Fukuda M, Mentis M J, Ma Y, Dhawan V, Antonini A, Lang A E, Lozano A M, Hammerstad J, Lyons K, Koller W C, Moeller J R, Eidelberg D
Center for Neurosciences, North Shore-Long Island Jewish Research Institute, Manhasset, New York 11030, USA.
Brain. 2001 Aug;124(Pt 8):1601-9. doi: 10.1093/brain/124.8.1601.
Employing [(18)F]fluorodeoxyglucose (FDG) and PET, we have found previously that stereotaxic ablation of the internal globus pallidus (GPi) for Parkinson's disease causes resting metabolic changes in brain regions remote from the lesion site. In this study we determined whether similar metabolic changes occur in Parkinson's disease patients treated with deep brain stimulation (DBS) of the GPi. We studied seven Parkinson's disease patients with FDG-PET to measure resting regional cerebral glucose utilization on and off GPi stimulation. We used statistical parametric mapping to identify significant changes in regional brain metabolism that occurred with this intervention. We also quantified stimulation-related changes in the expression of a specific abnormal Parkinson's disease-related pattern of metabolic covariation (PDRP) that had been identified in earlier FDG-PET studies. Metabolic changes with DBS were correlated with clinical improvement as measured by changes in Unified Parkinson's Disease Rating Scale (UPDRS) motor ratings off medication. GPi DBS improved UPDRS motor ratings (36%, P < 0.001) and significantly increased regional glucose metabolism in the premotor cortex ipsilateral to stimulation and in the cerebellum bilaterally. GPi DBS also resulted in a significant (P < 0.01) decline in PDRP activity ipsilateral to stimulation, which correlated significantly with clinical improvement in UPDRS motor ratings (P < 0.03). Clinical improvement with GPi DBS is associated with reduced expression of an abnormal Parkinson's disease-related metabolic network involving elements of the cortico-striato-pallido-thalamocortical and the cerebello-cortical motor loops.
我们之前利用[18F]氟脱氧葡萄糖（FDG）和正电子发射断层扫描（PET）发现，针对帕金森病进行的苍白球内侧部（GPi）立体定向毁损会导致远离损伤部位的脑区静息代谢发生变化。在本研究中，我们确定了接受GPi深部脑刺激（DBS）治疗的帕金森病患者是否会出现类似的代谢变化。我们对7名帕金森病患者进行了FDG-PET研究，以测量GPi刺激开启和关闭时的静息区域脑葡萄糖利用情况。我们使用统计参数映射来识别这种干预引起的区域脑代谢的显著变化。我们还对早期FDG-PET研究中确定的一种特定的与帕金森病相关的异常代谢协变模式（PDRP）的表达中与刺激相关的变化进行了量化。DBS引起的代谢变化与通过停药时统一帕金森病评定量表（UPDRS）运动评分变化所衡量的临床改善相关。GPi DBS改善了UPDRS运动评分（36%，P<0.001），并显著增加了刺激同侧运动前皮质和双侧小脑的区域葡萄糖代谢。GPi DBS还导致刺激同侧的PDRP活性显著下降（P<0.01），这与UPDRS运动评分的临床改善显著相关（P<0.03）。GPi DBS带来的临床改善与涉及皮质-纹状体-苍白球-丘脑皮质和小脑-皮质运动环路的与帕金森病相关的异常代谢网络表达降低有关。
