Networks mediating the clinical effects of pallidal brain stimulation for Parkinson's disease - A PET study of resting-state glucose metabolism
Networks mediating the clinical effects of pallidal brain stimulation for Parkinson's disease - A PET study of resting-state glucose metabolism
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DOI：
10.1093/brain/124.8.1601
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发表时间：
2001-08-01
期刊：
影响因子：
14.5
通讯作者：
Eidelberg, D
中科院分区：
文献类型：
--
作者：
Fukuda, M;Mentis, MJ;Eidelberg, D
利用[F-18]氟脱氧葡萄糖（FDG）和PET，我们之前发现，针对帕金森病的内部苍白球（GPi）立体定向消融会导致远离病变部位的大脑区域的静息代谢变化。在这项研究中，我们确定了接受 GPi 脑深部刺激 (DBS) 治疗的帕金森病患者是否会发生类似的代谢变化。我们研究了 7 名帕金森病患者，使用 FDG-PET 来测量 GPi 刺激开启和关闭时的静息区域大脑葡萄糖利用率。我们使用统计参数映射来识别这种干预所发生的区域大脑代谢的显着变化。我们还对早期 FDG-PET 研究中发现的特定异常帕金森病相关代谢共变模式 (PDRP) 的表达与刺激相关的变化进行了量化。 DBS 的代谢变化与临床改善相关，临床改善是通过统一帕金森病评定量表 (UPDRS) 运动评级的变化来衡量的。 GPi DBS 改善了 UPDRS 运动评分（36%，P < 0.001），并显着增加了刺激同侧前运动皮层和双侧小脑的区域葡萄糖代谢。 GPi DBS 还导致刺激同侧 PDRP 活性显着下降（P < 0.01），这与 UPDRS 运动评分的临床改善显着相关（P < 0.03）。 GPi DBS 的临床改善与异常帕金森病相关代谢网络的表达减少有关，该网络涉及皮质-纹状体-苍白球-丘脑皮质和小脑-皮质运动环路的元件。
Employing [F-18]fluorodeoxyglucose (FDG) and PET, we have found previously that stereotaxic ablation of the internal globus pallidus (GPi) for Parkinson's disease causes resting metabolic changes in brain regions remote from the lesion site. In this study we determined whether similar metabolic changes occur in Parkinson's disease patients treated with deep brain stimulation (DBS) of the GPi We studied seven Parkinson's disease patients with FDG-PET to measure resting regional cerebral glucose utilization on and off GPi stimulation. We used statistical parametric mapping to identify significant changes in regional brain metabolism that occurred with this intervention. We also quantified stimulation-related changes in the expression of a specific abnormal Parkinson's disease-related pattern of metabolic covariation (PDRP) that had been identified in earlier FDG-PET studies. Metabolic changes with DBS were correlated with clinical improvement as measured by changes in Unified Parkinson's Disease Rating Scale (UPDRS) motor ratings off medication. GPi DBS improved UPDRS motor ratings (36%, P < 0.001) and significantly increased regional glucose metabolism in the premotor cortex ipsilateral to stimulation and in the cerebellum bilaterally. GPi DBS also resulted in a significant (P < 0.01) decline in PDRP activity ipsilateral to stimulation, which correlated significantly with clinical improvement in UPDRS motor ratings (P < 0.03). Clinical improvement with GPi DBS is associated with reduced expression of an abnormal Parkinson's disease-related metabolic network involving elements of the cortico-striato-pallido-thalamocortical and the cerebello-cortical motor loops.