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Changes in Regional Cerebral Blood Flow Caused by Deep-Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease

¹ Department of Clinical Physiopathology, Nuclear Medicine Section, Careggi Hospital, University of Florence, Florence, Italy
² Departments of Neurological and Psychiatric Science, Careggi Hospital, University of Florence, Florence, Italy

View larger version (24K): [in a new window]   FIGURE 1. Plots of clinical scores (mean ± SD) for motor UPDRS, H&Y, and S&E for preoperative (before DBS) and postoperative conditions with STN stimulators on (DBS on) and off (DBS off) and plots of daily consumption of levodopa (L-Dopa) therapy before and after DBS implantation. Clinical scores were assessed in unmedicated patients. Reduction in motor UPDRS and H&Y scores and increase in S&E score indicate improvement in motor function, global stage disease, and performance of activities of daily living, respectively. Differences between mean scores for UPDRS, H&Y, S&E were significant (P < 0.001). Differences between mean scores of daily consumption of levodopa therapy were significant (P < 0.05). Results are expressed as mean ± SD

View larger version (37K): [in a new window]   FIGURE 2. Depiction of cortical areas showing significant rCBF increase with STN stimulators on (DBS on) in comparison with preoperatively (pre-DBS) and postoperatively with STN stimulators off (DBS off). STN stimulation induced rCBF increases in motor (right pre-SMA), associative (DLPFC and medial BA8), and limbic (ACC) areas of frontal lobes in living brain of 10 parkinsonian patients. (A) Results are displayed as SPM projections in 3 orthogonal views, with cutoff of P < 0.05 corrected for multiple comparisons. (B and C) Plots of mean and individual adjusted rCBF values during preoperative (pre-DBS) and postoperative (DBS on and DBS off) conditions are depicted for right pre-SMA (B) and, bilaterally, for ACC, DLPFC, and medial BA8 (C).

View larger version (53K): [in a new window]   FIGURE 3. Transaxial brain SPECT section of patient 2 during each scanning condition: preoperatively (left), postoperatively with STN stimulators on (middle), and postoperatively with STN stimulators off (right). Arrows show rCBF increase in right frontal cortex and, to lesser extent, left frontal cortex and ACC during STN stimulation in comparison with preoperatively and during no STN stimulation.

View larger version (29K): [in a new window]   FIGURE 4. Cortical regions whose increases in rCBF significantly correlated with observed improvement in motor function during STN stimulation in comparison with preoperatively and during no STN stimulation. Significant relationship was detected between motor UPDRS scores and rCBF in right supplementary motor area (pre-SMA) and in small area of adjacent ACC referred to as anterior cingulate motor area. Results are displayed as SPM projections in 3 orthogonal views (A) and on 3-dimensional template (B), with cutoff of P < 0.005 (uncorrected).