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Purpose <p>Motor improvement and neuropsychiatric symptoms may immediately follow implantation of subthalamic nucleus deep brain stimulation (STN-DBS) electrodes in Parkinson’s disease (PD). We investigated the impact of electrode implantation prior to stimulation on transient dysfunction using cerebral [<sup>18</sup>F]fluorodeoxyglucose positron emission tomography ([<sup>18</sup>F]FDG-PET). Additionally, we sought to identify clinical and imaging variables associated with neuropsychiatric side effects (SE).</p> Methods <p>This retrospective analysis included thirteen patients with advanced PD, receiving [<sup>18</sup>F]FDG-PET scans preoperatively and within three weeks (median 6 days) after STN-DBS surgery. We analyzed changes of regional metabolism in a voxel-wise manner and with volumes-of-interests. Moreover, we evaluated the extent and magnitude of metabolic decrease alongside the electrode trajectories. Neuropsychiatric SE were defined as novel, surgery-related neuropsychiatric symptoms listed in clinical records.</p> Results <p>PET analyses revealed hypometabolism along the electrodes (mean magnitude up to -35.9 ± 18.0% and mean extent of 19.9 ± 10.2&#xa0;ml per hemisphere) largely located in the frontal lobe (left: <i>k</i><sub>E</sub> = 1718 voxels; right: <i>k</i><sub>E</sub> = 1550 voxels, <i>p</i> &lt; 0.05, false discovery rate corrected). Patients with neuropsychiatric SE were older (61 vs. 55 years; <i>p</i> = 0.043) and had lower normalized [<sup>18</sup>F]FDG uptake in the middle frontal gyrus (MFG) preoperatively (1.01 vs. 1.06; <i>p</i> = 0.030). Preoperative metabolism in the MFG and age were indicative of the occurrence of neuropsychiatric SE (area under the Receiver Operating Characteristic curve = 0.90).</p> Conclusions <p>Reversible neuronal dysfunction after STN-DBS surgery can be detected by [<sup>18</sup>F]FDG-PET along the electrode trajectory. Preoperative MFG metabolism and age were associated with postoperative neuropsychiatric SE supporting the use of PET to improve patient selection and postoperative care concepts.</p>

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[18F]FDG-PET reveals early postoperative cortical dysfunction after subthalamic nucleus deep brain stimulation in Parkinson’s disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月2日

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  • Christian Volz,
  • Volker A. Coenen,
  • Lars Frings,
  • Michel Rijntjes,
  • Horst Urbach,
  • Philipp T. Meyer,
  • Bastian E. A. Sajonz,
  • Joachim Brumberg

摘要

Purpose

Motor improvement and neuropsychiatric symptoms may immediately follow implantation of subthalamic nucleus deep brain stimulation (STN-DBS) electrodes in Parkinson’s disease (PD). We investigated the impact of electrode implantation prior to stimulation on transient dysfunction using cerebral [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET). Additionally, we sought to identify clinical and imaging variables associated with neuropsychiatric side effects (SE).

Methods

This retrospective analysis included thirteen patients with advanced PD, receiving [18F]FDG-PET scans preoperatively and within three weeks (median 6 days) after STN-DBS surgery. We analyzed changes of regional metabolism in a voxel-wise manner and with volumes-of-interests. Moreover, we evaluated the extent and magnitude of metabolic decrease alongside the electrode trajectories. Neuropsychiatric SE were defined as novel, surgery-related neuropsychiatric symptoms listed in clinical records.

Results

PET analyses revealed hypometabolism along the electrodes (mean magnitude up to -35.9 ± 18.0% and mean extent of 19.9 ± 10.2 ml per hemisphere) largely located in the frontal lobe (left: kE = 1718 voxels; right: kE = 1550 voxels, p < 0.05, false discovery rate corrected). Patients with neuropsychiatric SE were older (61 vs. 55 years; p = 0.043) and had lower normalized [18F]FDG uptake in the middle frontal gyrus (MFG) preoperatively (1.01 vs. 1.06; p = 0.030). Preoperative metabolism in the MFG and age were indicative of the occurrence of neuropsychiatric SE (area under the Receiver Operating Characteristic curve = 0.90).

Conclusions

Reversible neuronal dysfunction after STN-DBS surgery can be detected by [18F]FDG-PET along the electrode trajectory. Preoperative MFG metabolism and age were associated with postoperative neuropsychiatric SE supporting the use of PET to improve patient selection and postoperative care concepts.