title: A preoperative metabolic marker of parkinsonian apathy following subthalamic nucleus stimulation.
abstract: BACKGROUND
  Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) has been associated with the development of postoperative apathy. Debate on the causes of postoperative apathy continues, and the dominant hypothesis is that stimulation or dopaminergic drug reductions are causal in its development. We hypothesized that a preoperative predisposition to apathy also could exist. To this end, we sought to identify a preoperative metabolic pattern using [(18)]Fluorodeoxyglucose Positron Emission Tomography (PET), which could be associated with the occurrence of postoperative apathy after STN-DBS for PD.
  
  
  METHODS
  Thirty-four patients with PD, not clinically apathetic, underwent an [(18)]Fluorodeoxyglucose-PET scan before surgery of STN-DBS, and were tested for the occurrence of apathy 1 y after surgery. Whole-brain voxel-based PET intergroup comparison (P < 0.005; corrected for the cluster) was evaluated between patients who developed apathy at 1 y and those who did not.
  
  
  RESULTS
  Eight patients (23.5%) became apathetic after surgery. Motor improvement and decrease in dopaminergic treatment were similar in both postoperative apathy and non-apathy groups. We found a cluster of significantly greater metabolism in the postoperative apathy group within the cerebellum, brainstem (in particular ventral tegmental area), temporal lobe, insula, amygdala, lentiform nucleus, subgenual anterior cingulate, and inferior frontal gyrus. A metabolic value above 68 could discriminate patients who would develop postoperative apathy with 100% sensitivity and 88.5% specificity.
  
  
  CONCLUSIONS
  We describe a preoperative metabolic pattern associated with the development of apathy after STN-DBS in PD. This suggests the existence of a predisposition to apathy, which may further be triggered by perioperative drug modifications.
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.|Institut de Neurosciences de la Timone UMR 7289, Aix Marseille Université, CNRS, Marseille, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Gesquière-Dando
authors.affiliation: Institut de Neurosciences de la Timone UMR 7289, Aix Marseille Université, CNRS, Marseille, France.|APHM, CHU Timone, Service Central de Biophysique et Médecine Nucléaire, Aix Marseille Université, Marseille, France.|CERIMED, Aix-Marseille Université, Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Guedj
authors.affiliation: APHM, CHU Timone, Unité d'Aide méthodologique à la Recherche Clinique et Epidémiologique, DRRC, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: APHM, CHU Timone, Department of Functional and Stereotactic Neurosurgery, Aix Marseille Université, Marseille, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Carron
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.|Institut de Neurosciences de la Timone UMR 7289, Aix Marseille Université, CNRS, Marseille, France.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Witjas
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Fluchère
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Delfini
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Mundler
authors.affiliation: APHM, CHU Timone, Department of Functional and Stereotactic Neurosurgery, Aix Marseille Université, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Regis
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.|Institut de Neurosciences de la Timone UMR 7289, Aix Marseille Université, CNRS, Marseille, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Azulay
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, Aix Marseille Université, Marseille, France.|Institut de Neurosciences de la Timone UMR 7289, Aix Marseille Université, CNRS, Marseille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Eusebio
mesh_terms: D000368:Aged; D057565:Apathy / Q000502:physiology*; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism*; D046690:Deep Brain Stimulation; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy*; D049268:Positron-Emission Tomography; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: FDG PET; Parkinson's disease; apathy; predictive marker; subthalamic nucleus stimulation