SPECT and PET analysis of subthalamic stimulation in Parkinson's disease: analysis using a manual segmentation.
The subthalamic nucleus (STN) has become an effective target of deep-brain stimulation (DBS) in severely disabled patients with advanced Parkinson's disease (PD). Clinical studies have reported DBS-induced adverse effects on cognitive functions, mood, emotion and behavior. STN DBS seems to interfere with the limbic functions of the basal ganglia, but the limbic effects of STN DBS are controversial. We measured prospectively resting regional cerebral metabolism (rCMb) with 18-fluorodeoxyglucose and PET, and resting regional cerebral blood flow (rCBF) with HMPAO and SPECT in six patients with Parkinson's disease. We compared PET and SPECT 1 month before and 3 months after STN DBS. On cerebral MRI, 13 regions of interest (ROI) were manually delineated slice by slice in frontal and limbic lobes. We obtained mean rCBF and rCMb values for each ROI and the whole brain. We normalized rCBF and rCMB values to ones for the whole brain volume, which we compared before and following STN DBS. No significant difference emerged in the SPECT analysis. PET analysis revealed a significant decrease in rCMb following STN DBS in the superior frontal gyri and left and right dorsolateral prefrontal cortex (p < 0.05). A non-significant decrease in rCMb in the left anterior cingulate gyrus appeared following STN DBS (p = 0.075). Our prospective SPECT and PET study revealed significantly decreased glucose metabolism of the two superior frontal gyri without any attendant perfusion changes following STN DBS. These results suggest that STN DBS may change medial prefrontal function and therefore the integration of limbic information, either by disrupting emotional processes within the STN, or by hampering the normal function of a limbic circuit.
Department of Neurosurgery, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. Claire.HAEGELEN@chu-rennes.fr
Claire
C
Haegelen
Daniel
D
García-Lorenzo
Florence
F
Le Jeune
Julie
J
Péron
Bernard
B
Gibaud
Laurent
L
Riffaud
Gilles
G
Brassier
Christian
C
Barillot
Marc
M
Vérin
Xavier
X
Morandi
D000368:Aged; D000679:Amygdala / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D001479:Basal Ganglia / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D001931:Brain Mapping / Q000379:methods; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004644:Emotions / Q000502:physiology; D005260:Female; D006624:Hippocampus / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008032:Limbic System / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D009434:Neural Pathways / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D017397:Prefrontal Cortex / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D020531:Subthalamic Nucleus / Q000033:anatomy & histology / Q000502:physiology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods