Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
Neurosurgery. 2018 Oct 1;83(4):666-674. doi: 10.1093/neuros/nyx475.
A host of influences contribute to cognitive and behavioral changes following deep brain stimulation. The location of the active cathode is likely an important variable but it has received little attention.
To determine whether active contact location relative to the subthalamic nucleus and other neighboring structures is related to nonmotor outcomes.
We identified a retrospective, cross-sectional sample of 46 patients who underwent subthalamic nucleus deep brain stimulation for treatment of idiopathic Parkinson's disease. T-tests or nonparametric equivalents were used to detect baseline differences between unilateral left, unilateral right, and bilateral surgical groups. Correlation and partial correlational analyses identified relationships between contact location variables and alterations in cognitive, mood, quality of life, motor, and disease variables.
Medial contact locations within the left subthalamic nucleus were correlated with improvements in self-reported mood (r12 = -0.78, P = .001; 95% confidence interval [CI] = -0.43 to -0.93) but worsening semantic fluency (r26 = -0.38, P = .048; 95% CI = -0.01 to -0.66). Phonemic fluency worsened with more posterior left placement (r34 = 0.35, P = .036; 95% CI = 0.03 to 0.61). Memory outcome was related to right hemisphere stimulation voltage (r29 = -0.40, P = .022; 95% CI = -0.05 to -0.66), which is likely a proxy for variable electrode location.
Location of the active contact is related to nonmotor outcomes, even in electrodes that are adequately placed. This is relevant to clinical care as there appears to be a trade-off between mood and fluency abilities that should be considered during surgical planning according to preoperative patient characteristics.
许多因素都会导致深部脑刺激后认知和行为的改变。激活阴极的位置可能是一个重要的变量，但它一直没有得到太多关注。
确定相对于丘脑底核和其他邻近结构的激活接触位置是否与非运动结果有关。
我们确定了 46 例接受丘脑底核深部脑刺激治疗特发性帕金森病的回顾性、横断面样本。使用 t 检验或非参数等效方法检测单侧左、单侧右和双侧手术组之间的基线差异。相关性和偏相关分析确定了接触位置变量与认知、情绪、生活质量、运动和疾病变量变化之间的关系。
左侧丘脑底核内的内侧接触位置与自我报告的情绪改善相关（r12 = -0.78，P =.001；95%置信区间[CI] = -0.43 至 -0.93），但语义流畅性恶化（r26 = -0.38，P =.048；95% CI = -0.01 至 -0.66）。左位更靠后，语音流畅性恶化（r34 = 0.35，P =.036；95% CI = 0.03 至 0.61）。记忆结果与右半球刺激电压有关（r29 = -0.40，P =.022；95% CI = -0.05 至 -0.66），这可能是电极位置变化的一个指标。
即使电极位置适当，激活接触的位置也与非运动结果有关。这与临床护理有关，因为在手术计划中，根据术前患者特征，似乎存在情绪和流畅性能力之间的权衡，这需要考虑。
