"Behavior and Basal Ganglia" Research Unit, University of Rennes 1, Rennes, France.
Department of Neurology, University Hospital of Rennes, Rennes, France.
J Neurol. 2019 Nov;266(11):2764-2771. doi: 10.1007/s00415-019-09482-y. Epub 2019 Jul 26.
Patients with Parkinson's disease sometimes report postural instability and gait disorders (PIGD) after subthalamic nucleus deep brain stimulation (STN-DBS). Whether this is the direct consequence of DBS or the result of natural disease progression is still subject to debate.
To compare changes in brain metabolism during STN-DBS between patients with and without PIGD after surgery.
We extracted consecutive patients from a database where all Rennes Hospital patients undergoing STN-DBS are registered, with regular prospective updates of their clinical data. Patients were divided into two groups (PIGD and No PIGD) according to changes after surgery, as measured with a composite score based on the selected Unified Parkinson's Disease Rating Scale items. All patients underwent positron emission tomography with [F]-fluorodeoxyglucose 3 months before and after surgery. We ran an ANOVA with two factors (group: PIGD vs. No PIGD; and phase: preoperative vs. postoperative) on SPM8 to compare changes in brain metabolism between the two groups.
Participants were 56 patients, including 10 in the PIGD group. The two groups had similar baseline (i.e., before surgery) characteristics. We found two clusters of increased metabolism in the PIGD group relative to the No PIGD group: dorsal midbrain/pons, including locomotor mesencephalic region and reticular pontine formation, and right motor cerebellum.
We found different metabolic changes during DBS-STN among patients with PIGD, concerning brain regions that are already known to be involved in gait disorders in Parkinson's disease, suggesting that DBS is responsible for the appearance of PIGD.
帕金森病患者在接受丘脑底核脑深部电刺激（STN-DBS）后有时会出现姿势不稳和步态障碍（PIGD）。这是 DBS 的直接后果还是疾病自然进展的结果仍存在争议。
比较术后伴有和不伴有 PIGD 的 STN-DBS 患者脑代谢变化。
我们从数据库中提取了连续的患者，该数据库中登记了所有在雷恩医院接受 STN-DBS 的患者，定期对他们的临床数据进行前瞻性更新。根据基于选定的统一帕金森病评定量表项目的综合评分，患者在手术后分为两组（PIGD 和无 PIGD）。所有患者在手术前后 3 个月均行[F]-氟脱氧葡萄糖正电子发射断层扫描。我们在 SPM8 上进行了一个具有两个因素（组：PIGD 与无 PIGD；和阶段：术前与术后）的方差分析，以比较两组之间脑代谢的变化。
参与者包括 56 名患者，其中 PIGD 组有 10 名。两组的基线（即术前）特征相似。我们发现 PIGD 组相对于无 PIGD 组有两个代谢增加的簇：中脑背侧/脑桥，包括运动性中脑区域和网状脑桥形成，以及右侧运动小脑。
我们发现 PIGD 患者在接受 DBS-STN 治疗时脑代谢发生了不同的变化，涉及到已知与帕金森病步态障碍有关的脑区，这表明 DBS 是 PIGD 出现的原因。
