THALAMIC BLOOD FLOW CHANGE INDUCED BY SUBTHALAMIC DEEP BRAIN STIMULATION IN PARKINSON'S DISEASE

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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has emerged as a promising treatment for medically refractory Parkinson's disease (PD). However, the true mechanism of the action in STN DBS is not well understood. In this study, we investigated the effect of STN stimulation on regional cerebral blood flow (rCBF) as an index of functional activity in five patients with PD. Regional CBF in resting condition was quantitatively measured with perfusion single photon emission computed tomography (SPECT) using iodine-123-labelled N-isopropyl-p-iodoamphetamine (IMP) in both stimulation-off and stimulation-on states. The data of the IMP SPECT was analyzed using fully automated rCBF quantification software, three-dimensional stereotaxic ROI template (3 DSRT). Bilateral STN DBS alleviated PD symptoms and its fluctuation markedly and reduced the need for dopaminergic medication in all five patients. Thalamic blood flow increased significantly when STN stimulation was on (p<0.05). No significant rCBF change with STN stimulation was found in other regions. STN DBS seems to inhibit activity in the STN and the internal portion of the globus pallidus (GPi), which reduce inhibition of the thalamus within the basal ganglia-thalamocortical circuit. Consequently, increased activity of motor thalamus appears to improve motor symptoms in PD.
名古屋市立大学の論文