丘脑底核刺激对帕金森病的非运动影响与刺激触点位置有关。
Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts.
机构信息
Department of Neurology, University Hospital Cologne, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.
Department of Neurology, University Hospital Cologne, Cologne, Germany.
出版信息
Brain Stimul. 2018 Jul-Aug;11(4):904-912. doi: 10.1016/j.brs.2018.03.009. Epub 2018 Mar 16.
BACKGROUND
Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS.
OBJECTIVE
To investigate the impact of active contact location on NMS in STN-DBS in PD.
METHODS
In this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Changes were analyzed with Wilcoxon signed-rank/t-test and Bonferroni-correction for multiple comparisons. Although the STN was targeted visually, we employed an atlas-based approach to explore the relationship between active contact locations and DBS outcomes. Based on fused MRI/CT-images, we identified Cartesian coordinates of active contacts with patient-specific Mai-atlas standardization. We computed linear mixed-effects models with x-/y-/z-coordinates as independent, hemispheres as within-subject, and test change scores as dependent variables.
RESULTS
NMSS, NMSQ, PDQ-8, motor examination, complications, and LEDD significantly improved at follow-up. Linear mixed-effect models showed that NMS and QoL improvement significantly depended on more medial (HADS-D, NMSS), anterior (HADS-D, NMSQ, PDQ-8), and ventral (HADS-A/-D, NMSS, PDQ-8) neurostimulation. ADL improved more in posterior, LEDD in lateral neurostimulation locations. No relationship was observed for motor examination and complications scores.
CONCLUSIONS
Our study provides evidence that more anterior, medial, and ventral STN-DBS is significantly related to more beneficial non-motor outcomes.
背景
丘脑底核（STN）深部脑刺激（DBS）可改善帕金森病（PD）患者的生活质量（QoL）、运动和非运动症状（NMS）。很少有研究调查神经刺激位置对 NMS 的影响。
目的
研究 STN-DBS 中活性接触位置对 PD 中 NMS 的影响。
方法
在这项前瞻性、开放标签、多中心研究中，我们纳入了 50 例接受双侧 STN-DBS 的 PD 患者，收集了 NMSScale（NMSS）、NMSQuestionnaire（NMSQ）、医院焦虑和抑郁量表（焦虑/抑郁，HADS-A/-D）、PDQuestionnaire-8（PDQ-8）、运动检查、运动并发症、日常生活活动（ADL）和左旋多巴等效日剂量（LEDD）量表，在术前和 6 个月随访时进行评估。采用 Wilcoxon 符号秩检验和 Bonferroni 校正进行多重比较分析。尽管 STN 是通过视觉定位的，但我们采用了基于图谱的方法来探索活性接触位置与 DBS 结果之间的关系。根据融合的 MRI/CT 图像，我们使用患者特异性 Mai 图谱标准化来识别活性接触的笛卡尔坐标。我们使用线性混合效应模型，将 x-、y-和 z-坐标作为独立变量，将半球作为被试内变量，将测试变化分数作为因变量。
结果
NMSS、NMSQ、PDQ-8、运动检查、并发症和 LEDD 在随访时显著改善。线性混合效应模型显示，NMS 和 QoL 的改善与更内侧（HADS-D、NMSS）、更前（HADS-D、NMSQ、PDQ-8）和更腹侧（HADS-A/-D、NMSS、PDQ-8）的神经刺激显著相关。ADL 在更后部位、LEDD 在更外侧神经刺激部位改善更明显。运动检查和并发症评分与神经刺激位置之间没有关系。
结论
本研究提供了证据表明，STN-DBS 中更前、更内侧和更腹侧的神经刺激与更有益的非运动结果显著相关。
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