苍白球内侧核深部脑刺激后帕金森病言语流畅性下降：电极轨迹的微损伤效应？
Decline in verbal fluency after subthalamic nucleus deep brain stimulation in Parkinson's disease: a microlesion effect of the electrode trajectory?
机构信息
Department of Neurology, Rouen University Hospital and University of Rouen, France.
Department of Neurosurgery, Rouen University Hospital and University of Rouen, France.
出版信息
J Parkinsons Dis. 2015;5(1):95-104. doi: 10.3233/JPD-140443.
BACKGROUND
Decline in verbal fluency (VF) is frequently reported after chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson disease (PD).
OBJECTIVE
We investigated whether the trajectory of the implanted electrode correlate with the VF decline 6 months after surgery.
METHODS
We retrospectively analysed 59 PD patients (mean age, 61.9 ± 7; mean disease duration, 13 ± 4.6) who underwent bilateral STN-DBS. The percentage of VF decline 6 months after STN-DBS in the on-drug/on-stimulation condition was determined in respect of the preoperative on-drug condition. The patients were categorised into two groups (decline and stable) for each VF. Cortical entry angles, intersection with deep grey nuclei (caudate, thalamic or pallidum), and anatomical extent of the STN affected by the electrode pathway, were compared between groups.
RESULTS
A significant decline of both semantic and phonemic VF was found after surgery, respectively 14.9% ± 22.1 (P < 0.05) and 14.2% ± 30.3 (P < 0.05). Patients who declined in semantic VF (n = 44) had a left trajectory with a more anterior cortical entry point (56 ± 53 versus 60 ± 55 degree, P = 0.01) passing less frequently trough the thalamus (P = 0.03).
CONCLUSIONS
Microlesion of left brain regions may contribute to subtle cognitive impairment following STN-DBS in PD.
背景
在帕金森病（PD）患者接受慢性丘脑底核（STN）深部脑刺激（DBS）后，言语流畅性（VF）经常下降。
目的
我们研究了植入电极的轨迹是否与术后 6 个月的 VF 下降相关。
方法
我们回顾性分析了 59 例接受双侧 STN-DBS 的 PD 患者（平均年龄 61.9 ± 7 岁；平均病程 13 ± 4.6 年）。在药物/刺激状态下，将 STN-DBS 后 6 个月的 VF 下降百分比与术前药物状态进行比较。根据每个 VF 将患者分为下降组和稳定组。比较两组之间皮质进入角度、与深部灰质核（尾状核、丘脑或苍白球）的交点以及电极通路影响的 STN 的解剖范围。
结果
手术后，语义和语音 VF 均明显下降，分别为 14.9% ± 22.1（P < 0.05）和 14.2% ± 30.3（P < 0.05）。语义 VF 下降的患者（n = 44）左侧轨迹的皮质进入点更靠前（56 ± 53 度 vs 60 ± 55 度，P = 0.01），通过丘脑的频率更低（P = 0.03）。
结论
左脑区域的微损伤可能导致 PD 患者接受 STN-DBS 后出现轻微认知障碍。
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