title: Subthalamic nucleus stimulation restores glucose metabolism in associative and limbic cortices and in cerebellum: evidence from a FDG-PET study in advanced Parkinson's disease.
abstract: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a highly effective surgical treatment in patients with advanced Parkinson's disease (PD). Because the STN has been shown to represent an important relay station not only in motor basal ganglia circuits, the modification of brain areas also involved in non-motor functioning can be expected by this intervention. To determine the impact of STN-DBS upon the regional cerebral metabolic rate of glucose (rCMRGlc), we performed positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in eight patients with advanced PD before surgery as well as in the DBS on- and off-conditions 4 months after electrode implantation and in ten age-matched healthy controls. Before surgery, PD patients showed widespread bilateral reductions of cortical rCMRGlc versus controls but a hypermetabolic state in the left rostral cerebellum. In the STN-DBS on-condition, clusters of significantly increased rCMRGlc were found in both lower thalami reaching down to the midbrain area and remote from the stimulation site in the right frontal cortex, temporal cortex, and parietal cortex, whereas rCMRGlc significantly decreased in the left rostral cerebellum. Therefore, STN-DBS was found to suppress cerebellar hypermetabolism and to partly restore physiologic glucose consumption in limbic and associative projection territories of the basal ganglia. These data suggest an activating effect of DBS upon its target structures and confirm a central role of the STN in motor as well as associative, limbic, and cerebellar basal ganglia circuits.
authors.affiliation: Departments of Neurology and dagger Stereotaxy and Functional Neurosurgery, University Hospital, Cologne, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Hilker
authors.forename: Juergen
authors.initials: J
authors.lastname: Voges
authors.forename: Simon
authors.initials: S
authors.lastname: Weisenbach
authors.forename: Elke
authors.initials: E
authors.lastname: Kalbe
authors.forename: Lothar
authors.initials: L
authors.lastname: Burghaus
authors.forename: Mehran
authors.initials: M
authors.lastname: Ghaemi
authors.forename: Ralph
authors.initials: R
authors.lastname: Lehrke
authors.forename: Athanasios
authors.initials: A
authors.lastname: Koulousakis
authors.forename: Karl
authors.initials: K
authors.lastname: Herholz
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Heiss
mesh_terms: D000368:Aged; D001923:Brain Chemistry / Q000502:physiology; D002525:Cerebellar Cortex / Q000000981:diagnostic imaging / Q000378:metabolism*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007700:Kinetics; D008032:Limbic System / Q000000981:diagnostic imaging / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D019275:Radiopharmaceuticals; D016634:Radiosurgery; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000502:physiology*; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose