Brain, Vol 120, Issue 8 1301-1313, Copyright © 1997 by Oxford University Press
M Samuel, AO Ceballos-Baumann, N Turjanski, H Boecker, A Gorospe, G Linazasoro, AP Holmes, MR DeLong, JL Vitek, DG Thomas, NP Quinn, JA Obeso and DJ Brooks
Supplementary motor area and right dorsal prefrontal cortex activation in
Parkinson's disease is selectively impaired during volitional limb
movements. Since posteroventral pallidotomy improves motor performance in
Parkinson's disease patients 'off' medication (i.e. off medication for 9-12
h), we hypothesized that it would also concomitantly increase supplementary
motor area and dorsal prefrontal cortex activation. Six Parkinson's disease
patients with a median total motor Unified Parkinson's Disease Rating Scale
(UPDRS) of 52.5 (range 34-66) 'off' medication underwent unilateral right
posteroventral pallidotomy. The patients had H2(15)O PET when 'off'
medication before and 3-4 months after surgery. Each PET study comprised
four to six measurements of regional cerebral blood flow either at rest or
while performing regularly paced joystick movements in freely selected
directions (forward, backward, left or right) using the left hand. Pre- and
postoperative scans were performed in an identical manner and the
associated levels of activation were compared using statistical parametric
mapping. After pallidotomy, the median total motor UPDRS score 'off'
medication decreased by 34.7% (P = 0.03) and mean response times of
joystick movements following the pacing tones improved by 13.8% (P = 0.08).
Relative increases in activation of the supplementary motor area and right
dorsal prefrontal cortex were observed during joystick movements (P <
0.001). Decreased activation was seen in the region of the right pallidum
(P = 0.001). We conclude that pallidotomy reduces pallidal inhibition of
thalamocortical circuits and reverses, at least partially, the impairment
of supplementary motor area and dorsal prefrontal cortex activation
associated with Parkinson's disease.
ARTICLES
Pallidotomy in Parkinson's disease increases supplementary motor area and prefrontal activation during performance of volitional movements an H2(15)O PET study
MRC Cyclotron Unit, Hammersmith Hospital, London, UK.
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