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Pallidal Deep Brain Stimulation and L‐Dopa Effect on PET Motor Activation in Advanced Parkinson's Disease
Author(s) -
Valálik István,
Emri Miklós,
Lengyel Zsolt,
Mikecz Pál,
Trón Lajos,
Csókay András,
Márián Teréz
Publication year - 2009
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2008.00304.x
Subject(s) - supplementary motor area , deep brain stimulation , sma* , medicine , statistical parametric mapping , parkinson's disease , premotor cortex , neuroscience , motor cortex , globus pallidus , levodopa , primary motor cortex , functional magnetic resonance imaging , stimulation , basal ganglia , psychology , magnetic resonance imaging , disease , central nervous system , anatomy , mathematics , dorsum , combinatorics , radiology
BACKGROUND AND PURPOSE The antiakinetic effect of internal Globus pallidus deep brain stimulation (Gpi‐DBS) in Parkinson's disease is not clear and not either how this effect is modulated by L‐dopa.METHODS Left Gpi‐DBS and/or L‐dopa effect was studied with auditory paced right‐handed sequential movements on 15 O‐butanol positron emission tomography (PET) in five patients. Rest and for conditions during movements (DBS off/L‐dopa off; DBS on/L‐dopa off; DBS off/L‐dopa on; DBS on/L‐dopa on) were compared with statistical parametric mapping.RESULTS Gpi‐DBS activated the right supplementary motor area/premotor (SMA/PMC), and right insular cortex (IC), and as L‐dopa decreased the left sensorimotor cortex (M1/S1) activity. L‐dopa increased the left ventrolateral thalamus (VLTH), and decreased the left superior parietal cortex (PC) activity. Gpi‐DBS and L‐dopa interaction showed right SMA/PMC, IC, and left PC activation, decrease of left VLTH, PMC, and dorsolateral prefrontal cortex (PFC) activity.CONCLUSIONS The improvement of bradykinesia with Gpi‐DBS is secondary and contributed to the regress of M1/S1‐related rigidity and compensatory SMA/PMC, and IC activation. L‐dopa and Gpi‐DBS alone each reduces M1/S1 overactivity. Interaction ignores this effect, moreover has akinetic effect in the left VLTH, PMC, and PFC. Motor improvement possibly related to left PC and compensatory right SMA/PMC, and IC activation.