurona pueden parecer irrelevantes, pero son importantes para la identificación de la célula puesto que determinan el modo, delimitan la frecuencia de la descarga y su forma.

La estimulación bilateral de la ZI es segura y eficaz para suprimir el componente postural del temblor esencial (Plaha et al., 2011).

La cuestión de si la estimulación de la ZI puede limitar los efectos límbicos es deconocida, pero la evidencia preliminar es que mantenida en el tiempo puede mejorar los síntomas de depresión y ansiedad en pacientes con estimulación cerebral profunda bilateral (Burrows et al., 2011).

En un estudio comparativo de estimulación subtalámica versus zona incerta en solo 4 pacientes con temblor esencial, la estimulación de la zona incerta fué superior (Blomstedt y col., 2011).

En un estudio con 18 pacientes,las actividades de la vida diaria mejoraron en un 65,8%, y no hubo necesidad de aumentar la intensidad de estimulación (Fytagoridis y col., 2011).

Bibliografía

Blomstedt, P. et al., 2011. Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor. Acta Neurochirurgica. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21904970

Burrows, A.M. et al., 2011. Limbic and Motor Function Comparison of Deep Brain Stimulation of the Zona Incerta and Subthalamic Nucleus. Neurosurgery. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21869721

Fytagoridis, Anders, Ulrika Sandvik, Mattias Aström, Tommy Bergenheim, and Patric Blomstedt. 2011. “Long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor.” Journal of Neurology, Neurosurgery, and Psychiatry (December 28). doi:10.1136/jnnp-2011-300765. http://www.ncbi.nlm.nih.gov/pubmed/22205676.

Fytagoridis, Anders, Rickard L Sjöberg, Mattias Aström, Anna Fredricks, Lars Nyberg, and Patric Blomstedt. 2012. “Effects of Deep Brain Stimulation in the Caudal Zona Incerta on Verbal Fluency.” Stereotactic and Functional Neurosurgery 91 (1) (November 13): 24–29. doi:10.1159/000342497.

Plaha, P. et al., 2011. Bilateral caudal zona incerta nucleus stimulation for essential tremor: outcome and quality of life. Journal of Neurology, Neurosurgery, and Psychiatry, 82(8), págs.899-904.

Bibliografía recomendada

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97: Supko DE, Uretsky NJ, Wallace LJ. AMPA/kainic acid glutamate receptor antagonism in the zona incerta dorsal to the subthalamic nucleus inhibits amphetamine-induced stereotypy bur not locomotor activity. Brain Res. 1992 Mar 27;576(1):89-96. PubMed PMID: 1325238.

98: Maillard CA, Edwards DA. Excitotoxin lesions of the zona incerta/lateral tegmentum continuum: effects on male sexual behavior in rats. Behav Brain Res. 1991 Dec 20;46(2):143-9. PubMed PMID: 1664729.

99: Supko DE, Uretsky NJ, Wallace LJ. Activation of AMPA/kainic acid glutamate receptors in the zona incerta stimulates locomotor activity. Brain Res. 1991 Nov 8;564(1):159-63. PubMed PMID: 1663813.

100: Sanghera MK, Anselmo-Franci J, McCann SM. Effect of medial zona incerta lesions on the ovulatory surge of gonadotrophins and prolactin in the rat. Neuroendocrinology. 1991 Nov;54(5):433-8. PubMed PMID: 1749458.

101: Edwards DA, Isaacs S. Zona incerta lesions: effects on copulation, partner-preference and other socio-sexual behaviors. Behav Brain Res. 1991 Aug 29;44(2):145-50. PubMed PMID: 1751005.

102: Kendrick KM, Hinton MR, Baldwin BA. GABA release in the zona incerta of the sheep in response to the sight and ingestion of food and salt. Brain Res. 1991 May 31;550(1):165-8. PubMed PMID: 1888995.

103: Lin CS, Nicolelis MA, Schneider JS, Chapin JK Jr. GABAergic pathway from zona incerta to neocortex: clarification. Science. 1991 Mar 8;251(4998):1162. PubMed PMID: 1706534.

104: Dornan WA, Peterson M, Matuszewich L, Malen P. Ibotenic acid-induced lesions of the medial zona incerta decrease lordosis behavior in the female rat. Behav Neurosci. 1991 Feb;105(1):210-4. PubMed PMID: 2025390.

105: Wilson CA, James MD, Grierson JP, Hole DR. Involvement of catecholaminergic systems in the zona incerta in the steroidal control of gonadotrophin release and female sexual behaviour. Neuroendocrinology. 1991 Feb;53(2):113-23. PubMed PMID: 1901630.

106: Arbogast LA, Voogt JL. Hyperprolactinemia increases and hypoprolactinemia decreases tyrosine hydroxylase messenger ribonucleic acid levels in the arcuate nuclei, but not the substantia nigra or zona incerta. Endocrinology. 1991 Feb;128(2):997-1005. PubMed PMID: 1703487.

107: Jurkowlaniec E, Trojniar W, Tokarski J. The EEG activity after lesions of the diencephalic part of the zona incerta in rats. Acta Physiol Pol. 1990 Nov-Dec;41(7):85-97. PubMed PMID: 2136322.

108: Wilson CA, James MD, Leigh AJ. Role of gamma-aminobutyric acid in the zona incerta in the control of luteinizing hormone release and ovulation. Neuroendocrinology. 1990 Oct;52(4):354-60. PubMed PMID: 2124661.

109: Lin CS, Nicolelis MA, Schneider JS, Chapin JK. A major direct GABAergic pathway from zona incerta to neocortex. Science. 1990 Jun 22;248(4962):1553-6. PubMed PMID: 2360049.

110: Ossowska K, Wardas J, Golembiowska K, Wolfarth S. Lateral hypothalamus-zona incerta region as an output station for the catalepsy induced by the blockade of striatal D1 and D2 dopamine receptors. Brain Res. 1990 Jan 8;506(2):311-5. PubMed PMID: 2154287.

111: Eaton MJ, Moss RL. Electrophysiological evidence for an excitatory amino acid projection from the ventromedial hypothalamus to the medial zona incerta. Synapse. 1990;5(1):77-9. PubMed PMID: 2300907.

112: Eaton MJ, Moss RL. Electrophysiology and pharmacology of neurons of the medial zona incerta: an in vitro slice study. Brain Res. 1989 Nov 13;502(1):117-26. PubMed PMID: 2479452.

113: Morrell JI, Rosenthal MF, McCabe JT, Harrington CA, Chikaraishi DM, Pfaff DW. Tyrosine hydroxylase mRNA in the neurons of the tuberoinfundibular region and zona incerta examined after gonadal steroid hormone treatment. Mol Endocrinol. 1989 Sep;3(9):1426-33. PubMed PMID: 2575219.

114: Kendrick KM, Baldwin BA. The effects of sodium appetite on the responses of cells in the zona incerta to the sight or ingestion of food, salt and water in sheep. Brain Res. 1989 Jul 17;492(1-2):211-8. PubMed PMID: 2752297.

115: Ficalora AS, Mize RR. The neurons of the substantia nigra and zona incerta which project to the cat superior colliculus are GABA immunoreactive: a double-label study using GABA immunocytochemistry and lectin retrograde transport. Neuroscience. 1989;29(3):567-81. PubMed PMID: 2739902.

116: Wardas J, Ossowska K, Wolfarth S. Evidence for the independent role of GABA synapses of the zona incerta-lateral hypothalamic region in haloperidol-induced catalepsy. Brain Res. 1988 Oct 18;462(2):378-82. PubMed PMID: 3191399.

117: Leanza G, Pellitteri R, Russo A, Stanzani S. Branching axons from subcoeruleus area project to the nucleus raphe pontis and hypothalamic zona incerta, as studied with the double fluorescent retrograde tracing technique. Neurosci Lett. 1988 Oct 5;92(2):132-6. PubMed PMID: 3185982.

118: Spencer SE, Sawyer WB, Loewy AD. L-glutamate stimulation of the zona incerta in the rat decreases heart rate and blood pressure. Brain Res. 1988 Aug 16;458(1):72-81. PubMed PMID: 2905195.

119: Tanaka J, Seto K. Neurons in the lateral hypothalamic area and zona incerta with ascending projections to the subfornical organ area in the rat. Brain Res. 1988 Jul 26;456(2):397-400. PubMed PMID: 3208088.

120: Merchenthaler I, Maderdrut JL, Weber E, Petrusz P. Characterization of metorphamide-like immunoreactivity in the zona incerta and lateral hypothalamus: co-localization with alpha-melanocyte-stimulating hormone-like immunoreactivity. Brain Res. 1988 Jun 14;452(1-2):87-96. PubMed PMID: 2841010.

121: MacKenzie FJ, James MD, Wilson CA. Changes in dopamine activity in the zona incerta (ZI) over the rat oestrous cycle and the effect of lesions of the ZI on cyclicity: further evidence that the incerto-hypothalamic tract has a stimulatory role in the control of LH release. Brain Res. 1988 Mar 15;444(1):75-83. PubMed PMID: 3129140.

122: Frankfurt M, Beaudet A. Reinnervation of dopamine neurons by regenerating serotonin axons in the rat medial zona incerta. A combined radioautographic and immunocytochemical ultrastructural study. Exp Brain Res. 1988;72(3):473-80. PubMed PMID: 2906880.

123: Ikeda K, Tomonaga M. The presence of creatine kinase (CK)-immunoreactive neurons in the zona incerta and lateral hypothalamic area of the mouse brain. Brain Res. 1987 Dec 1;435(1-2):348-50. PubMed PMID: 3322504.

124: James MD, MacKenzie FJ, Tuohy-Jones PA, Wilson CA. Dopaminergic neurones in the zona incerta exert a stimulatory control on gonadotrophin release via D1 dopamine receptors. Neuroendocrinology. 1987 May;45(5):348-55. PubMed PMID: 3035408.

125: Wardas J, Ossowska K, Wolfarth S. The role of gamma-aminobutyric acid mechanisms of the zona incerta-lateral hypothalamus in the catalepsy and muscle rigidity evoked by morphine. Brain Res. 1987 Apr 7;408(1-2):363-6. PubMed PMID: 3036305.

126: Mok D, Mogenson GJ. Convergence of signals in the zona incerta for angiotensin-mediated and osmotic thirst. Brain Res. 1987 Mar 31;407(2):332-40. PubMed PMID: 3567649.

127: Leanza G, Pellitteri R, Russo A, Stanzani S. [Afferent projections to the raphe pontis and zona incerta. Study using using fluorescent dye markers]. Boll Soc Ital Biol Sper. 1986 Nov 30;62(11):1389-93. Italian. PubMed PMID: 3828137.

128: Mok D, Mogenson GJ. Contribution of zona incerta to osmotically induced drinking in rats. Am J Physiol. 1986 Nov;251(5 Pt 2):R823-32. PubMed PMID: 3777209.

129: Kendrick KM, Baldwin BA, Cooper TR, Sharman DF. Uric acid is released in the zona incerta of the subthalamic region of the sheep during rumination and in response to feeding and drinking stimuli. Neurosci Lett. 1986 Oct 8;70(2):272-7. PubMed PMID: 2430241.

130: Kendrick KM, Baldwin BA. The activity of neurones in the lateral hypothalamus and zona incerta of the sheep responding to the sight or approach of food is modified by learning and satiety and reflects food preference. Brain Res. 1986 Jun 11;375(2):320-8. PubMed PMID: 3730826.

131: Kendrick KM, Baldwin BA. Characterization of neuronal responses in the zona incerta of the subthalamic region of the sheep during ingestion of food and liquid. Neurosci Lett. 1986 Jan 30;63(3):237-42. PubMed PMID: 3951750.

132: Romanowski CA, Mitchell IJ, Crossman AR. The organisation of the efferent projections of the zona incerta. J Anat. 1985 Dec;143:75-95. PubMed PMID: 3870735; PubMed Central PMCID: PMC1166426.

133: Roger M, Cadusseau J. Afferents to the zona incerta in the rat: a combined retrograde and anterograde study. J Comp Neurol. 1985 Nov 22;241(4):480-92. PubMed PMID: 4078044.

134: Shiosaka S, Kawai Y, Shibasaki T, Tohyama M. The descending alpha-MSHergic (alpha-melanocyte-stimulating hormone-ergic) projections from the zona incerta and lateral hypothalamic area to the inferior colliculus and spinal cord in the rat. Brain Res. 1985 Jul 15;338(2):371-5. PubMed PMID: 4027603.

135: Mogenson GJ, Swanson LW, Wu M. Evidence that projections from substantia innominata to zona incerta and mesencephalic locomotor region contribute to locomotor activity. Brain Res. 1985 May 13;334(1):65-76. PubMed PMID: 3995314.

136: Shammah-Lagnado SJ, Negrão N, Ricardo JA. Afferent connections of the zona incerta: a horseradish peroxidase study in the rat. Neuroscience. 1985 May;15(1):109-34. PubMed PMID: 4010931.

137: Uemura-Sumi M, Osterstock J, Millhouse OE. The zona incerta: another source of centrifugal fibers to the main olfactory bulb. Neurosci Lett. 1985 Feb 4;53(3):241-5. PubMed PMID: 3982710.

138: Cadusseau J, Roger M. [Description of a reciprocal connection between the zona incerta and the posterior nucleus of the hypothalamus. Anatomic study in rats]. C R Acad Sci III. 1985;300(17):643-6. French. PubMed PMID: 2427174.

139: Shiosaka S, Shibasaki T, Tohyama M. Bilateral alpha-melanocyte stimulating hormonergic fiber system from zona incerta to cerebral cortex: combined retrograde axonal transport and immunohistochemical study. Brain Res. 1984 Sep 10;309(2):350-3. PubMed PMID: 6383519.

140: Bosler O, Joh TH, Beaudet A. Ultrastructural relationships between serotonin and dopamine neurons in the rat arcuate nucleus and medial zona incerta: a combined radioautographic and immunocytochemical study. Neurosci Lett. 1984 Aug 10;48(3):279-85. PubMed PMID: 6148725.

141: Köhler C, Haglund L, Swanson LW. A diffuse alpha MSH-immunoreactive projection to the hippocampus and spinal cord from individual neurons in the lateral hypothalamic area and zona incerta. J Comp Neurol. 1984 Mar 10;223(4):501-14. PubMed PMID: 6325509.

142: Tepper BJ, Kanarek RB. 2-DG-induced glucopenia does elicit feeding in rats with lesions of the zona incerta. Physiol Behav. 1984 Mar;32(3):441-6. PubMed PMID: 6379706.

143: Dalton LD, Grossman SP. Responses to dietary adulterations in rats with zona incerta lesions. Physiol Behav. 1982 Jul;29(1):51-60. PubMed PMID: 7122735.

144: Oertel WH, Tappaz ML, Berod A, Mugnaini E. Two-color immunohistochemistry for dopamine and GABA neurons in rat substantia nigra and zona incerta. Brain Res Bull. 1982 Jul-Dec;9(1-6):463-74. PubMed PMID: 6129046.

145: Steriade M, Parent A, Ropert N, Kitsikis A. Zona incerta and lateral hypothalamic afferents to the midbrain reticular core of cat–HRP and electrophysiological study. Brain Res. 1982 Apr 22;238(1):13-28. PubMed PMID: 7083012.

146: Ricardo JA. Efferent connections of the subthalamic region in the rat. II. The zona incerta. Brain Res. 1981 Jun 9;214(1):43-60. PubMed PMID: 7237165.

147: Kawana E, Watanabe K. A cytoarchitectonic study of zona incerta in the rat. J Hirnforsch. 1981;22(5):535-41. PubMed PMID: 7328309.

148: Loskutova LV, Vinnitskii IM, Il'yuchenok RYu. Participation of the zona incerta in mechanisms of the conditioned avoidance reaction. Neurosci Behav Physiol. 1981 Jan-Feb;11(1):60-2. PubMed PMID: 6973707.

149: Kiefer SW, Grijalva CV. Taste reactivity in rats following lesions of the zona incerta or amygdala. Physiol Behav. 1980 Oct;25(4):549-54. PubMed PMID: 7208651.

150: Kelly J, Swanson LW. Additional forebrain regions projecting to the posterior pituitary: preoptic region, bed nucleus of the stria terminalis, and zona incerta. Brain Res. 1980 Sep 15;197(1):1-9. PubMed PMID: 7397547.

151: Brown B, Grossman SP. Evidence that nerve cell bodies in the zona incerta influence ingestive behavior. Brain Res Bull. 1980 Sep-Oct;5(5):593-7. PubMed PMID: 7427756.

152: McDermott LJ, Grossman SP. The effects of amphetamine or caffeine on the response to glucoprivation in rats with rostral zona incerta lesions. Pharmacol Biochem Behav. 1980 Jun;12(6):949-57. PubMed PMID: 6995995.

153: Roehrs TA, Allen JD. Delayed acquisition of schedule-induced polydipsia in rats with zona incerta lesions. Physiol Behav. 1980 May;24(5):895-9. PubMed PMID: 7403292.

154: McDermott LJ, Grossman SP. Responsiveness to 2-deoxy-d-glucose and insulin in rats with rostral zona incerta lesions. Physiol Behav. 1980 Mar;24(3):585-92. PubMed PMID: 6990433.

155: McDermott LJ, Grossmann SP. Circadian rhythms in ingestive behavior and responsiveness to glucoprivic and osmotic challenges in rats with rostral zona incerta lesions. Physiol Behav. 1980 Mar;24(3):575-84. PubMed PMID: 6990432.

156: Dubrovina NI, Il'iuchenok RIu. [Descending and ascending influences on zona incerta neurons]. Neirofiziologiia. 1980;12(1):46-52. Russian. PubMed PMID: 7366781.

157: Iwahori N, Mizuno N. A Golgi study on the zona incerta of the mouse. Anat Embryol (Berl). 1980;161(2):145-58. PubMed PMID: 6162402.

158: McDermott LJ, Grossman SP. Regulation of calorie intake in rats with rostral zona incerta lesions: effects of caloric density or palatability of the diet. Physiol Behav. 1979 Dec;23(6):1135-40. PubMed PMID: 542524.

159: Legg CR. Visual discrimination impairments after lesions in zona incerta or lateral terminal nucleus of accessory optic tract. Brain Res. 1979 Nov 30;177(3):461-78. PubMed PMID: 497846.

160: Stamoutsos BA, Carpenter RG, Grossman L, Grossman SP. Impaired feeding responses to intragastric, intraperitoneal, and subcutaneous injections of 2-deoxy-D-glucose in rats with zona incerta lesions. Physiol Behav. 1979 Oct;23(4):771-6. PubMed PMID: 504474.

161: Rowland N, Grossman SP, Grossman L. Zona incerta lesions: regulatory drinking deficits to intravenous NaCl, angiotensin, but not to salt in the food. Physiol Behav. 1979 Oct;23(4):745-50. PubMed PMID: 504470.

162: Loskutova LV, Vinnitskiĭ IM, Il'iuchenok RIu. [Participation of the zona incerta in conditioned avoidance reaction mechanisms]. Zh Vyssh Nerv Deiat Im I P Pavlova. 1979 Mar-Apr;29(2):396-8. Russian. PubMed PMID: 452723.

163: Kaelber WW, Smith TB. Projections of the zona incerta in the cat, with stimulation controls. Exp Neurol. 1979 Jan;63(1):177-200. PubMed PMID: 467542.

164: Grossman SP, Grossman L. Parametric study of the regulatory capabilities of rats with rostromedial zona incerta lesions: responsiveness to hypertonic saline and polyethylene glycol. Physiol Behav. 1978 Sep;21(3):431-40. PubMed PMID: 740760.

165: Walsh LL, Grossman SP. Dissociation of responses to extracellular thirst stimuli following zona incerta lesions. Pharmacol Biochem Behav. 1978 Apr;8(4):409-15. PubMed PMID: 353819.

166: Walsh LL, Halaris AE, Grossman L, Grossman SP. Some biochemical effects of zona incerta lesions that interfere with the regulation of water intake. Pharmacol Biochem Behav. 1977 Oct;7(4):351-6. PubMed PMID: 928493.

167: Evered MD, Mogenson GJ. Impairment in fluid ingestion in rats with lesions of the zona incerta. Am J Physiol. 1977 Jul;233(1):R53-8. PubMed PMID: 879344.

168: Walsh LL, Grossman SP. Electrolytic lesions and knife cuts in the region of the zona incerta impair sodium appetite. Physiol Behav. 1977 Apr;18(4):587-96. PubMed PMID: 896971.

169: Kuzemenský J. Contribution to the cytoarchitectonics of the zona incerta and Forel's field in rodents. Folia Morphol (Praha). 1977;25(4):366-70. PubMed PMID: 336492.

170: Evered MD, Mogenson GJ. Regulatory and secondary water intake in rats with lesions of the zona incerta. Am J Physiol. 1976 Apr;230(4):1049-57. PubMed PMID: 1266998.

171: Walsh LL, Grossman SP. Zona incerta lesions impair osmotic but not hypovolemic thirst. Physiol Behav. 1976 Feb;16(2):211-5. PubMed PMID: 940862.

172: Walsh LL, Grossman SP. Loss of feeding in response to 2-deoxy-D-glucose but not insulin after zona incerta lesions in the rat. Physiol Behav. 1975 Oct;15(5):481-5. PubMed PMID: 1221455.

173: Bubnov AN. [Neurosurgical anatomy of the zona incerta applicable to subthalamotomy]. Vopr Neirokhir. 1975 Jan-Feb;(1):36-40. Russian. PubMed PMID: 1091095.

174: Mascarenhas JF, Gogate MG, Dhume RA. Effect of lesions of zona incerta on the plasma seromucoid levels in cats. Indian J Med Res. 1974 Mar;62(3):407-12. PubMed PMID: 4616012.

175: Walsh LL, Grossman SP. Zona incerta lesions: disruption of regulatory water intake. Physiol Behav. 1973 Dec;11(6):885-7. PubMed PMID: 4763477.

176: Duckett S. Horizontal cells in the zona incerta of the developing human telencephalon. Experientia. 1973 Sep 15;29(9):1124. PubMed PMID: 4744869.

177: Boivie J. The termination in the thalamus and the zona incerta of fibres from the dorsal column nuclei (DCN) in the cat. an experimental study with silver impregnation methods. Brain Res. 1971 May 21;28(3):459-90. PubMed PMID: 4106845.

178: Duensing F, Haufe F. Afferent information and stimulation effects in the nucleus interstitialis and the zona incerta of rabbits. Electroencephalogr Clin Neurophysiol. 1969 Apr;26(4):436. PubMed PMID: 4183576.

179: Mundinger F. Stereotaxic interventions on the zona incerta area for treatment of extrapyramidal motor disturbances and their results. Confin Neurol. 1965;26(3):222-30. PubMed PMID: 5329822.

180: ELLEN P, POWELL EW. TIMING BEHAVIOR AFTER LESIONS OF ZONA INCERTA AND MAMMILLARY BODY. Science. 1963 Aug 30;141(3583):828-30. PubMed PMID: 14045145.

181: HYDE JE, TOCZEK S. Functional relation of interstitial nucleus to rotatory movements evoked from zona incerta stimulation. J Neurophysiol. 1962 Jul;25:455-66. PubMed PMID: 14450319.

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