ORIGINAL ARTICLES  PARKINSON’S DISEASE 

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

Copyright © 2004 EDIZIONI MINERVA MEDICA

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

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.