Article Text
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