title: Long-term dopamine transporter imaging in Parkinson's disease treated with zona incerta stimulation.
abstract: OBJECTIVE
  The caudal zona incerta (cZI) is a promising, clinically beneficial target for deep brain stimulation (DBS) in Parkinson's disease (PD). To assess whether DBS of the cZI affects the rate of dopamine terminal dysfunction, PD patients with and without DBS were followed prospectively with I FP-Cit single photon emission tomography from the first diagnosis and up to 8 years.
  
  
  METHODS
  Six patients underwent DBS of the cZI during the survey period. Twenty-two PD patients only on pharmacotherapy served as controls. I FP-Cit and clinical assessment were performed at baseline and after 1, 3 and 5 years in all patients. Ten patients also underwent a I FP-Cit after 8 years. Image data were evaluated semiquantitatively. Mixed-model analysis was used to assess the relative change in I FP-Cit uptake and comparison between surgically and conservatively treated PD patients.
  
  
  RESULTS
  The relative decrease in I FP-Cit uptake was more pronounced in DBS-treated patients than in controls in the more affected caudate (P=0.037) and putamen (P=0.013). The annual decrease rates were higher in the less affected than the more affected putamen, and were slightly greater in DBS-treated patients (4.8%, 95%confidence interval: 8.5-2.2%) than in controls (4.0%, 95% confidence interval: 5.1-3.1%).
  
  
  CONCLUSIONS
  This long-term prospective study confirms that the underlying dopaminergic dysfunction continues despite clinical improvement in PD patients with DBS of the cZI. A slightly faster rate of decrease in I FP-Cit uptake in these patients compared with conservatively treated PD patients may reflect a more aggressive form of PD.
authors.affiliation: Departments of aRadiation Sciences, Diagnostic Radiology bPharmacology and Clinical Neuroscience cEpidemiology and Global Health, Public Health and Clinical Medicine, Umeå University, Umeå, Sweden dUnit of Functional Neurosurgery, UCL Institute of Neurology, London, UK.
authors.forename: Susanna Jakobson
authors.initials: SJ
authors.lastname: Mo
authors.forename: Jan
authors.initials: J
authors.lastname: Linder
authors.forename: Patric
authors.initials: P
authors.lastname: Blomstedt
authors.forename: Gabriel
authors.initials: G
authors.lastname: Granåsen
authors.forename: Lars
authors.initials: L
authors.lastname: Forsgren
authors.forename: Marwan
authors.initials: M
authors.lastname: Hariz
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057054:Molecular Imaging; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D021381:Protein Transport; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D065820:Zona Incerta / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*
chemical_list: D050483:Dopamine Plasma Membrane Transport Proteins