Division of Movement Disorders, Department of Neurology;
J Neurosurg. 2013 Dec;119(6):1530-6. doi: 10.3171/2013.8.JNS122025. Epub 2013 Sep 27.
While many centers place bilateral deep brain stimulation (DBS) systems simultaneously, unilateral subthalamic nucleus (STN) DBS followed by a staged contralateral procedure has emerged as a treatment option for many patients. However, little is known about whether the preoperative phenotype predicts when staged placement of a DBS electrode in the opposite STN will be required. The authors aimed to determine whether preoperative clinical phenotype predicts early staged placement of a second STN DBS electrode in patients who undergo unilateral STN DBS for Parkinson disease (PD).
Eighty-two consecutive patients with advanced PD underwent unilateral STN DBS contralateral to the most affected hemibody and had at least 2 years of follow-up. Multivariate logistic regression analysis determined preoperative characteristics that predicted staged placement of a second electrode in the opposite STN. Preoperative measurements included aspects of the Unified Parkinson's Disease Rating Scale (UPDRS), motor asymmetry index, and body weight.
At 2-year follow-up, 28 (34%) of the 82 patients had undergone staged placement of a contralateral electrode while the remainder chose to continue with unilateral stimulation. Statistically significant improvements in UPDRS total and Part 3 scores were retained at the end of the 2-year follow-up period in both subsets of patients. Multivariate logistic regression analysis showed that the most important predictors for early staged placement of a second subthalamic stimulator were low asymmetry index (OR 13.4, 95% CI 2.8-64.9), high tremor subscore (OR 7.2, CI 1.5-35.0), and low body weight (OR 5.5, 95% CI 1.4-22.3).
This single-center study provides evidence that elements of the preoperative PD phenotype predict whether patients will require early staged bilateral STN DBS. These data may aid in the management of patients with advanced PD who undergo STN DBS.
虽然许多中心同时放置双侧深部脑刺激(DBS)系统,但单侧丘脑底核(STN)DBS 随后进行分期对侧手术已成为许多患者的治疗选择。然而,对于术前表型是否预测何时需要分期放置对侧 STN 的 DBS 电极,知之甚少。作者旨在确定接受单侧 STN DBS 治疗的帕金森病(PD)患者的术前临床表型是否预测早期分期放置对侧 STN 的第二个 DBS 电极。
82 例接受单侧 STN DBS 的连续患者进行了与受影响最严重的半侧相反的 STN DBS,并进行了至少 2 年的随访。多变量逻辑回归分析确定了预测对侧 STN 分期放置第二个电极的术前特征。术前测量包括统一帕金森病评定量表(UPDRS)、运动不对称指数和体重的各个方面。
在 2 年的随访中,82 例患者中有 28 例(34%)进行了分期对侧电极放置,其余患者选择继续进行单侧刺激。在两组患者中,UPDRS 总分和第 3 部分评分在 2 年随访结束时均保持显著改善。多变量逻辑回归分析表明,早期分期放置第二个丘脑底核刺激器的最重要预测因素是低不对称指数(OR 13.4,95%CI 2.8-64.9)、高震颤子得分(OR 7.2,CI 1.5-35.0)和低体重(OR 5.5,95%CI 1.4-22.3)。
这项单中心研究提供了证据,表明术前 PD 表型的元素预测患者是否需要早期分期双侧 STN DBS。这些数据可能有助于管理接受 STN DBS 的晚期 PD 患者。