Effects of STN-DBS surgery on cerebral glucose metabolism and distribution of DAT in Parkinson's disease

Ganhua Luo; Xinchong Shi; LuLu Jiang; Lei Wu; Chang Yi; Wenbiao Xian; Yanmei Liu; Fuhua Wen; Hao Qian; Jie Chen; Xiaoli Fu; Jinlong Liu; Xiangsong Zhang; Ling Chen

doi:10.1002/brb3.3172

Effects of STN-DBS surgery on cerebral glucose metabolism and distribution of DAT in Parkinson's disease

Brain Behav. 2023 Aug;13(8):e3172. doi: 10.1002/brb3.3172. Epub 2023 Jul 17.

Authors

Ganhua Luo¹, Xinchong Shi¹, LuLu Jiang^{2

3}, Lei Wu^{2

3}, Chang Yi¹, Wenbiao Xian^{2

3}, Yanmei Liu^{2

3}, Fuhua Wen¹, Hao Qian^{2

3}, Jie Chen^{2

3}, Xiaoli Fu^{2

3}, Jinlong Liu⁴, Xiangsong Zhang¹, Ling Chen^{2

3}

Affiliations

¹ Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
⁴ Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

Introduction: Parkinson's disease (PD) is a neurodegenerative disorder that affects millions of people worldwide. Subthalamic nucleus (STN) deep brain stimulation (DBS) has been shown to be an effective treatment for PD; however, the effects of this surgery on cerebral metabolism and presynaptic dopamine transporter (DAT) distribution are still being studied.

Methods: In this study, we included 12 PD patients (6 male and 6 female) who underwent STN-DBS surgery and had both ¹⁸ F-FDG and ¹¹ C-CFT PET/CT imaging before and 1 year after the surgery. We used paired t-tests to identify changes in cerebral metabolism and calculated PD-related metabolic covariance pattern (PDRP) scores. We also assessed the uptake of ¹¹ C-CFT in the striatum using striatal-to-occipital ratios (SORs).

Results: One year after surgery, we observed significant reductions in tremor, rigidity, akinesia, postural instability/gait disturbance, and Unified Parkinson's Disease Rating Scale Part III scores (p < .01, p < .001, p < .001, p < .001, and p < .001, respectively). Hamilton Depression Rating Scale and quality of life (PDQ-39 SI) were also significantly reduced (p < .05 and p < .01, respectively). The mean PDRP score decreased by 37% from 13.0 ± 6.6 to 8.2 ± 7.9 after STN-DBS surgery (p < .05). We observed decreased ¹⁸ F-FDG uptake in several areas, including the temporal lobe (BA22), thalamus, putamen, and cingulate gyrus (BA24), whereas it was increased in the supplementary motor area, postcentral gyrus, lingual gyrus, and precuneus (p < .05). SORs of ¹¹ C-CFT in the bilateral caudate nucleus and ipsilateral posterior putamen were significantly decreased compared to preoperative levels (p < .05).

Conclusion: Our findings suggest that STN-DBS surgery modifies the metabolic network of PD patients and improves motor symptoms, depression, and quality of life. However, it does not prevent the decrease of DAT in striatal areas.

Keywords: 11C-CFT; 18F-FDG; PET; Parkinson's disease; STN-DBS; dopamine transporter.

MeSH terms

Deep Brain Stimulation* / methods
Dopamine Plasma Membrane Transport Proteins / metabolism
Female
Fluorodeoxyglucose F18
Glucose
Humans
Male
Parkinson Disease* / diagnostic imaging
Parkinson Disease* / metabolism
Parkinson Disease* / therapy
Positron Emission Tomography Computed Tomography
Quality of Life
Subthalamic Nucleus* / diagnostic imaging
Treatment Outcome

Substances

Fluorodeoxyglucose F18
Dopamine Plasma Membrane Transport Proteins
Glucose