title: Changes in brain glucose metabolism in subthalamic nucleus deep brain stimulation for advanced Parkinson's disease.
abstract: BACKGROUND
  Despite its large clinical application, our understanding about the mechanisms of action of deep brain stimulation of the subthalamic nucleus is still limited. Aim of the present study was to explore cortical and subcortical metabolic modulations measured by Positron Emission Tomography associated with improved motor manifestations after deep brain stimulation in Parkinson disease, comparing the ON and OFF conditions.
  
  
  METHODS
  Investigations were performed in the stimulator off- and on-conditions in 14 parkinsonian patients and results were compared with a group of matched healthy controls. The results were also used to correlate metabolic changes with the clinical effectiveness of the procedure.
  
  
  RESULTS
  The comparisons using Statistical parametric mapping revealed a brain metabolic pattern typical of advanced Parkinson disease. The direct comparison in ON vs OFF condition showed mainly an increased metabolism in subthalamic regions, corresponding to the deep brain stimulation site. A positive correlation exists between neurostimulation clinical effectiveness and metabolic differences in ON and OFF state, including the primary sensorimotor, premotor and parietal cortices, anterior cingulate cortex.
  
  
  CONCLUSIONS
  Deep brain stimulation seems to operate modulating the neuronal network rather than merely exciting or inhibiting basal ganglia nuclei. Correlations with Parkinson Disease cardinal features suggest that the improvement of specific motor signs associated with deep brain stimulation might be explained by the functional modulation, not only in the target region, but also in surrounding and remote connecting areas, resulting in clinically beneficial effects.
authors.affiliation: Department of Neurology, INSPE, San Raffaele Scientific Institute, Via Olgettina 48, I-20132 Milan, Italy. volonte.mariaantonietta@hsr.it
authors.forename: M A
authors.initials: MA
authors.lastname: Volonté
authors.forename: V
authors.initials: V
authors.lastname: Garibotto
authors.forename: F
authors.initials: F
authors.lastname: Spagnolo
authors.forename: A
authors.initials: A
authors.lastname: Panzacchi
authors.forename: P
authors.initials: P
authors.lastname: Picozzi
authors.forename: A
authors.initials: A
authors.lastname: Franzin
authors.forename: E
authors.initials: E
authors.lastname: Giovannini
authors.forename: L
authors.initials: L
authors.lastname: Leocani
authors.forename: M
authors.initials: M
authors.lastname: Cursi
authors.forename: G
authors.initials: G
authors.lastname: Comi
authors.forename: D
authors.initials: D
authors.lastname: Perani
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D016022:Case-Control Studies; D046690:Deep Brain Stimulation; D005260:Female; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism; D005947:Glucose / Q000378:metabolism*; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000378:metabolism*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose