Low Pulvinar Intensity in Susceptibility-Weighted Imaging May Suggest Cognitive Worsening After Deep Brain Stimulation Therapy in Patients With Parkinson's Disease

Keita Matsuura; Masayuki Maeda; Masayuki Satoh; Ken-Ichi Tabei; Tomohiro Araki; Maki Umino; Hiroyuki Kajikawa; Naoko Nakamura; Hidekazu Tomimoto

doi:10.3389/fneur.2019.01158

Low Pulvinar Intensity in Susceptibility-Weighted Imaging May Suggest Cognitive Worsening After Deep Brain Stimulation Therapy in Patients With Parkinson's Disease

Front Neurol. 2019 Oct 31:10:1158. doi: 10.3389/fneur.2019.01158. eCollection 2019.

Authors

Keita Matsuura^{1

2}, Masayuki Maeda³, Masayuki Satoh⁴, Ken-Ichi Tabei⁴, Tomohiro Araki⁵, Maki Umino⁶, Hiroyuki Kajikawa², Naoko Nakamura², Hidekazu Tomimoto¹

Affiliations

¹ Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Japan.
² Department of Neurology, Suzuka Kaisei Hospital, Suzuka, Japan.
³ Department of Advanced Diagnostic Imaging, Graduate School of Medicine, Mie University, Tsu, Japan.
⁴ Dementia Prevention and Therapeutics, Mie University, Tsu, Japan.
⁵ Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Japan.
⁶ Department of Radiology, Graduate School of Medicine, Mie University, Tsu, Japan.

Abstract

Purpose: Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD). However, deteriorating cognitive function after DBS is a considerable problem for affected patients. This study was undertaken to assess whether pulvinar findings in susceptibility-weighted imaging (SWI) can suggest cognitive worsening. Methods: We examined 21 patients with PD who underwent DBS along with SWI and neuromelanin-sensitive MR imaging (NMI). We further assessed pulvinar hypointensity based on the SWI findings and also the area of the substantia nigra (SN) pars compacta in NMI. We then examined associations among cognitive changes, pulvinar hypointensity, and SN area. The cognitive function of the patient immediately before surgery was compared with function at 1 year postoperatively. Results: Pulvinar hypointensity in SWI was found in 11 of 21 patients with PD at baseline. One year postoperatively, six of the 21 patients demonstrated a Mini-Mental State Examination score that was ≥3 points lower than the baseline score. We observed pulvinar hypointensity in SWI before DBS surgery in five of these six patients (p = 0.072). During the first postoperative year, six of 21 patients reported both transient or permanent hallucinations; we observed pulvinar hypointensity in these six patients, while 10 patients without pulvinar hypointensity had no hallucinations. Conclusion: Pulvinar hypointensity in SWI in patients with PD may provide information that is useful for suggesting cognitive deterioration after DBS treatment.

Keywords: Parkinson's disease; cognitive function; deep brain stimulation; diffusion-weighted imaging; pulvinar nuclei; susceptibility-weighted imaging.