Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study
Identifieur interne : 000881 ( Main/Corpus ); précédent : 000880; suivant : 000882Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study
Auteurs : R. Cilia ; G. Marotta ; A. Landi ; I. U. Isaias ; F. Vergani ; R. Benti ; E. Sganzerla ; P. Gerundini ; G. Pezzoli ; A. AntoniniSource :
- European Journal of Neurology [ 1351-5101 ] ; 2008-01.
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- KwdEn :
Abstract
Extradural motor cortex stimulation (EMCS) has been proposed as alternative to deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD). Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc‐99m cysteinate dimer bicisate off‐medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre‐central gyrus, pre‐motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. Perfusion increments were found in cerebellum bilaterally. EMCS determined significant modulation of neuronal activity within the cortico‐basal ganglia‐thalamo‐cortical motor loop in our cohort of advanced PD patients. However, these effects were paralleled by mild and variable clinical efficacy.
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DOI: 10.1111/j.1468-1331.2007.01993.x
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Cilia</name><affiliation><mods:affiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Marotta, G" sort="Marotta, G" uniqKey="Marotta G" first="G." last="Marotta">G. Marotta</name><affiliation><mods:affiliation>Nuclear Medicine, IRCCS‐Ospedale Maggiore, Milan, Italy;</mods:affiliation></affiliation></author><author><name sortKey="Landi, A" sort="Landi, A" uniqKey="Landi A" first="A." last="Landi">A. Landi</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Isaias, I U" sort="Isaias, I U" uniqKey="Isaias I" first="I. U." last="Isaias">I. U. Isaias</name><affiliation><mods:affiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Vergani, F" sort="Vergani, F" uniqKey="Vergani F" first="F." last="Vergani">F. Vergani</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Benti, R" sort="Benti, R" uniqKey="Benti R" first="R." last="Benti">R. Benti</name><affiliation><mods:affiliation>Nuclear Medicine, IRCCS‐Ospedale Maggiore, Milan, Italy;</mods:affiliation></affiliation></author><author><name sortKey="Sganzerla, E" sort="Sganzerla, E" uniqKey="Sganzerla E" first="E." last="Sganzerla">E. 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Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc‐99m cysteinate dimer bicisate off‐medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre‐central gyrus, pre‐motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. 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Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc‐99m cysteinate dimer bicisate off‐medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre‐central gyrus, pre‐motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. Perfusion increments were found in cerebellum bilaterally. EMCS determined significant modulation of neuronal activity within the cortico‐basal ganglia‐thalamo‐cortical motor loop in our cohort of advanced PD patients. However, these effects were paralleled by mild and variable clinical efficacy.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>cerebral blood flow</term></item><item><term>extradural motor cortex stimulation</term></item><item><term>Parkinson's disease</term></item><item><term>SPECT imaging</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-01">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/77F7E3C52CE525BE75E3F4C150553A9CE13CBA81/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1468-1331</doi><issn type="print">1351-5101</issn><issn type="electronic">1468-1331</issn><idGroup><id type="product" value="ENE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="EUROPEAN JOURNAL OF NEUROLOGY">European Journal of Neurology</title></titleGroup></publicationMeta><publicationMeta level="part" position="01001"><doi origin="wiley">10.1111/ene.2008.15.issue-1</doi><numberingGroup><numbering type="journalVolume" number="15">15</numbering><numbering type="journalIssue" number="1">1</numbering></numberingGroup><coverDate startDate="2008-01">January 2008</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="5" status="forIssue"><doi origin="wiley">10.1111/j.1468-1331.2007.01993.x</doi><idGroup><id type="unit" value="ENE1993"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="tocHeading1">Original Articles</title></titleGroup><eventGroup><event type="firstOnline" date="2007-11-27"></event><event type="publishedOnlineFinalForm" date="2007-11-27"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:FullText result:FullText" date="2010-04-07"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-24"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-16"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="22">22</numbering><numbering type="pageLast" number="28">28</numbering></numberingGroup><correspondenceTo>Roberto Cilia, Parkinson Institute, Instituti Clinici di Perfezionamento, Via Bignami 1, 20126 Milano, Italy (tel.: +39 02 57993222; fax: +39 02 57993319; e‐mail: <email>roberto.cilia@tiscali.it</email>).</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:ENE.ENE1993.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received 3 July 2007 Accepted 12 October 2007</unparsedEditorialHistory><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="3"></count></countGroup><titleGroup><title type="main">Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study</title><title type="shortAuthors">R. Cilia <i>et al.</i></title><title type="short">Cerebral blood flow changes during extradural motor cortex stimulation</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1 #a2"><personName><givenNames>R.</givenNames><familyName>Cilia</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a3"><personName><givenNames>G.</givenNames><familyName>Marotta</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a4"><personName><givenNames>A.</givenNames><familyName>Landi</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1 #a2"><personName><givenNames>I. U.</givenNames><familyName>Isaias</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a4"><personName><givenNames>F.</givenNames><familyName>Vergani</familyName></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a3"><personName><givenNames>R.</givenNames><familyName>Benti</familyName></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a4"><personName><givenNames>E.</givenNames><familyName>Sganzerla</familyName></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a3"><personName><givenNames>P.</givenNames><familyName>Gerundini</familyName></personName></creator><creator creatorRole="author" xml:id="cr9" affiliationRef="#a1"><personName><givenNames>G.</givenNames><familyName>Pezzoli</familyName></personName></creator><creator creatorRole="author" xml:id="cr10" affiliationRef="#a1"><personName><givenNames>A.</givenNames><familyName>Antonini</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="IT"><unparsedAffiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="IT"><unparsedAffiliation>Department of Neurology, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="IT"><unparsedAffiliation>Nuclear Medicine, IRCCS‐Ospedale Maggiore, Milan, Italy;</unparsedAffiliation></affiliation><affiliation xml:id="a4" countryCode="IT"><unparsedAffiliation>Department of Neurosurgery, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">cerebral blood flow</keyword><keyword xml:id="k2">extradural motor cortex stimulation</keyword><keyword xml:id="k3">Parkinson's disease</keyword><keyword xml:id="k4">SPECT imaging</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p>Extradural motor cortex stimulation (EMCS) has been proposed as alternative to deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD). Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc‐99m cysteinate dimer bicisate off‐medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre‐central gyrus, pre‐motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. Perfusion increments were found in cerebellum bilaterally. EMCS determined significant modulation of neuronal activity within the cortico‐basal ganglia‐thalamo‐cortical motor loop in our cohort of advanced PD patients. However, these effects were paralleled by mild and variable clinical efficacy.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study</title></titleInfo><titleInfo type="abbreviated"><title>Cerebral blood flow changes during extradural motor cortex stimulation</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study</title></titleInfo><name type="personal"><namePart type="given">R.</namePart><namePart type="family">Cilia</namePart><affiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><affiliation>Department of Neurology, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Marotta</namePart><affiliation>Nuclear Medicine, IRCCS‐Ospedale Maggiore, Milan, Italy;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Landi</namePart><affiliation>Department of Neurosurgery, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I. U.</namePart><namePart type="family">Isaias</namePart><affiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><affiliation>Department of Neurology, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.</namePart><namePart type="family">Vergani</namePart><affiliation>Department of Neurosurgery, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="family">Benti</namePart><affiliation>Nuclear Medicine, IRCCS‐Ospedale Maggiore, Milan, Italy;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E.</namePart><namePart type="family">Sganzerla</namePart><affiliation>Department of Neurosurgery, University of Milan‐Bicocca, San Gerardo Hospital, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Gerundini</namePart><affiliation>Nuclear Medicine, IRCCS‐Ospedale Maggiore, Milan, Italy;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Pezzoli</namePart><affiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Antonini</namePart><affiliation>Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2008-01</dateIssued><edition>Received 3 July 2007 Accepted 12 October 2007</edition><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">3</extent></physicalDescription><abstract lang="en">Extradural motor cortex stimulation (EMCS) has been proposed as alternative to deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD). Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc‐99m cysteinate dimer bicisate off‐medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre‐central gyrus, pre‐motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. Perfusion increments were found in cerebellum bilaterally. EMCS determined significant modulation of neuronal activity within the cortico‐basal ganglia‐thalamo‐cortical motor loop in our cohort of advanced PD patients. However, these effects were paralleled by mild and variable clinical efficacy.</abstract><subject lang="en"><genre>Keywords</genre><topic>cerebral blood flow</topic><topic>extradural motor cortex stimulation</topic><topic>Parkinson's disease</topic><topic>SPECT imaging</topic></subject><relatedItem type="host"><titleInfo><title>European Journal of Neurology</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">1351-5101</identifier><identifier type="eISSN">1468-1331</identifier><identifier type="DOI">10.1111/(ISSN)1468-1331</identifier><identifier type="PublisherID">ENE</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>15</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>22</start><end>28</end><total>7</total></extent></part></relatedItem><identifier type="istex">77F7E3C52CE525BE75E3F4C150553A9CE13CBA81</identifier><identifier type="DOI">10.1111/j.1468-1331.2007.01993.x</identifier><identifier type="ArticleID">ENE1993</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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