Pallidal deep brain stimulation and L-dopa effect on PET motor activation in advanced Parkinson's disease.
BACKGROUND AND PURPOSE The antiakinetic effect of internal Globus pallidus deep brain stimulation (Gpi-DBS) in Parkinson's disease is not clear and not either how this effect is modulated by L-dopa. METHODS Left Gpi-DBS and/or L-dopa effect was studied with auditory paced right-handed sequential movements on (15)O-butanol positron emission tomography (PET) in five patients. Rest and for conditions during movements (DBS off/L-dopa off; DBS on/L-dopa off; DBS off/L-dopa on; DBS on/L-dopa on) were compared with statistical parametric mapping. RESULTS Gpi-DBS activated the right supplementary motor area/premotor (SMA/PMC), and right insular cortex (IC), and as L-dopa decreased the left sensorimotor cortex (M1/S1) activity. L-dopa increased the left ventrolateral thalamus (VLTH), and decreased the left superior parietal cortex (PC) activity. Gpi-DBS and L-dopa interaction showed right SMA/PMC, IC, and left PC activation, decrease of left VLTH, PMC, and dorsolateral prefrontal cortex (PFC) activity. CONCLUSIONS The improvement of bradykinesia with Gpi-DBS is secondary and contributed to the regress of M1/S1-related rigidity and compensatory SMA/PMC, and IC activation. L-dopa and Gpi-DBS alone each reduces M1/S1 overactivity. Interaction ignores this effect, moreover has akinetic effect in the left VLTH, PMC, and PFC. Motor improvement possibly related to left PC and compensatory right SMA/PMC, and IC activation.
Valálik
István
I
Department of Neurosurgery, St. John's Hospital, Budapest, Hungary. valalik@parkinson.hu
Emri
Miklós
M
Lengyel
Zsolt
Z
Mikecz
Pál
P
Trón
Lajos
L
Csókay
András
A
Márián
Teréz
T
D000704:Analysis of Variance; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001931:Brain Mapping; D000440:Butanols; D046690:Deep Brain Stimulation; D018450:Disease Progression; D005260:Female; D005917:Globus Pallidus / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects / Q000502:physiology; D010104:Oxygen Radioisotopes; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D049268:Positron-Emission Tomography; D011930:Reaction Time; D013647:Task Performance and Analysis
D000978:Antiparkinson Agents; D000440:Butanols; D010104:Oxygen Radioisotopes; D007980:Levodopa