Predictive potential of pre-operative functional neuroimaging in patients treated with subthalamic stimulation.
OBJECTIVE
The aim of this study was to investigate the predictive potential of pre-operative regional cerebral blood flow (rCBF) in the pre-supplementary motor area (pre-SMA) and clinical factors in Parkinson's disease (PD) patients treated with subthalamic nucleus (STN) stimulation.


METHODS
Ten patients underwent rCBF SPECT and motor Unified Parkinson's Disease Rating Scale (UPDRS) pre- and post-operatively during stimulation at 5 and 42 months. Statistical parametric mapping (SPM) was used to extract rCBF values in the pre-SMA because it is related with motor improvement. Post-operative outcomes included motor response to stimulation and percent improvement in UPDRS. Pre-operative predictors were explored by correlation test, linear regression and multivariate analyses.


RESULTS
Higher pre-operative rCBF in the pre-SMA and younger age were associated with favourable outcomes at 5 and 42 months. Pre-operative rCBF results were significantly associated with baseline clinical factors.


CONCLUSIONS
This study shows that PD patients with younger age have higher rCBF values in the pre-SMA and better outcome, thus giving the rationale to the hypothesis that STN stimulation could be considered early in the course of disease.
Sestini
Stelvio
S
Department of Diagnostic Imaging, Nuclear Medicine Unit, Ospedale Misericordia e Dolce, Piazza Ospedale 5, 59100 Prato, Italy. ssestini@usl4.toscana.it
Pupi
Alberto
A
Ammannati
Franco
F
Ramat
Silvia
S
Sorbi
Sandro
S
Sciagrà
Roberto
R
Mansi
Luigi
L
Castagnoli
Antonio
A
D004599:Electric Stimulation Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000000981:diagnostic imaging*; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D011379:Prognosis; D011877:Radionuclide Imaging; D020531:Subthalamic Nucleus; D016896:Treatment Outcome