Evolving metabolic changes during the first postoperative year after subthalamotomy
Journal
Journal of Neurosurgery
Journal Volume
99
Journal Issue
5
Pages
872-878
Date Issued
2003
Author(s)
Abstract
Object. Short-term benefit from unilateral subthalamotomy for advanced Parkinson disease (PD) is associated with metabolic alterations in key targets of subthalamic nucleus (STN) and globus pallidus (GP) output. In this study positron emission tomography (PET) scanning was used to assess these changes and their relation to long-term benefits of subthalamotomy. Methods. To determine whether the early postoperative changes persisted at longer-term follow up, the authors assessed six patients with advanced PD by using [ 18F]fluorodeoxyglucose-PET at 3 and 12 months postsurgery. The authors compared each of the postoperative images with baseline studies, and assessed interval changes between the short- and long-term follow-up scans. Clinical improvement at 3 and 12 months was associated with sustained metabolic decreases in the midbrain GP internus (GPi), thalamus, and pons of the lesioned side (p < 0.01). The activity of a PD-related multiregional brain network, which correlated with bradykinesia and rigidity, was reduced at both postoperative time points (p < 0.05). Comparisons of 3- and 12-month images revealed a relative metabolic increase in the GP externus (GPe) (p < 0.001), which was associated with worsening gait, postural stability, and tremor at long-term follow up. Conclusions. These findings indicate that subthalamotomy may have differential effects on each of the functional pathways that mediate parkinsonian symptomatology. Sustained relief of amnesia and rigidity is associated with suppression of a pathological network involving the GPi and its output. In contrast, the recurrence of tremor may relate to changes in the function of an STN-GPe oscillatory network.
Subjects
Globus pallidus; Parkinson disease; Positron emission tomography; Subthalamic nucleus; Subthalamotomy
SDGs
Other Subjects
fluorodeoxyglucose f 18; adult; akinesia; article; body equilibrium; body posture; brain function; brain metabolism; brain region; clinical article; controlled study; correlation analysis; disease severity; female; follow up; gait disorder; globus pallidus; glucose utilization; human; image analysis; imaging system; isotope labeling; male; mesencephalon; nerve cell network; nerve projection; oscillation; outcomes research; Parkinson disease; pons; positron emission tomography; postoperative period; priority journal; rigidity; scoring system; subthalamic nucleus; symptomatology; thalamotomy; thalamus; tremor
Type
journal article