Network modulation in the treatment of Parkinson's disease
Network modulation in the treatment of Parkinson's disease
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DOI：
10.1093/brain/awl162
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发表时间：
2006-10-01
期刊：
影响因子：
14.5
通讯作者：
Eidelberg, David
中科院分区：
文献类型：
--
作者：
Asanuma, Kotaro;Tang, Chengke;Eidelberg, David
已经提出，丘脑底核的脑深部电刺激（DBS）和多巴胺能治疗通过类似的功能机制改善帕金森病的症状。我们使用PET检查了这一概念，以比较这些治疗方法的代谢效应。9名帕金森病患者（年龄61.7 +/- 11.1岁）接受了ON和OFF双刺激扫描，另外9名患者（年龄60.0 +/- 9.3岁）接受了ON和OFF单独滴定静脉内左旋多巴输注扫描。两个治疗组的基线疾病严重程度以及对治疗的临床反应相匹配。使用统计参数图（SPM）评估给药对局部代谢影响的相似性和差异。此外，我们使用网络分析来评估治疗对异常帕金森病相关空间协方差模式（PDRP）表达的影响。我们发现，DBS和左旋多巴治疗与壳核/苍白球、感觉运动皮质和小脑蚓部的代谢显著减少（P < 0.001）以及楔前叶的代谢增加（BA 7）相关。两种干预措施的代谢效应在前额叶皮层和内侧前额叶皮层不同，前者结构的刺激相对增加，后者减少。网络定量揭示了两种干预措施的PDRP活性降低，这与临床改善相关（P < 0.05）。两种治疗方法的网络调节程度无显著差异（P > 0.6）。这些发现支持了先前的影像学研究结果，表明帕金森病的有效对症治疗涉及一个共同的机制。病理性脑网络的调节是帕金森综合征治疗反应的关键特征。
It has been proposed that deep brain stimulation (DBS) of the subthalamic nucleus (STN DBS) and dopaminergic therapy ameliorate the symptoms of Parkinson's disease through similar functional mechanisms. We examined this notion using PET to compare the metabolic effects of these treatment approaches. Nine Parkinson's disease patients (age 61.7 +/- 11.1 years) were scanned ON and OFF STN stimulation and nine others (age 60.0 +/- 9.3 years) were scanned ON and OFF an individual titrated intravenous levodopa infusion. The two treatment groups were matched for baseline disease severity as well as clinical response to therapy. Similarities and differences in the effects of treatment on regional metabolism were assessed using statistical parametric mapping (SPM). In addition, we used network analysis to assess the effect of therapy on the expression of an abnormal Parkinson's disease-related spatial covariance pattern (PDRP). We found that both STN DBS and levodopa therapy were associated with significant (P < 0.001) metabolic reductions in the putamen/globus pallidus, sensorimotor cortex and cerebellar vermis, as well as increases in the precuneus (BA 7). The metabolic effects of the two interventions differed in the STN and medial prefrontal cortex, with relative increases with stimulation in the former structure and decreases in the latter. Network quantification disclosed reductions in PDRP activity with both interventions, which correlated with clinical improvement (P < 0.05). The degree of network modulation by therapy did not differ significantly for the two treatment approaches (P > 0.6). These findings support the results of previous imaging studies indicating that effective symptomatic therapies for Parkinson's disease involve a common mechanism. The modulation of pathological brain networks is a critical feature of the treatment response in parkinsonism.