From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Neurology. 2016 Feb 23;86(8):755-61. doi: 10.1212/WNL.0000000000002401. Epub 2016 Jan 27.
To compare motor symptoms, cognition, mood, and behavior 3 years after deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) in advanced Parkinson disease (PD).
Patients with PD eligible for DBS were randomized to bilateral GPi DBS and bilateral STN DBS (1:1). The primary outcome measures were (1) improvement in motor symptoms in off-drug phase measured with the Unified Parkinson Disease Rating Scale (UPDRS) and (2) a composite score for cognitive, mood, and behavioral effects, and inability to complete follow-up at 36 months after surgery.
Of the 128 patients enrolled, 90 were able to complete the 3-year follow-up. We found significantly more improvement of motor symptoms after STN DBS (median [interquartile range (IQR)] at 3 years, GPi 33 [23-41], STN 28 [20-36], p = 0.04). No between-group differences were observed on the composite score (GPi 83%, STN 86%). Secondary outcomes showed larger improvement in off-drug functioning in the AMC Linear Disability Scale score after STN DBS (mean ± SD, GPi 65.2 ± 20.1, STN 72.6 ± 18.0, p = 0.05). Medication was reduced more after STN DBS (median levodopa equivalent dose [IQR] at 3 years, GPi 1,060 [657-1,860], STN 605 [411-875], p < 0.001). No differences in adverse effects were recorded, apart from more reoperations to a different target after GPi DBS (GPi n = 8, STN n = 1).
Off-drug phase motor symptoms and functioning improve more after STN DBS than after GPi DBS. No between-group differences were observed on a composite score for cognition, mood, and behavior, and the inability to participate in follow-up.
This study provides Class II evidence that STN DBS provides more off-phase motor improvement than GPi DBS, but with a similar risk for cognitive, mood, and behavioral complications.
比较深部脑刺激（DBS）治疗晚期帕金森病（PD）患者内侧苍白球（GPi）和丘脑底核（STN） 3 年后的运动症状、认知、情绪和行为。
符合 DBS 适应证的 PD 患者被随机分为双侧 GPi-DBS 和双侧 STN-DBS（1:1）。主要观察指标为（1）停药期运动症状改善，采用统一帕金森病评定量表（UPDRS）评分；（2）认知、情绪和行为影响的综合评分，以及术后 36 个月无法完成随访。
128 例患者中，90 例完成 3 年随访。我们发现 STN-DBS 后运动症状改善更明显（中位数[四分位数范围（IQR）]，3 年时 GPi 为 33[23-41]，STN 为 28[20-36]，p = 0.04）。复合评分无组间差异（GPi 为 83%，STN 为 86%）。次要结局显示，STN-DBS 后停药时 AMC 线性残疾量表评分改善更大（平均 ± 标准差，GPi 为 65.2 ± 20.1，STN 为 72.6 ± 18.0，p = 0.05）。STN-DBS 后药物剂量减少更多（中位数[IQR]，3 年时 GPi 为 1060[657-1860]，STN 为 605[411-875]，p < 0.001）。除了 GPi-DBS 后更多的再手术至不同靶点（GPi n = 8，STN n = 1）外，未记录到其他不良反应差异。
与 GPi-DBS 相比，STN-DBS 可使停药期运动症状和功能改善更明显。认知、情绪和行为的综合评分以及无法参与随访无组间差异。
本研究提供 II 级证据，表明 STN-DBS 提供的停药期运动改善优于 GPi-DBS，但认知、情绪和行为并发症的风险相似。
