Velasco Francisco, Llanos Sara, Avila-Rodriguez Miguel A, Avendaño-Estrada Arturo, Soto Julián, Concha Luis, García Gomar María Guadalupe, Carrillo-Ruiz José D
Unit for Stereotactic, Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico City, Mexico.
Stereotact Funct Neurosurg. 2015;93(5):333-41. doi: 10.1159/000438997. Epub 2015 Sep 10.
The aim of this work was to study mechanisms of action of electrical stimulation of prelemniscal radiations (Raprl) in the treatment of Parkinson disease, using 2-deoxy-2-fluoro-D-glucose (18F-FDG) Positron Emission Tomography (PET/CT). Materialand Methods: Five patients with PD and predominant unilateral tremor, rigidity and bradykinesia underwent deep brain stimulation (DBS) in contralateral Raprl that improved symptoms from 82.4 to 94.5%. 18F-FDG PET studies were performed before electrode implantation and after DBS therapy. Changes in metabolic activity in PET were evaluated by the maximal standardized uptake value (MSUV) and statistical parametric mapping (SPM) for regions of interest (ROIs) ipsilateral and contralateral to the stimulation site. ROIs were derived from a preoperative probabilistic tractography and included primary motor, supplementary motor and orbitofrontal cortices: Raprl, ventrolateral thalamus, putamen and cerebellum.
No significant MSUV changes occurred in ROIs contralateral to Raprl-DBS. In contrast, MSUV decreased ipsilateral to DBS in Raprl, the thalamus, and the primary and supplementary motor cortices. SPM analysis showed metabolic changes which were significantly different after DBS therapy in all ROIs ipsilateral to DBS compared to those in the contralateral side.
Raprl-DBS decreases the metabolic activity of areas anatomically related to its fiber composition. Improvement of symptoms may result from a decrease in pathological overactivity of circuits related to the ROIs.
本研究旨在利用2-脱氧-2-氟-D-葡萄糖（18F-FDG）正电子发射断层扫描（PET/CT）研究刺激丘脑前辐射（Raprl）治疗帕金森病的作用机制。材料与方法：5例以单侧震颤、强直和运动迟缓为主的帕金森病患者接受了对侧Raprl的深部脑刺激（DBS），症状改善率从82.4%提高到94.5%。在电极植入前和DBS治疗后进行了18F-FDG PET研究。通过最大标准化摄取值（MSUV）和感兴趣区（ROI）同侧和对侧刺激部位的统计参数映射（SPM）评估PET中的代谢活性变化。ROI来自术前概率性纤维束成像，包括初级运动皮层、辅助运动皮层和眶额皮层：Raprl、腹外侧丘脑、壳核和小脑。
Raprl-DBS对侧的ROI中未出现显著的MSUV变化。相比之下，Raprl、丘脑以及初级和辅助运动皮层中DBS同侧的MSUV降低。SPM分析显示，与对侧相比，DBS同侧所有ROI在DBS治疗后的代谢变化有显著差异。
Raprl-DBS降低了与其纤维组成相关区域的代谢活性。症状改善可能源于与ROI相关回路病理性过度活动的减少。
