1. ¹Université Lyon I, Hospices Civils de Lyon, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neurologie C, Lyon, France
2. ²INSERM, U 864, Bron, France
3. ³CERMEP Imagerie du vivant, PET Unit, Lyon, France
4. ⁴CHU de Nantes, CIC 4 and INSERM, U 643, Nantes, France
5. ⁵Clermont 1,UFR Medecine, EA 3845 and CHU Clermont-Ferrand, Service de Neurologie, Clermont-Ferrand, France
6. ⁶Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurologie, Marseille, France

Correspondence: Dr S Thobois, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, 59 Bd Pinel, Lyon 69003, France. E-mail: stephane.thobois@chu-lyon.fr

Received 1 October 2007; Revised 28 November 2007; Accepted 29 November 2007; Published online 30 January 2008.

Abstract

Tardive dystonia (TD) is a disabling disorder induced by neuroleptics. Internal globus pallidus (GPi) stimulation can dramatically improve TD. The present positron emission tomography and H₂¹⁵O study aimed to characterize the abnormalities of brain activation of TD and the impact of GPi stimulation on these abnormalities in five TD patients treated with GPi stimulation and eight controls. Changes of regional cerebral blood flow (rCBF) were determined: (i) at rest; (ii) when moving a joystick with the right hand in three freely chosen directions in on and off bilateral GPi stimulation. A significant increase of rCBF was found in TD patients in off-stimulation condition compared to controls: (1) during motor execution in the prefrontal, premotor lateral, and anterior cingulate cortex; (2) at rest, in the prefrontal and anterior cingulate cortex and the cerebellum. Internal globus pallidus stimulation led to a reduction of rCBF (1) during motor execution, in the primary motor and prefrontal cortex and the cerebellum; (2) at rest, in the primary motor and anterior cingulate cortex and supplementary motor area. The results are as follows: (1) TD is related to an excess of brain activity notably in the prefrontal and premotor areas; (2) GPi stimulation reduces the activation of motor, premotor, and prefrontal cortex as well as cerebellum.