Parkinson's Disease and Movement Disorders Clinic, Sagol Neuroscience Center and Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.
PLoS One. 2013 Jun 11;8(6):e65270. doi: 10.1371/journal.pone.0065270. Print 2013.
To evaluate how bilateral subthalamic nucleus deep brain stimulation (STN-DBS) affects visuo-motor coordination (VMC) in patients with Parkinson's disease (PD).
VMC involves multi-sensory integration, motor planning, executive function and attention. VMC deficits are well-described in PD. STN-DBS conveys marked motor benefit in PD, but pyscho-cognitive complications are recognized and the effect on VMC is not known.
Thirteen PD patients with bilateral STN-DBS underwent neurological, cognitive, and mood assessment before VMC testing with optimal DBS stimulation parameters ('on-stimulation') and then, on the same day without any medication changes, after DBS silencing and establishing motor function deterioration ('off-stimulation'). Twelve age-matched healthy controls performed 2 successive VMC testing sessions, with a break of similar duration to that of the PD group. The computer cursor was controlled with a dome-shaped 'mouse' hidden from view that minimized tremor effects. Movement duration, hand velocity, tracking continuity, directional control variables, and feedback utilization variables were measured. MANOVA was performed on (1) clinically measured motor function, (2) VMC performance and (3) mood and attention, looking for main and interaction effects of: (1) group (controls/PD), (2) test-order (controls: first/second, PD: on-stimulation/off-stimulation), (3) path (sine/square/circle) and (4) hand (dominant/non-dominant).
Unified PD Rating Scale (UPDRS) Part III worsened off-stimulation versus on-stimulation (mean: 42.3 versus 21.6, p = 0.02), as did finger tapping (p = 0.02), posture-gait (p = 0.01), upper limb function (p<0.001) and backwards digit span (p = 0.02). Stimulation state did not affect mood. PD patients performed worse in non-velocity related VMC variables than controls (F(5,18) = 8.5, p<0.001). In the control group there were significant main effects of hand (dominant/non-dominant), path (sine/square/circle) and test-order (Test_1/Test_2). In the PD group, hand and path effects, but no test-order (on-stimulation/off-stimulation), were found.
'Low-level' clinically-measured motor function responds to STN-DBS but 'high-level' motor and cognitive functions relating to VMC may be unresponsive to STN-DBS.
评估双侧丘脑底核深部脑刺激（STN-DBS）如何影响帕金森病（PD）患者的视动协调（VMC）。
VMC 涉及多感觉整合、运动规划、执行功能和注意力。PD 患者的 VMC 缺陷已得到充分描述。STN-DBS 可显著改善 PD 的运动功能，但已认识到心理认知并发症，而其对 VMC 的影响尚不清楚。
13 名接受双侧 STN-DBS 的 PD 患者在使用最佳 DBS 刺激参数（“开启刺激”）进行 VMC 测试之前接受了神经学、认知和情绪评估，然后在同一天不改变任何药物治疗且在 DBS 关闭导致运动功能恶化（“关闭刺激”）的情况下进行测试。12 名年龄匹配的健康对照者进行了 2 次连续的 VMC 测试，两次测试之间的休息时间与 PD 组相似。用隐藏式的圆形“鼠标”控制计算机光标，最大程度地减少震颤的影响。测量运动持续时间、手部速度、跟踪连续性、方向控制变量和反馈利用变量。在（1）临床测量的运动功能、（2）VMC 表现和（3）情绪和注意力方面进行了 MANOVA 分析，寻找：（1）组（对照组/PD）、（2）测试顺序（对照组：第一次/第二次，PD：开启刺激/关闭刺激）、（3）路径（正弦/正方形/圆形）和（4）手（优势/非优势）的主要和交互效应。
与开启刺激相比，关闭刺激时统一帕金森病评定量表（UPDRS）第 III 部分恶化（平均：42.3 对 21.6，p=0.02），手指敲击（p=0.02）、姿势步态（p=0.01）、上肢功能（p<0.001）和向后数字跨度（p=0.02）也恶化。刺激状态不影响情绪。PD 患者在非速度相关 VMC 变量上的表现比对照组差（F（5,18）=8.5，p<0.001）。在对照组中，手（优势/非优势）、路径（正弦/正方形/圆形）和测试顺序（测试 1/测试 2）有显著的主要效应。在 PD 组中，发现了手和路径的效应，但没有测试顺序（开启刺激/关闭刺激）的效应。
“低水平”的临床测量运动功能对 STN-DBS 有反应，但与 VMC 相关的“高水平”运动和认知功能可能对 STN-DBS 无反应。
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