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Are there adaptive changes in the human brain of patients with Parkinson’s disease treated with long-term deep brain stimulation of the subthalamic nucleus? A 4-year follow-up study with regional cerebral blood flow SPECT

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Abstract

Purpose

The aim of this follow-up study was to assess persistent motor and regional cerebral blood flow (rCBF) changes in patients with Parkinson’s disease (PD) treated with high-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN).

Methods

Ten PD patients with STN-DBS underwent three rCBF SPECT studies at rest, once preoperatively in the off-drug condition (T0), and twice postoperatively in the off-drug/off-stimulation conditions at 5 ± 2 (T1) and 42 ± 7 months (T2). Patients were assessed using the UPDRS, H&Y and S&E scales. SPM was used to investigate baseline rCBF changes from the preoperative condition to the postoperative conditions and the relationship between rCBF and UPDRS scores used as covariate of interest.

Results

Parkinsonian patients showed a clinical improvement which was significant only on follow-up at 42 months. The main effect of treatment from T0 to T1 was to produce baseline rCBF increases in the pre-supplementary motor area (pre-SMA), premotor cortex and somatosensory association cortex. From T1 to T2 a further baseline rCBF increase was detected in the pre-SMA (p < 0.0001). A correlation was detected between the slight improvement in motor scores and the rCBF increase in the pre-SMA (p < 0.0001), which is known to play a crucial role in clinical progression.

Conclusion

Our study suggests the presence of adaptive functional changes in the human brain of PD patients treated with long-term STN-DBS. Such adaptive processes seem to occur in the pre-SMA and to play only a slightly beneficial role in terms of functional compensation of motor impairment.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Nuclear Medicine Unit, Ospedale Misericordia e Dolce, Piazza Ospedale 5, 59100, Prato, Italy

    Stelvio Sestini & Antonio Castagnoli

  2. Department of Clinical Physiopathology, Nuclear Medicine Unit, University of Florence, Florence, Italy

    Alberto Pupi

  3. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy

    Franco Ammannati, Ramat Silvia & Sandro Sorbi

Authors
  1. Stelvio Sestini
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  2. Alberto Pupi
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  3. Franco Ammannati
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  4. Ramat Silvia
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  5. Sandro Sorbi
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  6. Antonio Castagnoli
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Correspondence to Stelvio Sestini.

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Sestini, S., Pupi, A., Ammannati, F. et al. Are there adaptive changes in the human brain of patients with Parkinson’s disease treated with long-term deep brain stimulation of the subthalamic nucleus? A 4-year follow-up study with regional cerebral blood flow SPECT. Eur J Nucl Med Mol Imaging 34, 1646–1657 (2007). https://doi.org/10.1007/s00259-007-0428-z

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