Subthalamic nucleus stimulation affects limbic and associative circuits: a PET study.
OBJECTIVE
Although high-frequency deep brain stimulation of the subthalamic nucleus (STN DBS) improves motor symptoms in advanced Parkinson's disease (PD), clinical studies have reported cognitive, motivational and emotional changes. These results suggest that the STN forms part of a broadly distributed neural network encompassing the associative and limbic circuits. We sought to pinpoint the cortical and subcortical brain areas modulated by STN DBS, in order to assess the STN's functional role and explain neuropsychological modifications following STN DBS in PD.


METHODS
We studied resting state glucose metabolism in 20 PD patients before and after STN DBS and 13 age-matched healthy controls using (18)F-FDG PET. We used statistical analysis (SPM2) first to compare pre-stimulation metabolism in PD patients with metabolism in healthy controls, then to study metabolic modifications in PD patients following STN DBS.


RESULTS
The first analysis revealed no pre-stimulation metabolic abnormalities in associative or limbic circuitry. After STN DBS, metabolic modifications were found in several regions known for their involvement in the limbic and associative circuits.


CONCLUSIONS
These metabolic results confirm the STN's central role in associative and limbic basal ganglia circuits. They will provide information for working hypotheses for future studies investigating neuropsychological changes and metabolic modifications related to STN DBS, with a view to improving our knowledge of this structure's functional role.
Le Jeune
Florence
F
Service de Médecine Nucléaire, Centre Eugène Marquis, rue de la Bataille Flandres Dunkerque, 35042 Rennes, France. f.lejeune@rennes.fnclcc.fr
Péron
Julie
J
Grandjean
Didier
D
Drapier
Sophie
S
Haegelen
Claire
C
Garin
Etienne
E
Millet
Bruno
B
Vérin
Marc
M
D016022:Case-Control Studies; D046690:Deep Brain Stimulation; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008032:Limbic System / Q000378:metabolism / Q000502:physiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009415:Nerve Net / Q000378:metabolism / Q000502:physiology* / Q000503:physiopathology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D049268:Positron-Emission Tomography; D017397:Prefrontal Cortex / Q000378:metabolism; D020531:Subthalamic Nucleus / Q000601:surgery*
D019788:Fluorodeoxyglucose F18; D005947:Glucose