99Tc(m)-ECD SPET perfusion changes by internal pallidum stimulation in Parkinson's disease.
High-frequency stimulation of the internal pallidum is an effective surgical approach for patients with advanced Parkinson's disease suffering from motor fluctuations and L-dopa induced dyskinesia. To study the acute effects of internal pallidum stimulation, changes in cerebral blood flow were measured by means of a single-day split-dose protocol using 99Tc(m)-ECD SPET. Nine patients with advanced Parkinson's disease and with a clinical picture predominated by tremor and drug-induced dyskinesia, were imaged before and immediately after electrostimulation. Brain perfusion data were mirrored to the same electrode side (five left and four right implants), co-registered and analysed statistically on a voxel-by-voxel basis (Statistical Parametric Mapping) and by an automated volume-of-interest approach. Acute stimulation of the internal pallidum induced a significantly decreased perfusion in the ipsilateral thalamus and striatum, as well as in the right parietal cortex. For the subgroup of seven patients with effective motor score improvements, a significant correlation between thalamic and striatal perfusion changes and UPDRS III motor score was present (P = 0.04). These results suggest that effective stimulation of the internal globus pallidus may produce symptom relief through decreased activity in pallido-thalamo-cortical circuits.
van Laere
K
K
Division of Nulclear Medicine, Gent University Hospital, Belgium. koen.vanlaere@rug.ac.be
van der Linden
C
C
Santens
P
P
Vandewalle
V
V
Caemaert
J
J
Ir
P L
PL
van den Abbeele
D
D
Dierckx
R
R
D000328:Adult; D000368:Aged; D001931:Brain Mapping; D002560:Cerebrovascular Circulation; D003545:Cysteine / Q000031:analogs & derivatives*; D004558:Electric Stimulation; D004566:Electrodes; D005260:Female; D005917:Globus Pallidus / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine