Levodopa versus non-levodopa brain language fMRI in Parkinson's disease.

OBJECTIVE: To identify the effect of levodopa in language areas in Parkinson's disease patients. METHODS: We evaluated 50 patients with mild to moderate Parkinson's disease, age and gender paired to 47 healthy volunteers. We selected two homogeneous groups of 18 patients taking levodopa and 7 no levodopa patients. The functional magnetic resonance imaging verbal fluency task, with low and high cognitive demands, was performed at a 3T magnetic resonance imaging equipment. Data was analyzed with XBAM software for group maps and ANOVA comparison. RESULTS: Patients without levodopa had more activation than the ones with levodopa in the medial frontal and in the left frontal and parieto-occipital areas. The striatal activation in patients taking levodopa had similar result of the activation detected in the healthy volunteer group. Parieto-occipital areas were less activated in the levodopa group than in the no levodopa one. CONCLUSION: Parkinson's disease patients without levodopa replacement, during a verbal fluency effort, had more diffuse and intense cerebral activation in left hemisphere, mainly in the frontal and parieto-occipital areas. The striatal activation in verbal fluency of patients with levodopa intake was more similar to the activation found in healthy volunteers. These initial evidences suggested a role of levodopa inhibiting activation in parieto-occipital compensating areas.

Levodopa versus non-levodopa brain language fMRI in Parkinson's disease / RMf de linguagem na doença de Parkinson: levodopa versus não levodopa

Objective: To identify the effect of levodopa in language areas in Parkinson's disease patients. Methods: We evaluated 50 patients with mild to moderate Parkinson's disease, age and gender paired to 47 healthy volunteers. We selected two homogeneous groups of 18 patients taking levodopa and 7 no levodopa patients. The functional magnetic resonance imaging verbal fluency task, with low and high cognitive demands, was performed at a 3T magnetic resonance imaging equipment. Data was analyzed with XBAM software for group maps and ANOVA comparison. Results: Patients without levodopa had more activation than the ones with levodopa in the medial frontal and in the left frontal and parieto-occipital areas. The striatal activation in patients taking levodopa had similar result of the activation detected in the healthy volunteer group. Parietooccipital areas were less activated in the levodopa group than in the no levodopa one. Conclusion: Parkinson's disease patients without levodopa replacement, during a verbal fluency effort, had more diffuse and intense cerebral activation in left hemisphere, mainly in the frontal and parieto-occipital areas. The striatal activation in verbal fluency of patients with levodopa intake was more similar to the activation found in healthy volunteers. These initial evidences suggested a role of levodopa inhibiting activation in parieto-occipital compensating areas.

Objetivo: Identificar o efeito da levodopa nas áreas de linguagem em pacientes com doença de Parkinson. Métodos: Foram avaliados 50 pacientes com doença de Parkinson leve a moderada e pareados, por gênero e idade, a 47 voluntários saudáveis. Foram selecionados dois grupos homogêneos de 18 pacientes que usavam e 7 que não usavam levodopa. O exame de ressonância magnética funcional, com tarefa de fluência verbal por geração de palavras de maiores e menores demandas cognitivas, foi realizado em equipamento de 3T. Os dados foram analisados pelo programa XBAM para os mapas de grupo e as comparações ANOVA. Resultados: Os pacientes sem utilização de levodopa tiveram maior ativação nas áreas frontais mediais e esquerdas e áreas parieto-occipitais que com levodopa. A ativação estriatal nos pacientes em uso de levodopa foi similar à detectada no grupo de voluntários saudáveis. Conclusão: Pacientes com doença de Parkinson, sem utilização de levodopa durante o esforço da fluência verbal, tiveram ativação mais difusa e intensa, principalmente no hemisfério esquerdo, em áreas frontais e parieto-occipitais. A atividade cerebral estriatal na fluência verbal de pacientes em uso de levodopa foi semelhante a dos voluntários saudáveis. Essas evidências iniciais sugerem um papel inibidor da levodopa na ativação compensatória de áreas parieto-occipitais.