Introduction

Internal globus pallidus (GPi) deep brain stimulation (DBS) is a safe and effective alternative treatment in Parkinson’s disease (PD) for patients with cognitive impairment. However, no study has yet investigated metabolic changes within a large series of patients undergoing GPi stimulation.

Objective

We assessed motor, cognitive and psychiatric changes, as well as modifications in brain glucose metabolism measured with FDG-PET, before and after bilateral GPi-DBS.

Methods

In the same week, 32 patients with PD underwent a motor, cognitive and psychiatric assessment and a resting-state FDG-PET scan, 4 months before and 4 months after GPi-DBS surgery. For the voxelwise metabolic change assessment, the p value was controlled for multiple comparisons using the family wise error rate.

Results

After GPi-DBS surgery, patients showed a significant overall improvement in motor status. No cognitive or psychiatric changes were observed after surgery. Nor were any clusters with significantly relative metabolic changes found in the limbic circuit after surgery. Clusters with significantly relative metabolic changes were observed in the left and right Brodmann area (BA) 6, the right BA 9, the right and left BA 39 and the left BA 17.

Conclusion

The present study confirmed that GPi-DBS is an effective treatment in patients with advanced PD, owing to metabolic changes in the areas involved in motor execution. The absence of relative metabolic decrease in the limbic circuit and the few changes affecting the associative circuit could explain why GPi-DBS is cognitively safe.

中文翻译：

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PET研究显示，大脑深部内苍白球的深部刺激不会影响帕金森氏病患者的边缘回路。

介绍

内部苍白球（GPi）深部脑刺激（DBS）是帕金森氏病（PD）对于认知障碍患者的一种安全有效的替代疗法。但是，尚无研究调查GPi刺激的大量患者体内的代谢变化。

目的

我们评估了双侧GPi-DBS前后运动，认知和精神方面的变化，以及用FDG-PET测量的脑葡萄糖代谢的变化。

方法

在同一周，GPi-DBS手术前4个月和手术后4个月，对32例PD患者进行了运动，认知和精神病学评估以及静止状态FDG-PET扫描。对于体素代谢变化评估，使用家族误差率对p值进行多次比较进行控制。

结果

GPi-DBS手术后，患者的运动状况总体改善。手术后未观察到认知或精神方面的变化。手术后在边缘区也没有发现具有明显相对代谢变化的簇。在左侧和右侧Brodmann区域（BA）6，右侧BA 9，右侧和左侧BA 39和左侧BA 17中观察到具有明显相对代谢变化的簇。

结论

本研究证实，由于参与运动执行的区域的代谢变化，GPi-DBS是晚期PD患者的有效治疗方法。边缘回路中没有相对代谢的减少，而影响缔合回路的变化很少，这可以解释为什么GPi-DBS在认知上是安全的。