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Mechanisms of unilateral STN-DBS in patients with Parkinson’s disease

A PET study

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Abstract

Bilateral symptoms and signs of Parkinson’s disease (PD) are often improved by unilateral subthalamic nucleus deep brain stimulation (STN-DBS). However, the mechanism for such bilateral effects is unknown. This study was intended to examine effects of unilateral STN-DBS using positron emission computed tomography (PET) and to elucidate mechanisms for bilateral improvement achieved by unilateral stimulation.

We conducted 18F-fluorodeoxyglucose (18FDG) and 18F-fluorodopa (18F-DOPA ) PET scans in PD patients whose bilateral limb symptoms and axial symptoms were improved by unilateral DBS. Two scans were performed in each PET study: when DBS was on and off. We compared those images using statistic parametric mapping (SPM) 99.

The significant clinical improvement obtained by unilateral DBS was shown as improvements in bilateral motor limb, axial, and gait subscores of the Unified PD Rating Scale (UPDRS). Moreover, 18FDG PET revealed significant metabolic increases in the ipsilateral ventrolateral thalamic areas and metabolic decrease at the contralateral globus pallidus interna (GPi). In contrast, 18F-DOPA PET showed no significant differences between DBS on and off.

Ipsilateral thalamic activation might induce ipsilateral motor cortical activation, which explains the improvement of contralateral limb symptoms. Furthermore, deactivation of the contralateral GPi might disinhibit the thalamus and contralateral motor cortex, which explains reduction of ipsilateral limb symptoms. These results suggest the mechanisms for bilateral improvement achieved by unilateral DBS.

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Authors and Affiliations

  1. Dept. of Neurology, Division of Neuroscience, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    N. Arai &  Y. Ugawa

  2. Dept. of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu City, Tokyo, 183-0042, Japan

    F. Yokochi & R. Okiyama

  3. Dept. of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu City, Tokyo, 183-0042, Japan

    M. Taniguchi & H. Takahashi

  4. Dept. of Radiology, National Center Hospital of Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira City, Tokyo, 187-8551, Japan

    N. Arai, T. Ohnishi & H. Matsuda

  5. Dept. of Radiology, Division of Nuclear Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    T. Momose

  6. Dept. of Neurology, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan

    Y. Ugawa

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  1. N. Arai
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  2. F. Yokochi
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  3. T. Ohnishi
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  4. T. Momose
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  5. R. Okiyama
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  6. M. Taniguchi
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  7. H. Takahashi
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  8. H. Matsuda
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  9. Y. Ugawa
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Correspondence to Y. Ugawa.

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Arai, N., Yokochi, F., Ohnishi, T. et al. Mechanisms of unilateral STN-DBS in patients with Parkinson’s disease. J Neurol 255, 1236–1243 (2008). https://doi.org/10.1007/s00415-008-0906-7

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  • DOI: https://doi.org/10.1007/s00415-008-0906-7

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