title: Preoperative brain metabolism and quality of life after subthalamic nucleus stimulation in Parkinson's disease.
abstract: Subthalamic nucleus deep brain stimulation (STN-DBS) has been proven to improve health-related quality of life (HRQoL) in patients with Parkinson's disease (PD) presenting medically refractory motor complications and dyskinesia. However, some patients fail to benefit from STN-DBS despite rigorous preoperative selection. We postulated that they have a particular, clinically ineloquent, brain metabolism before surgery. We divided 40 stimulated PD patients into two groups (responders vs. nonresponders) depending on whether they reported or not a clinically significant improvement in their quality of life 1 year after surgery. We retrospectively compared their preoperative brain metabolism on the basis of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans. We also analyzed their neuropsychological and psychiatric profiles before and after surgery. All 40 patients met the STN-DBS selection criteria, but only 50% of them had significantly improved 1 year after surgery. Preoperative PET scans showed that metabolism was higher in the left insula, both inferior frontal gyri and left precentral gyrus in nonresponders than in responders. Clinically, postoperative motor scores were similar in both groups, but a worsening of the depression score was observed among nonresponders. PET imaging revealed that nonresponders were characterized by distinctive brain functioning pre-surgery, in regions involved in associative and limbic circuits, as a result of PD-related degeneration. STN-DBS may have interfered with this already abnormal circuitry, leading to the occurrence of complex nonmotor symptoms reducing quality of life. Preoperative brain metabolism could be a useful biomarker for anticipating STN-DBS efficacy in terms of HRQoL in the context of advanced PD.
authors: Department of Neurology, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France, sofilemercier@gmail.com.
authors: Sophie
authors: S
authors: Langner-Lemercier
authors: Sophie
authors: S
authors: Drapier
authors: Florian
authors: F
authors: Naudet
authors: Nathalie
authors: N
authors: Le Clanche
authors: Jean-François
authors: JF
authors: Houvenaghel
authors: Paul
authors: P
authors: Sauleau
authors: Pierre
authors: P
authors: Jannin
authors: Claire
authors: C
authors: Haegelen
authors: Florence
authors: F
authors: Le Jeune
authors: Marc
authors: M
authors: Vérin
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000378:metabolism* / Q000628:therapy*; D063868:Patient Outcome Assessment; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D011788:Quality of Life; D020531:Subthalamic Nucleus
references: J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181-4
references: 1564476
references: Neurology. 2014 Oct 28;83(18):1627-33
references: 25274851
references: Mov Disord. 2006 Jun;21 Suppl 14:S290-304
references: 16892449
references: Neurobiol Aging. 2012 May;33(5):933-44
references: 20961663
references: BMJ. 1994 Sep 24;309(6957):780
references: 7950567
references: J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):308-12
references: 10945804
references: J Neurol. 1998 May;245 Suppl 1:S10-4
references: 9617716
references: N Engl J Med. 1998 Oct 15;339(16):1105-11
references: 9770557
references: J Neurol. 2005 May;252(5):583-8
references: 15778909
references: Neurology. 2012 Sep 11;79(11):1155-60
references: 22895582
references: Brain. 2007 Jul;130(Pt 7):1834-46
references: 17470495
references: Arch Neurol. 2011 Feb;68(2):165
references: 20937936
references: Eur J Nucl Med Mol Imaging. 2010 Aug;37(8):1512-20
references: 20349231
references: Psychiatry Res. 1991 Aug;38(2):143-62
references: 1754629
references: Eur J Neurol. 2014 Mar;21(3):519-24
references: 24447695
references: Mov Disord. 2011 Nov;26(13):2371-80
references: 21735480
references: J Neurol Sci. 2011 Nov 15;310(1-2):58-60
references: 21831400
references: Parkinsonism Relat Disord. 2006 Jun;12(5):265-72
references: 16621661
references: Mov Disord. 2011 Dec;26(14):2516-21
references: 22170276
references: Parkinsonism Relat Disord. 2013 Jan;19(1):56-61
references: 22841616
references: Br J Psychiatry. 1979 Apr;134:382-9
references: 444788
references: Mov Disord. 2009 Aug 15;24(11):1641-9
references: 19514014
references: PLoS One. 2013 May 22;8(5):e64222
references: 23717572
references: Proc Natl Acad Sci U S A. 2013 Nov 19;110(47):E4502-9
references: 24194552
references: J Neurol. 1998 May;245 Suppl 1:S2-6
references: 9617714
references: Cortex. 1976 Dec;12(4):313-24
references: 1009768
references: Mov Disord. 1992;7(1):2-13
references: 1557062
references: Hum Brain Mapp. 2008 Jun;29(6):683-95
references: 17598168
references: Lancet Neurol. 2006 Mar;5(3):235-45
references: 16488379
references: Age Ageing. 2001 Jul;30(4):299-302
references: 11509307
references: Curr Alzheimer Res. 2011 Jun;8(4):354-60
references: 21222591
references: Acta Neurol Belg. 1990;90(4):207-17
references: 2124031
references: Lancet. 1993 Aug 14;342(8868):418-21
references: 8101908
references: Parkinsonism Relat Disord. 2011 Jan;17(1):1-9
references: 20833572