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From the Center for Neuroscience Research, North Shore University Hospital, Manhasset, and New York University School of Medicine (Drs. Feigin, Fukuda, Dhawan, Mentis, and Eidelberg); Departments of Neurology and Pathology (Drs. Przedborski and Jackson-Lewis), Columbia University; and Department of Psychiatry (Dr. Moeller), Columbia College of Physicians and Surgeons, New York.
Address correspondence and reprint requests to Dr. Feigin, Center for Neuroscience Research, North Shore University Hospital, 350 Community Drive, Manhasset, NY 11030; e-mail: asfeigin{at}aol.com
Objective:— To assess the effects of levodopa on resting-state brain metabolism in PD.
Background:— In previous studies the authors used [18F] fluorodeoxyglucose (FDG) and PET to quantify regional metabolic abnormalities in PD. They found that this disease is characterized reproducibly by a specific abnormal PD-related pattern (PDRP). In this study the authors used IV levodopa infusion to quantify the effects of dopamine replacement on regional metabolism and PDRP network activity. They tested the hypothesis that clinical response to dopaminergic therapy correlates with these metabolic changes.
Methods:— The authors used FDG/PET to measure resting-state regional brain metabolism in seven patients with PD (age, 59.4 ± 4.2 years; Hoehn and Yahr stage, 1.9 ± 0.7, mean ± SD); subjects were scanned both off levodopa and during an individually titrated constant-rate IV levodopa infusion. The authors used statistical parametric mapping to identify significant changes in regional brain metabolism that occurred with this intervention. They also quantified levodopa-induced changes in PDRP expression. Metabolic changes with levodopa correlated with clinical improvement as measured by changes in Unified PD Rating Scale (UPDRS) motor scores.
Results:— Levodopa infusion improved UPDRS motor ratings (30.6% ± 12.0%, p < 0.002) and significantly decreased regional glucose metabolism in the left putamen, right thalamus, bilateral cerebellum, and left primary motor cortex (p < 0.001). Changes in pallidal metabolism correlated significantly with clinical improvement in UPDRS motor ratings (p < 0.01). Levodopa infusion also resulted in a significant (p = 0.01) decline in PDRP expression. The changes in PDRP activity mediated by levodopa correlated significantly with clinical improvement in UPDRS motor ratings (r = -0.78, p < 0.04).
Conclusion:— Levodopa reduces brain metabolism in the putamen, thalamus, and cerebellum in patients with PD. Additionally, levodopa reduces PD-related pattern activity, and the degree of network suppression correlates with clinical improvement. The response to dopaminergic therapy in Patients with PD may be determined by the modulation of cortico-striato-pallido-thalamocortical pathways.
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