The impact of stereotactic pallidal surgery on the dopamine D2 receptor in Parkinson disease:: a positron emission tomography study

Object. The aim of this study was to estimate the impact of stereotactic pallidal surgery on the binding potential of dopamine D, receptors in patients with advanced Parkinson disease (PD). Methods. Six patients with advanced PD (three men and three women; mean age 56.7 +/- 9.8 years, Hoehn and Yahr stage 3.3 +/- 1.1/3.9 +/- 1.2 [on/off scores], mean +/- standard deviation) underwent stereotactic pallidal surgery. One underwent right posteroventral pallidotomy (PVP), one received left PVP, three were treated with deep brain stimulation (DBS) of the left globus pallidus internus (GPi), and one with bilateral DBS of the GPi. The binding potential of the dopamine D(2) receptors of these patients was determined before and after surgery by using positron emission tomography scanning with (11)C-nemonapride and it was compared with the value in eight healthy volunteers. The authors also examined whether changes in the D(2) receptor binding potential were correlated with the clinical outcome. The clinical symptoms, especially those in the off state, were significantly improved after surgery. Preoperatively, the D(2) receptor binding potential in the putamen was elevated by 27% (p < 0.01) and that in the thalamus was 29% lower than that in controls (p < 0.01). The D(2) receptor binding potential in the putamen and thalamus returned to control levels after surgery. The preoperative level of the D(2) receptor binding potential in the anterior cingulate cortex was comparable to that of controls, but it declined significantly after surgery, whereas the D(2) receptor binding potential in other regions of both hemispheres showed no significant changes after surgery. Although the D(2) receptor binding potential did not correlate with the Hoehn and Yahr stage, the Schwab and England score, or the Unified PD Rating Scale (UPDRS) score, a positive correlation was seen between the percent improvement rate of the total UPDRS score in the off state and the percentage change of the D(2) receptor binding potential in the putamen (r = 0.773, p = 0.0417 according to the Pearson linear correlation). Conclusions. The altered dopamine D(2) receptor binding potential in the putamen might play a crucial role in clinical improvement after PVP or DBS of the GPi in advanced PD.