Metabolic changes following subthalamotomy for advanced Parkinson's disease

Authors

  • Philip C. Su MD,

    1. Departments of Neurology, Neurosurgery, Radiology Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Yilong Ma PhD,

    1. Center for Neurosciences, North Shore—Long Island Jewish Research Institute, Manhasset, New York
    2. Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York
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  • Masafumi Fukuda MD,

    1. Center for Neurosciences, North Shore—Long Island Jewish Research Institute, Manhasset, New York
    2. Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York
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  • Marc J. Mentis MD,

    1. Center for Neurosciences, North Shore—Long Island Jewish Research Institute, Manhasset, New York
    2. Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York
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  • Ham-Min Tseng MD,

    1. Departments of Neurology, Neurosurgery, Radiology Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Ruoh-Fang Yen MD,

    1. Departments of Neurology, Neurosurgery, Radiology Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Hon-Man Liu MD,

    1. Departments of Neurology, Neurosurgery, Radiology Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • J. R. Moeller PhD,

    1. Department of Psychiatry, Columbia University, New York, NY
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  • David Eidelberg MD

    Corresponding author
    1. Center for Neurosciences, North Shore—Long Island Jewish Research Institute, Manhasset, New York
    2. Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York
    • Center for Neurosciences, North Shore—Long Island Jewish Research Institute, 350 Community Drive, Manhasset, NY 11030
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Abstract

We studied 6 advanced-stage Parkinson's disease patients with [18F] fluorodeoxyglucose/positron emission tomography before and 3 months after unilateral ablation of the subthalamic nucleus performed with microelectrode mapping. Operative changes in glucose metabolism were assessed by comparing baseline and postoperative scans. We also quantified operative changes in the activity of an abnormal Parkinson's disease-related metabolic network that we had identified in previous [18F] fluorodeoxyglucose/positron emission tomography studies. Following unilateral subthalamic nucleus ablation, a highly significant reduction in glucose utilization was present in the midbrain ipsilateral to the lesion site, most pronounced in the vicinity of the substantia nigra pars reticularis. Significant metabolic reductions were also present in the ipsilateral internal globus pallidus, ventral thalamus, and pons. Operative changes in Parkinson's disease network activity differed significantly for the lesioned and unlesioned hemispheres. In the lesioned hemisphere, network activity declined significantly following surgery, but was unaltered in the contralateral, unlesioned hemisphere. These results suggest that subthalamotomy reduces basal ganglia output through internal globus pallidus/substantia nigra pars reticularis and also influences downstream neural activity in the pons and ventral thalamus. This procedure also reduces the activity of abnormal Parkinson's disease-related metabolic brain networks, suggesting a widespread modulation of motor circuitry.

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