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ORIGINAL ARTICLES  PARKINSON’S DISEASE


Journal of Neurosurgical Sciences 2003 March;47(1):40-6

lingua: Inglese

Functional neuroimaging (PET and SPECT) in the selection and assessment of patients with Parkinson’s disease undergoing deep brain stimulation

Antonini A. 1, Landi A. 2, Benti R. 3, Mariani C. 1, De Notaris R. 1, Marotta G. 3, Pezzoli G. 1, Gaini S. M. 2, Gerundini P. 3

1 Department of Neurosciences, Parkinson’s Disease Cen­tre Istituti Clinici di Perfezionamento, Milan, Italy,
2 Neurosurgical Clinic, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy,
3 Department of Nuclear Medicine, IRCCS, Ospedale Maggiore, Polyclinic, Milan, Italy


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Deep brain Stimulation (DBS) is an effec­tive treat­ment for ­patients ­with ­advanced Parkinson’s dis­ease (PD) and ­motor com­pli­ca­tions who can no long­er be ­improved by adjust­ment of med­i­cal ther­a­py. Selection of sur­gery can­di­dates and fol­low-up ­after sur­gery are crit­i­cal for ­good out­come. Functional neu­ro­im­ag­ing can ­help in the clin­i­cal assess­ment of ­these ­patients. We ­have ­used sin­gle pho­ton emis­sion com­put­ed tomog­ra­phy (­SPECT) and the trac­er ECD to meas­ure region­al cere­bral ­blood ­flow ­before and 6 ­months ­after DBS of the sub­tha­lam­ic nucle­us (STN) in 20 ­patients ­with ­advanced PD. We ­found a sig­nif­i­cant ­increase in the ante­ri­or cin­gu­late/sup­ple­men­tary ­motor cor­tex in the 12 ­good respond­ers (­change in off uni­fied UPDRS >50%). Conversely, ­patients ­with ­poor ­response (n=8; ­change in off ­UPDRS-III <50% fol­low­ing DBS) ­revealed a sig­nif­i­cant wors­en­ing of cor­ti­cal hypo­per­fu­sion par­tic­u­lar­ly in the pre­fron­tal are­as. No ­flow decre­ments ­were detect­ed in the ­basal gan­glia and in the thal­a­mus in ­both ­groups dur­ing DBS stim­u­la­tion sug­gest­ing ­that DBS ­does not ­have a “­lesion ­like” ­effect. If DBS stim­u­lates and ­does not inac­ti­vate STN pro­jec­tion neu­rons, ­flow reduc­tion in the ­poor respond­ers may be sec­on­dary to ­increased inhib­i­to­ry ­basal gan­glia out­put.

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