Pallidal Deep Brain Stimulation and L-Dopa Effect on PET Motor Activation in Advanced Parkinson's Disease

Authors: Valálik, István; Emri, Miklós; Lengyel, Zsolt; Mikecz, Pál; Trón, Lajos; Csókay, András; Márián, Teréz

Source: Journal of Neuroimaging, Volume 19, Number 3, July 2009 , pp. 253-258(6)

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Abstract:

BACKGROUND AND PURPOSE

The antiakinetic effect of internal Globus pallidus deep brain stimulation (Gpi-DBS) in Parkinson's disease is not clear and not either how this effect is modulated by L-dopa. METHODS

Left Gpi-DBS and/or L-dopa effect was studied with auditory paced right-handed sequential movements on ¹⁵O-butanol positron emission tomography (PET) in five patients. Rest and for conditions during movements (DBS off/L-dopa off; DBS on/L-dopa off; DBS off/L-dopa on; DBS on/L-dopa on) were compared with statistical parametric mapping. RESULTS

Gpi-DBS activated the right supplementary motor area/premotor (SMA/PMC), and right insular cortex (IC), and as L-dopa decreased the left sensorimotor cortex (M1/S1) activity. L-dopa increased the left ventrolateral thalamus (VLTH), and decreased the left superior parietal cortex (PC) activity. Gpi-DBS and L-dopa interaction showed right SMA/PMC, IC, and left PC activation, decrease of left VLTH, PMC, and dorsolateral prefrontal cortex (PFC) activity. CONCLUSIONS

The improvement of bradykinesia with Gpi-DBS is secondary and contributed to the regress of M1/S1-related rigidity and compensatory SMA/PMC, and IC activation. L-dopa and Gpi-DBS alone each reduces M1/S1 overactivity. Interaction ignores this effect, moreover has akinetic effect in the left VLTH, PMC, and PFC. Motor improvement possibly related to left PC and compensatory right SMA/PMC, and IC activation.

J Neuroimaging 2009;19:253-258.

Keywords: PET; Parkinson's disease; globus pallidus; L-dopa; deep brain stimulation; sequential movements

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1552-6569.2008.00304.x

Affiliations: 1: From the'Department of Neurosurgery, St. John's Hospital, Budapest, Hungary (IV, AC); PET Centre, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary (ME, ZL, PM, LT, TM); PET Study Group of the Hungarian Academy of Science, Budapest, Hungary (LT, TM).[Correction added after online publication 10-June-2009: Received and revised dates have been corrected.]

Publication date: 2009-07-01

Pallidal Deep Brain Stimulation and L-Dopa Effect on PET Motor Activation in Advanced Parkinson's Disease

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