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Perfusion brain SPECT in assessing motor improvement after deep brain stimulation in Parkinson’s disease

  • Clinical Article - Movement Disorders
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Abstract

Background

High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an established therapeutic approach for the management of patients with late-stage idiopathic Parkinson’s disease (PD). The aim of the present study was to assess regional cerebral blood flow (rCBF) changes related to motor improvement.

Methods

Twenty-one PD patients underwent two rCBF SPECT studies at rest, once preoperatively in the off-meds state and the other postoperatively (at 6 ± 2 months) in the off medication/on stimulation state. Patients were classified according to the UPDRS and H&Y scale. NeuroGam software was used to register, quantify, and compare two sequential brain SPECT studies of the same patient in order to investigate rCBF changes during STN stimulation in comparison with preoperative rCBF. The relationship between rCBF and UPDRS scores was used as a covariate of interest.

Results

Twenty patients showed clinical improvement during the first months after surgery, resulting in a 44 % reduction of the UPDRS motor score. The administered mean daily levodopa dose significantly decreased from 850 ± 108 mg before surgery to 446 ± 188 mg during the off-meds state (p < 0.001, paired t test). At the 6-month postoperative assessment, we noticed rCBF increases in the pre-supplementary motor area (pre-SMA) and the premotor cortex (PMC) (mean rCBF increase = 10.2 %, p < 0.05), the dorsolateral prefrontal cortex and in associative and limbic territories of the frontal cortex (mean rCBF increase = 8.2 %, p > 0.05). A correlation was detected between the improvement in motor scores and the rCBF increase in the pre-SMA and PMC (r = 0.89, p < 0.001).

Conclusions

Our study suggests that STN stimulation leads to improvement in neural activity and rCBF increase in higher-order motor cortical areas.

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Acknowledgments

The authors would like to thank Miltos Georgiopoulos, Zinovia Kefalopoulou, and Elli Markaki for helpful advice and assistance.

Conflicts of interest

None.

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Authors and Affiliations

  1. Nuclear Medicine Department, Patras University Hospital, Patras, Rion, 26500, Greece

    Anna Paschali

  2. Neurosurgery and Functional Neurosurgery Department, Patras University Hospital, Patras, Rion, 26500, Greece

    Constantinos Constantoyannis

  3. Basic Medical Sciences, Department of Physiology, Medical School of the University of Patras, University of Patras, Panepistemioupolis, 26500, Greece

    Fevronia Angelatou

  4. Nuclear Medicine Department of Patras University Hospital, Medical School of the University of Patras, Patras, Rion, 26500, Greece

    Pavlos Vassilakos

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  1. Anna Paschali
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  2. Constantinos Constantoyannis
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Correspondence to Anna Paschali.

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Paschali, A., Constantoyannis, C., Angelatou, F. et al. Perfusion brain SPECT in assessing motor improvement after deep brain stimulation in Parkinson’s disease. Acta Neurochir 155, 497–505 (2013). https://doi.org/10.1007/s00701-012-1610-z

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  • DOI: https://doi.org/10.1007/s00701-012-1610-z

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