title: Disease progression continues in patients with advanced Parkinson's disease and effective subthalamic nucleus stimulation.
abstract: OBJECTIVE
  Glutamate mediated excitotoxicity of the hyperactive subthalamic nucleus (STN) has been reported to contribute to nigral degeneration in Parkinson's disease (PD). Deep brain stimulation of the STN (STN DBS), in its role as a highly effective treatment of severe PD motor complications, has been thought to inhibit STN hyperactivity and therefore decrease progression of PD.
  
  
  METHODS
  In a prospective two centre study, disease progression was determined by means of serial (18)F-fluorodopa (F-dopa) positron emission tomography (PET) in 30 patients with successful STN DBS over the first 16 (SD 6) months after surgery.
  
  
  RESULTS
  Depending on the method of PET data analysis used in the two centres, annual progression rates relative to baseline were 9.5-12.4% in the caudate and 10.7-12.9% in the putamen.
  
  
  CONCLUSIONS
  This functional imaging study is the first to demonstrate a continuous decline of dopaminergic function in patients with advanced PD under clinically effective bilateral STN stimulation. The rates of progression in patients with STN DBS were within the range of previously reported data from longitudinal imaging studies in PD. Therefore this study could not confirm the neuroprotective properties of DBS in the STN target.
authors.affiliation: Department of Neurology, University Hospital, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany. hilker@pet.mpin-koeln.mpg.de
authors.forename: R
authors.initials: R
authors.lastname: Hilker
authors.forename: A T
authors.initials: AT
authors.lastname: Portman
authors.forename: J
authors.initials: J
authors.lastname: Voges
authors.forename: M J
authors.initials: MJ
authors.lastname: Staal
authors.forename: L
authors.initials: L
authors.lastname: Burghaus
authors.forename: T
authors.initials: T
authors.lastname: van Laar
authors.forename: A
authors.initials: A
authors.lastname: Koulousakis
authors.forename: R P
authors.initials: RP
authors.lastname: Maguire
authors.forename: J
authors.initials: J
authors.lastname: Pruim
authors.forename: B M
authors.initials: BM
authors.lastname: de Jong
authors.forename: K
authors.initials: K
authors.lastname: Herholz
authors.forename: V
authors.initials: V
authors.lastname: Sturm
authors.forename: W-D
authors.initials: WD
authors.lastname: Heiss
authors.forename: K L
authors.initials: KL
authors.lastname: Leenders
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology* / Q000628:therapy*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011954:Receptors, Dopamine / Q000502:physiology; D020531:Subthalamic Nucleus / Q000502:physiology*
chemical_list: D011954:Receptors, Dopamine