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  • Disease progression continues in patients with advanced Parkinson’s disease and effective subthalamic nucleus stimulation

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Disease progression continues in patients with advanced Parkinson’s disease and effective subthalamic nucleus stimulation
  1. R Hilker1,*,
  2. A T Portman2,*,
  3. J Voges3,
  4. M J Staal4,
  5. L Burghaus1,
  6. T van Laar2,
  7. A Koulousakis3,
  8. R P Maguire2,
  9. J Pruim5,
  10. B M de Jong2,
  11. K Herholz1,
  12. V Sturm3,
  13. W-D Heiss1,6,
  14. K L Leenders2
  1. 1Department of Neurology, Medical University of Cologne, Cologne, Germany
  2. 2Department of Neurology, University Hospital, Groningen, the Netherlands
  3. 3Department of Stereotaxy and Functional Neurosurgery, Medical University of Cologne, Cologne, Germany
  4. 4Department of Neurosurgery, University Hospital, Groningen, the Netherlands
  5. 5PET Centre, University Hospital, Groningen, the Netherlands
  6. 6Max-Planck-Institute for Neurological Research Cologne, Cologne, Germany
  1. Correspondence to:
 Dr R Hilker
 Department of Neurology, University Hospital, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany; hilkerpet.mpin-koeln.mpg.de

Abstract

Objectives: Glutamate mediated excitotoxicity of the hyperactive subthalamic nucleus (STN) has been reported to contribute to nigral degeneration in Parkinson’s disease (PD). Deep brain stimulation of the STN (STN DBS), in its role as a highly effective treatment of severe PD motor complications, has been thought to inhibit STN hyperactivity and therefore decrease progression of PD.

Methods: In a prospective two centre study, disease progression was determined by means of serial 18F-fluorodopa (F-dopa) positron emission tomography (PET) in 30 patients with successful STN DBS over the first 16 (SD 6) months after surgery.

Results: Depending on the method of PET data analysis used in the two centres, annual progression rates relative to baseline were 9.5–12.4% in the caudate and 10.7–12.9% in the putamen.

Conclusions: This functional imaging study is the first to demonstrate a continuous decline of dopaminergic function in patients with advanced PD under clinically effective bilateral STN stimulation. The rates of progression in patients with STN DBS were within the range of previously reported data from longitudinal imaging studies in PD. Therefore this study could not confirm the neuroprotective properties of DBS in the STN target.

  • DBS, direct brain stimulation
  • Kocc, influx constant
  • LEDD, levodopa equivalent daily dose
  • PET, positron emission tomography
  • ROI, region of interest
  • SOR, striatal to occipital ratio
  • STN, subthalamic nucleus
  • UPDRS, Unified Parkinson’s Disease Rating Scale
  • Parkinson’s disease
  • deep brain stimulation
  • positron emission tomography

https://doi.org/10.1136/jnnp.2004.057893

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    Footnotes

    • ↵* The first two authors contributed equally to this work.

    • See Editorial Commentary, p 1186

    • This study was supported by the Stichting Internationaal Parkinson Fonds, Hoofddorp (the Netherlands).

    • Competing interests: none declared

    • The study was approved by local ethics committees of Cologne and Groningen medical faculties.

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