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Preoperative brain metabolism and quality of life after subthalamic nucleus stimulation in Parkinson’s disease

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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.

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Acknowledgments

The authors would like to thank all the members of the neurology department for their help in gathering and collating the data.

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standard

Written informed consent was obtained from each participant, and the study met the ethical standards of the institutional ethical standards committee on human experimentation.

Author information

Authors and Affiliations

  1. Department of Neurology, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France

    Sophie Langner-Lemercier, Sophie Drapier, Jean-François Houvenaghel & Marc Vérin

  2. Department of Psychiatry, Guillaume Régnier Hospital Centre, Rennes, France

    Florian Naudet & Nathalie Le Clanche

  3. Behavior and Basal Ganglia Research Unit 4712, University of Rennes 1, Rennes, France

    Sophie Drapier, Florian Naudet, Nathalie Le Clanche, Jean-François Houvenaghel, Paul Sauleau, Florence Le Jeune & Marc Vérin

  4. Clinical Investigation Center, INSERM 0203, Rennes University Hospital, University of Rennes 1, Rennes, France

    Florian Naudet

  5. Department of Neurophysiology, Rennes University Hospital, Rennes, France

    Paul Sauleau

  6. INSERM UMR 1099, LTSI, University of Rennes 1, Rennes, France

    Pierre Jannin & Claire Haegelen

  7. Department of Neurosurgery, Rennes University Hospital, Rennes, France

    Claire Haegelen

  8. Department of Nuclear Medicine, Eugene Marquis Hospital Centre, Rennes, France

    Florence Le Jeune

Authors
  1. Sophie Langner-Lemercier
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  2. Sophie Drapier
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  3. Florian Naudet
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  4. Nathalie Le Clanche
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  5. Jean-François Houvenaghel
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  6. Paul Sauleau
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  7. Pierre Jannin
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  8. Claire Haegelen
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  9. Florence Le Jeune
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  10. Marc Vérin
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Corresponding author

Correspondence to Sophie Langner-Lemercier.

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Langner-Lemercier, S., Drapier, S., Naudet, F. et al. Preoperative brain metabolism and quality of life after subthalamic nucleus stimulation in Parkinson’s disease. J Neurol 262, 881–889 (2015). https://doi.org/10.1007/s00415-015-7647-1

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  • DOI: https://doi.org/10.1007/s00415-015-7647-1

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