Deep brain stimulation of the subthalamic nucleus versus levodopa challenge in Parkinson's disease: measuring the on- and off-conditions with FDG-PET

Summary. In order to compare the effects of high-frequency stimulation of the subthalamic nucleus (STN-DBS) and a levodopa-challenge on cerebral metabolic activity, we conducted PET scans with [18F]2-fluoro-2-deoxyglucose (FDG) in the drug- and stimulation- on- and off-condition in a single patient suffering from advanced PD. Our data revealed evidence for improved thalamocortical processing released from inhibition by overactive basal ganglia output nuclei in both on-conditions. While levodopa also led to a reduction of lentiform hyperactivity, effective STN stimulation seemed to interfere with distinct cerebellar and limbic circuits.

[1]  T. Ishikawa,et al.  The Metabolic Topography of Parkinsonism , 1994, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[2]  E. Tolosa,et al.  Effects of bilateral subthalamic stimulation on cognitive function in Parkinson disease. , 2001, Archives of neurology.

[3]  H. Savaki,et al.  Functional Metabolic Mapping of the Rat Brain during Unilateral Electrical Stimulation of the Subthalamic Nucleus , 1994, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[4]  Karl Herholz,et al.  Noise Characteristic of 3D PET Scans from Single Subject Activation Studies , 2001 .

[5]  B Conrad,et al.  A positron emission tomographic study of subthalamic nucleus stimulation in Parkinson disease: enhanced movement-related activity of motor-association cortex and decreased motor cortex resting activity. , 1999, Archives of neurology.

[6]  Albert Gjedde,et al.  Physiological imaging of the brain with PET , 2001 .

[7]  A. Damasio,et al.  Somatic markers and the guidance of behavior: Theory and preliminary testing. , 1991 .

[8]  W Lang,et al.  Bilateral subthalamic nucleus stimulation improves frontal cortex function in Parkinson's disease. An electrophysiological study of the contingent negative variation. , 1999, Brain : a journal of neurology.

[9]  A. Benabid,et al.  Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. , 1998, The New England journal of medicine.

[10]  Richard S. J. Frackowiak,et al.  Changes in cerebral activity pattern due to subthalamic nucleus or internal pallidum stimulation in Parkinson's disease , 1997, Annals of neurology.

[11]  J. Rothwell,et al.  The impact of deep brain stimulation on executive function in Parkinson's disease. , 2000, Brain : a journal of neurology.

[12]  L. Parsons,et al.  Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. , 1999, The American journal of psychiatry.

[13]  G. E. Alexander,et al.  Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, "prefrontal" and "limbic" functions. , 1990, Progress in brain research.

[14]  Alan C. Evans,et al.  A Three-Dimensional Statistical Analysis for CBF Activation Studies in Human Brain , 1992, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[15]  W Fernandez,et al.  Impaired activation of the supplementary motor area in Parkinson's disease is reversed when akinesia is treated with apomorphine , 1992, Annals of neurology.

[16]  [Cognitive functions of the frontal lobe]. , 2004, Revista de neurologia.

[17]  Richard S. J. Frackowiak,et al.  Thalamic stimulation and suppression of parkinsonian tremor. Evidence of a cerebellar deactivation using positron emission tomography. , 1993, Brain : a journal of neurology.