MRI EVALUATION OF DBS IN PARKINSON'S DISEASE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall goal of this study is to characterize the changes in motor pathway activity produced by deep brain stimulation in the subthalamic nucleus (STN DBS) in patients with Parkinson¿s disease (PD) using functional magnetic resonance imaging (fMRI). STN DBS provides excellent symptom relief for PD patients in the late stages of the disease when medical therapies are no longer effective or produce too many unwanted side effects. Present understanding of the mechanisms of STN DBS for PD is derived primarily from animal models and inferences drawn from lesional therapies in humans. The aims of the study are 1) to determine the pattern of fMRI activation associated with optimal relief in Parkinsonian motor signs during STN DBS, 2) to determine the relationship between functional MRI activation and clinical efficacy in DBS of the STN in PD and 3) to determine the pattern of activation associated with unilateral stimulation which results in bilateral symptom relief. It is hypothesized that DBS of the STN in PD will 1) produce a consistent pattern of activation in the globus pallidus and thalamus with optimal symptom relief such that activation in these regions will be a sensitive and specific marker of symptomatic benefit, 2) produce activation that will positively correlate in degree with the amount of Parkinsonian motor symptom relief, and 3) in subjects with strong bilateral symptom relief from unilateral stimulation will produce a bilateral pattern of activation in during unilateral stimulation. The GCRC will be used for a 72 hour inpatient stay. Subjects will receive a placement of a DBS for treatment of Parkinson's disease on Tuesday of a given week. The placement procedure will be performed as a 23 hour observational admission. Subject will then be discharged from the hospital and admitted to the GCRC. On postoperative day 2 (Thursday) the subject will receive a clinical examination evaluating the United Parkinson's Disease Rating Scale Motor Subscore (UPDRSSS) for each of the DBS settings to be used during the fMRI evaluation. The subject will then go from the GCRC to the MRI scanner for functional MRI examination. Following the functional MRI examination the subject will return to the GCRC. The subject will be then discharged from the GCRC on Friday morning and have a final surgery for internalization of the deep brain stimulator only turns and placement of the internal pulse generator. The GCRC will be utilized in or to defer the expense of hospital admission as the subjects cannot leave the hospital environment with an externalized DBS in place.