Metabolic network as an objective biomarker in monitoring deep brain stimulation for Parkinson’s disease: a longitudinal study

Abstract

Background With the advance of subthalamic nucleus (STN) deep brain stimulation (DBS) in the treatment of Parkinson’s disease (PD), it is desired to identify objective criteria for the monitoring of the therapy outcome. This paper explores the feasibility of metabolic network derived from positron emission tomography (PET) with 18F-fluorodeoxyglucose in monitoring the STN DBS treatment for PD. Methods Age-matched 33 PD patients, 33 healthy controls (HCs), 9 PD patients with bilateral DBS surgery and 9 controls underwent 18F-FDG PET scans. The DBS patients were followed longitudinally to investigate the alternations of the PD-related metabolic covariance pattern (PDRP) expressions. Results The PDRP expression was abnormally elevated in PD patients compared with HCs (P < 0.001). For DBS patients, a significant decrease in the Unified Parkinson’s Disease Rating Scale (UPDRS, P = 0.001) and PDRP expression (P = 0.004) was observed 3 months after STN DBS treatment, while a rollback was observed in both UPDRS and PDRP expressions (both P < 0.01) 12 months after treatment. The changes in PDRP expression mediated by STN DBS were generally in line with UPDRS improvement. The graphical network analysis shows increased connections at 3 months and a return at 12 months confirmed by small-worldness coefficient. Conclusions The preliminary results demonstrate the potential of metabolic network expression as complimentary objective biomarker for the assessment and monitoring of STN DBS treatment in PD patients. Clinical Trial Registration ChiCTR-DOC-16008645. http://www.chictr.org.cn/showproj.aspx?proj=13865.

Aerobic glycolysis imaging of epileptic foci during the inter-ictal period

“… 22 Thus, our detection of increased OGI during the inter-ictal phase on the ipsilateral hemisphere to epileptic foci may help clinicians understand individual patients’ aetiology. While metabolic networks based on FDG-PET have sometimes been considered an objective biomarker for the assessment of certain treatments, 23 OGI appears to provide complementary information to glucose uptake, which may help locate or rank epileptic foci. In addition, of the three patients with poor outcomes (Engel class II or III), two of them had a bilateral disruption in relative OGI, whereas SEEG and SUV glc in those patients were only disrupted on one side (Supplemental Table S3).…”

A Systematic Review of the Biological Processes Involved in Deep-Brain Stimulation for Parkinson's disease: A Focus on the Potential Disease-Modifying Effects

“…Two further studies [53,56] investigated a potential disease-modifying effect of DBS but did not report any significant results. Ge et al [53] examined PD-related metabolic covariance patterns (PDRP) after STN-DBS surgery but did not find any significant differences at 12 months of follow-up compared to baseline.…”

“…Two further studies [53,56] investigated a potential disease-modifying effect of DBS but did not report any significant results. Ge et al [53] examined PD-related metabolic covariance patterns (PDRP) after STN-DBS surgery but did not find any significant differences at 12 months of follow-up compared to baseline. Hilker et al [56], found a significant decrease in the uptake of striatal 18F-dopa in PD subjects, thus revealing a decline in dopaminergic function even in PD subjects that were effectively treated with STN stimulation.…”

“…Only eleven studies assessed the UPDRS scale in the OFF phase (without stimulation), reporting a mean score ranging from 27.4 to 54.6. Only one [53] study reported a UPDRS score of <30, with a progressive increase nine months after surgery (mean score = 49.3 ±18.2). Sixteen studies reported a mean UPDRS score in the ON phase (with DBS stimulation) ranging from 9.2 to 37.6, with nine of them (56.2%) reporting a score of ≤20.…”

“…Most of the neuroimaging studies included in this review had explored different cerebral pathways to assess a potential neurophysiological effect of DBS. Four studies [53,56,57,63] investigated the potential of DBS to affect the progression of the disease through possible neuroprotective effects. None of these studies reported any significant results.…”