Shogo Furukawa1, Shigeki Hirano2, Tatsuya Yamamoto3, Masato Asahina4, Tomoyuki Uchiyama5, Yoshitaka Yamanaka6, Yoshikazu Nakano7, Ai Ishikawa8, Kazuho Kojima9, Midori Abe10, Yuriko Uji11, Yoshinori Higuchi12, Takuro Horikoshi13, Takashi Uno14, Satoshi Kuwabara15. 1. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: JAG06466@nifty.ne.jp. 2. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: s_hirano@chiba-u.jp. 3. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Department of Rehabilitation, Chiba Prefectural University of Health Sciences, Chiba, 261-0014, Japan. Electronic address: tatsuya-yamamoto@mbc.nifty.com. 4. Neurology Clinic Tsudanuma, Chiba, 274-0825, Japan. Electronic address: asahina@snow.ocn.ne.jp. 5. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Department of Neurology, School of Medicine, International University of Health and Welfare and International University of Health and Welfare Narita Hospital, Chiba, 272-0827, Japan. Electronic address: uchiyama@faculty.chiba-u.jp. 6. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: y-yama@jk9.so-net.ne.jp. 7. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: y.nakano.neuro@gmail.com. 8. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: ishikawa716@yahoo.co.jp. 9. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: niece_dream@yahoo.co.jp. 10. Division of Rehabilitation, Chiba University Hospital, Chiba, 260-8670, Japan. Electronic address: m3abe@chiba-u.jp. 11. Division of Rehabilitation, Chiba University Hospital, Chiba, 260-8670, Japan. Electronic address: uji84@office.chiba-u.jp. 12. Department of Neurological Surgery, Graduate School of Medicine, Chiba University Chiba, 260-8670, Japan. Electronic address: yhiguchi@faculty.chiba-u.jp. 13. Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: horikoshi@chiba-u.jp. 14. Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: unotakas@faculty.chiba-u.jp. 15. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. Electronic address: kuwabara-s@faculty.chiba-u.jp.
Abstract
BACKGROUND: Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for alleviating motor symptoms in advanced Parkinson's disease (PD) patients; however, a postoperative decline in cognitive and speech function has become problematic although its mechanism remains unclear. The aim of the present study was to elucidate the properties of language and drawing ability and cerebral perfusion in PD patients after bilateral STN DBS surgery. METHODS: Western aphasia battery, including drawing as a subcategory, and perfusion (N-isopropyl-p-[123I] iodoamphetamine) SPECT scan was conducted in 21 consecutive PD patients, before, and three to six months after, bilateral STN DBS surgery while on stimulation. Perfusion images were compared with those of 17 age- and gender-matched healthy volunteers. In the parametric image analysis, the statistical peak threshold was set at P < 0.001 uncorrected with a cluster threshold set at P < 0.05 uncorrected. RESULTS: Although motor symptoms were improved and general cognition was preserved in the patient group, 11 patients (52.4%) showed a decline in the drawing subcategory after surgery, which showed a reduction in Frontal Assessment Battery score in this group of patients. Statistical parametric analysis of the brain perfusion images showed a decrease of cerebral blood flow in the prefrontal and cingulate cortex after surgery. Patients whose drawing ability declined showed decreased perfusion in the middle cingulate cortex comparing before and after surgery. CONCLUSION: Present results show that some PD patients show a decline in drawing ability after bilateral STN DBS which may attributable by dysfunction in the cingulate network.
BACKGROUND: Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for alleviating motor symptoms in advanced Parkinson's disease (PD) patients; however, a postoperative decline in cognitive and speech function has become problematic although its mechanism remains unclear. The aim of the present study was to elucidate the properties of language and drawing ability and cerebral perfusion in PDpatients after bilateral STN DBS surgery. METHODS: Western aphasia battery, including drawing as a subcategory, and perfusion (N-isopropyl-p-[123I] iodoamphetamine) SPECT scan was conducted in 21 consecutive PDpatients, before, and three to six months after, bilateral STN DBS surgery while on stimulation. Perfusion images were compared with those of 17 age- and gender-matched healthy volunteers. In the parametric image analysis, the statistical peak threshold was set at P < 0.001 uncorrected with a cluster threshold set at P < 0.05 uncorrected. RESULTS: Although motor symptoms were improved and general cognition was preserved in the patient group, 11 patients (52.4%) showed a decline in the drawing subcategory after surgery, which showed a reduction in Frontal Assessment Battery score in this group of patients. Statistical parametric analysis of the brain perfusion images showed a decrease of cerebral blood flow in the prefrontal and cingulate cortex after surgery. Patients whose drawing ability declined showed decreased perfusion in the middle cingulate cortex comparing before and after surgery. CONCLUSION: Present results show that some PDpatients show a decline in drawing ability after bilateral STN DBS which may attributable by dysfunction in the cingulate network.