Altered Thalamic Response to Levodopa in Parkinson's Patients with Dopa-Induced Dyskinesias

• Published in: Proceedings of the National Academy of Sciences - PNAS Vol. 95; no. 20; pp. 12016 - 12021
• Main Authors: Hershey, Tamara, Black, Kevin J., Stambuk, Mikula K., Carl, Juanita L., McGee-Minnich, Lori A., Perlmutter, Joel S.
• Format: Journal Article
• Language: English
• Published: United States National Academy of Sciences of the United States of America 29.09.1998; National Acad Sciences; National Academy of Sciences
• Subjects: Adult; Aged; Basal ganglia; Biological Sciences; Blood flow; Carbidopa - blood; Case-Control Studies; Cerebrovascular Circulation - drug effects; Dyskinesia; Dyskinesia, Drug-Induced - etiology; Dyskinesia, Drug-Induced - physiopathology; Dyskinesia, Drug-Induced - surgery; Female; Globus pallidus; Globus Pallidus - physiopathology; Globus Pallidus - surgery; Humans; Levodopa - administration & dosage; Levodopa - adverse effects; Levodopa - blood; Male; Middle Aged; Motor cortex; Motor Cortex - blood supply; Motor Cortex - drug effects; Motor Cortex - physiopathology; Neurology; Neurons; Pallidotomy; Parkinson disease; Parkinson Disease - drug therapy; Parkinson Disease - physiopathology; Parkinson's disease; Pharmaceuticals; Positron emission tomography; Thalamus; Thalamus - blood supply; Thalamus - drug effects; Thalamus - physiopathology; Tomography, Emission-Computed
• ISSN: 0027-8424; 1091-6490
• DOI: 10.1073/pnas.95.20.12016

Parkinson's disease (PD) is a progressive neurologic condition characterized by tremor, slowness, stiffness, and unstable posture. Degeneration of dopamine-producing neurons in the substantia nigra causes PD. Treatment with levodopa, a precursor of dopamine, initially ameliorates the clinical manifestations of PD. However, chronic levodopa treatment can produce severe involuntary movements (so-called dopa-induced dyskinesias or DID), limiting treatment. Pallidotomy, placement of a surgical lesion in the internal segment of the globus pallidus, reduces DID. Because this result is inconsistent with current theories of both basal ganglia function and DID, it prompted us to investigate the brain's response to levodopa. We measured regional cerebral blood flow response to levodopa with positron-emission tomography in 6 PD patients with DID, 10 chronically treated PD patients without DID, 17 dopa-naive PD patients, and 11 normals. The dose of levodopa was chosen to produce clinical benefit without inducing DID. This strategy allowed us to examine the brain response to levodopa across groups without the confounding effect of differences in motor behavior. We found that the DID group had a significantly greater response in ventrolateral thalamus than the other groups. This was associated with decreased activity in primary motor cortex. These findings are consistent with increased inhibitory output from the internal segment of the globus pallidus to thalamus after levodopa administration. They provide a physiological explanation for the clinical efficacy of pallidotomy and new insights into the physiology of the basal ganglia.