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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 71, Number 10, September 2, 2008 JapaneseTranslation All Versions of this Article: 01.wnl.0000312380.01852.77v1 71/10/708    most recent Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hilker, R. Articles by Heiss, W. D. Search for Related Content PubMed PubMed Citation Articles by Hilker, R. Articles by Heiss, W. D. Related Collections PET Parkinson's disease/Parkinsonism Surgery/Stimulation

STN-DBS activates the target area in Parkinson disease

An FDG-PET study

From the Department of Neurology (R.H., J.R., S.B.), Goethe University, Frankfurt; Department of Stereotaxy and Functional Neurosurgery (J.V., M.H., V.S.) and Department of Neurology (T.W.), University Hospital, Cologne; and Max-Planck-Institute for Neurological Research (L.W.K., W.D.H.), Cologne, Germany.

Address correspondence and reprint requests to Dr. Ruediger Hilker, Department of Neurology, Goethe-University, Schleusenweg 2-16, D-60528 Frankfurt, Germany hilker{at}med.uni-frankfurt.de

Objective: The immediate effects of deep brain stimulation (DBS) on subcortical neurons of its target region are controversial.

Methods: We measured the regional normalized resting cerebral metabolic rate of glucose (nCMRGlc) with 18-fluorodeoxyglucose (FDG) and PET in 12 patients with Parkinson disease (PD) and bilateral DBS of the subthalamic nucleus (STN) compared to 10 age-matched controls. PET was performed before surgery and 6 months after electrode implantation in DBS off- and on-conditions. Stereotactic coordinates of active STN electrode poles were determined with intraoperative skull x-ray and transferred to preoperative MR images. Subsequently, volumes of interest (VOIs) were placed around active electrode contacts, in the STN and in the globus pallidus. DBS induced changes of nCMRGlc values were determined in each VOI after PET and MRI coregistration.

Results: Electrode placement without stimulation led to significant FDG uptake reduction in the electrode region and in the STN (microlesional effect). Under active DBS, the local nCMRGlc significantly increased in all VOIs under investigation.

Conclusions: The data demonstrate that deep brain stimulation (DBS) induced metabolic activation of the subthalamic region and the directly connected globus pallidus which is in line with local and remote excitation of neurons by high frequency stimulation. These PET findings most likely reflect tonic driving of the DBS target area and its projection sites via ortho- and antidromic fiber conduction. We conclude that subthalamic nucleus DBS has predominant excitatory properties and does, therefore, fundamentally differ from lesional neurosurgery.

Abbreviations: DBS = deep brain stimulation; FDG = 18-fluorodeoxyglucose; FWHM = full width at half maximum; GP = globus pallidus; GPi = internal pallidum; nCMRGlc = normalized resting cerebral metabolic rate of glucose; PD = Parkinson disease; PVE = partial volume effects; RC = recovery coefficient; rCBF = regional cerebral blood flow; rCMRGlc = regional cerebral metabolic rates of glucose; STN = subthalamic nucleus; TE = echo time; TR = repetition time; UPDRS = Unified Parkinson’s Disease Rating Scale; VIM = ventral intermediate nucleus; VOI = volume of interest.

Editorial, page 704

e-Pub ahead of print on July 23, 2008, at www.neurology.org.

Disclosure: The authors report no disclosures.

Received October 19, 2007. Accepted in final form February 15, 2008.

This article has been cited by other articles:

				E. B. Montgomery Jr and R. Hilker STN-DBS ACTIVATES THE TARGET AREA IN PARKINSON DISEASE Neurology, July 28, 2009; 73(4): 327 - 328. [Full Text] [PDF]

				W. R. W. Martin and M. Wieler Subthalamic nucleus stimulation in Parkinson disease: Exciting or depressing? Neurology, September 2, 2008; 71(10): 704 - 705. [Full Text] [PDF]

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