TY - JOUR
T1 - Common and unique responses to dopamine agonist therapy and deep brain stimulation in Parkinson's disease
T2 - An H215O PET study
AU - Bradberry, Trent J.
AU - Metman, Leonard Verhagen
AU - Contreras-Vidal, José L.
AU - Van Den Munckhof, Pepijn
AU - Hosey, Lara A.
AU - Thompson, Jennifer L.W.
AU - Schulz, Geralyn M.
AU - Lenz, Fredrick
AU - Pahwa, Rajesh
AU - Lyons, Kelly E.
AU - Braun, Allen R.
PY - 2012/10
Y1 - 2012/10
N2 - Background: Dopamine agonist therapy and deep brain stimulation (DBS) of the subthalamic nucleus (STN) are antiparkinsonian treatments that act on a different part of the basal ganglia-thalamocortical motor circuitry, yet produce similar symptomatic improvements. Objective/Hypothesis: The purpose of this study was to identify common and unique brain network features of these standard treatments. Methods: We analyzed images produced by H215O positron emission tomography (PET) of patients with Parkinson's disease (PD) at rest. Nine patients were scanned before and after injection of apomorphine, and 11 patients were scanned while bilateral stimulators were off and while they were on. Results: Both treatments produced common deactivations of the neocortical sensorimotor areas, including the supplementary motor area, precentral gyrus, and postcentral gyrus, and in subcortical structures, including the putamen and cerebellum. We observed concomitant activations of the superior parietal lobule and the midbrain in the region of the substantia nigra/STN. We also detected unique, treatment-specific changes with possible motor-related consequences in the basal ganglia, thalamus, neocortical sensorimotor cortex, and posterolateral cerebellum. Unique changes in nonmotor regions may reflect treatment-specific effects on verbal fluency and limbic functions. Conclusions: Many of the common effects of these treatments are consistent with the standard pathophysiologic model of PD. However, the common effects in the cerebellum are not readily explained by the model. Consistent deactivation of the cerebellum is interesting in light of recent reports of synaptic pathways directly connecting the cerebellum and basal ganglia, and may warrant further consideration for incorporation into the model.
AB - Background: Dopamine agonist therapy and deep brain stimulation (DBS) of the subthalamic nucleus (STN) are antiparkinsonian treatments that act on a different part of the basal ganglia-thalamocortical motor circuitry, yet produce similar symptomatic improvements. Objective/Hypothesis: The purpose of this study was to identify common and unique brain network features of these standard treatments. Methods: We analyzed images produced by H215O positron emission tomography (PET) of patients with Parkinson's disease (PD) at rest. Nine patients were scanned before and after injection of apomorphine, and 11 patients were scanned while bilateral stimulators were off and while they were on. Results: Both treatments produced common deactivations of the neocortical sensorimotor areas, including the supplementary motor area, precentral gyrus, and postcentral gyrus, and in subcortical structures, including the putamen and cerebellum. We observed concomitant activations of the superior parietal lobule and the midbrain in the region of the substantia nigra/STN. We also detected unique, treatment-specific changes with possible motor-related consequences in the basal ganglia, thalamus, neocortical sensorimotor cortex, and posterolateral cerebellum. Unique changes in nonmotor regions may reflect treatment-specific effects on verbal fluency and limbic functions. Conclusions: Many of the common effects of these treatments are consistent with the standard pathophysiologic model of PD. However, the common effects in the cerebellum are not readily explained by the model. Consistent deactivation of the cerebellum is interesting in light of recent reports of synaptic pathways directly connecting the cerebellum and basal ganglia, and may warrant further consideration for incorporation into the model.
KW - Parkinson's disease
KW - apomorphine
KW - deep brain stimulation
KW - positron emission tomography
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UR - http://www.scopus.com/inward/citedby.url?scp=84867572306&partnerID=8YFLogxK
U2 - 10.1016/j.brs.2011.09.002
DO - 10.1016/j.brs.2011.09.002
M3 - Article
C2 - 22019080
AN - SCOPUS:84867572306
SN - 1935-861X
VL - 5
SP - 605
EP - 615
JO - Brain Stimulation
JF - Brain Stimulation
IS - 4
ER -