Yonsei Med J.  2015 May;56(3):726-736. 10.3349/ymj.2015.56.3.726.

A Network Analysis of 15O-H2O PET Reveals Deep Brain Stimulation Effects on Brain Network of Parkinson's Disease

• Park HJ
• Park B
• Kim HY
• Oh MK
• Kim JI
• Yoon M
• Lee JD
• Chang JW

• KMID: 2450347
• DOI: http://doi.org/10.3349/ymj.2015.56.3.726

Abstract

PURPOSE
As Parkinson's disease (PD) can be considered a network abnormality, the effects of deep brain stimulation (DBS) need to be investigated in the aspect of networks. This study aimed to examine how DBS of the bilateral subthalamic nucleus (STN) affects the motor networks of patients with idiopathic PD during motor performance and to show the feasibility of the network analysis using cross-sectional positron emission tomography (PET) images in DBS studies.
MATERIALS AND METHODS
We obtained [15O]H2O PET images from ten patients with PD during a sequential finger-to-thumb opposition task and during the resting state, with DBS-On and DBS-Off at STN. To identify the alteration of motor networks in PD and their changes due to STN-DBS, we applied independent component analysis (ICA) to all the cross-sectional PET images. We analysed the strength of each component according to DBS effects, task effects and interaction effects.
RESULTS
ICA blindly decomposed components of functionally associated distributed clusters, which were comparable to the results of univariate statistical parametric mapping. ICA further revealed that STN-DBS modifies usage-strengths of components corresponding to the basal ganglia-thalamo-cortical circuits in PD patients by increasing the hypoactive basal ganglia and by suppressing the hyperactive cortical motor areas, ventrolateral thalamus and cerebellum.
CONCLUSION
Our results suggest that STN-DBS may affect not only the abnormal local activity, but also alter brain networks in patients with PD. This study also demonstrated the usefulness of ICA for cross-sectional PET data to reveal network modifications due to DBS, which was not observable using the subtraction method.

Keyword

Deep brain stimulation; brain networks; Parkinson's disease; H2O PET; independent component analysis

MeSH Terms

Aged
Brain/*radionuclide imaging
Cross-Sectional Studies
Deep Brain Stimulation/*methods
Female
Functional Laterality/*physiology
Humans
Male
Middle Aged
Parkinson Disease/radionuclide imaging/*therapy
Positron-Emission Tomography
Severity of Illness Index
Subthalamic Nucleus/*physiopathology

Figure

• 

  Fig. 1 SPM results of rCBF changes in patients with PD. (A) A map of significant task effects [rCBF increase (red) and decrease (blue) during the finger-to-thumb opposition task versus rest]. (B) A map of significant DBS effects [increased (red) and decreased (blue) rCBF regions during DBS-On versus DBS-Off]. The rCBF during the finger-to-thumb opposition task was compared to rCBF in the resting state with (C) DBS-Off and (D) DBS-On. Blue shows decreased rCBF and red shows increased rCBF during DBS-On versus DBS-Off. An uncorrected p<0.005, cluster size >227 voxels (1816 mm3), corresponding to corrected p<0.05 in the cluster level by Monte Carlo simulation [except for B, uncorrected p<0.005, cluster size >35 voxels (280 mm3)] are displayed. Gp, globus pallidum; MdB, midbrain; PrC, precentral gyrus; PrCu, precuneus; SMA, supplementary motor area; SFG, superior frontal gyrus; Th, thalamus; SPM, statistical parametric mapping; rCBF, regional cerebral blood flow; PD, Parkinson's disease.

• 

  Fig. 2 Functional components for task performance with DBS-On and DBS-Off. Results from the repeated measures ANOVA of the independent components (ICs) with weights for significant task effect, DBS effect and task×DBS interaction, task induced changes according to the paired t-test during DBS-On and DBS-Off and the difference between DBS-On and DBS-Off during the resting state (p<0.05) are displayed. Voxel intensities at each IC component were Z-transformed, and clusters with Z>2 or Z<-2, cluster size >100 voxels are displayed. The main task effect was found in IC25. DBS effect was found in IC25, IC9, IC6, IC4, and IC40. DBS and task interaction were found in IC8. A task-induced increase was found in IC40 for DBS-On and IC16 for DBS-Off. Reduced involvement due to DBS during the resting state was found in IC8 and IC14. Note that red and blue colors indicate anti-phase subregions in a network. ACC, anterior cigulate cortex; Cd, caudate; Cu, cuneus; Gp, globlus pallidum; LG, lingual gyrus; MCC, middle cingulate cortex; MdB, midbrain; MeFG, medial frontal gyrus; MFG, middle frontal gyrus; MTG, middle temporal gyrus; PaC, paracentral gyrus; PaH, parahippocampal gyrus; PCC, postcentral cortex; PoC, postcentral gyrus; PrC, precentral gyrus; PrM, premotor area; PrCu, precuneus; pSMA, pre supplementary motor area; Pu, putamen; SFG, superior frontal gyrus; SMA, supplementary motor area; STG, superior temporal gyrus; ThP, thalamus pulvinar; ThVL, ventrolateral thalamus; DBS, deep brain stimulation; IFG, inferior frontal gyrus; ANOVA, analysis of variance.

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