Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany.
Ann Neurol. 2019 Oct;86(4):527-538. doi: 10.1002/ana.25567.
To investigate whether functional sweet spots of deep brain stimulation (DBS) in the subthalamic nucleus (STN) can predict motor improvement in Parkinson disease (PD) patients.
Stimulation effects of 449 DBS settings in 21 PD patients were clinically and quantitatively assessed through standardized monopolar reviews and mapped into standard space. A sweet spot for best motor outcome was determined using voxelwise and nonparametric permutation statistics. Two independent cohorts were used to investigate whether stimulation overlap with the sweet spot could predict acute motor outcome (10 patients, 163 settings) and long-term overall Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) improvement (63 patients).
Significant clusters for suppression of rigidity and akinesia, as well as for overall motor improvement, resided around the dorsolateral border of the STN. Overlap of the volume of tissue activated with the sweet spot for overall motor improvement explained R = 37% of the variance in acute motor improvement, more than triple what was explained by overlap with the STN (R = 9%) and its sensorimotor subpart (R = 10%). In the second independent cohort, sweet spot overlap explained R = 20% of the variance in long-term UPDRS-III improvement, which was equivalent to the variance explained by overlap with the STN (R = 21%) and sensorimotor STN (R = 19%).
This study is the first to predict clinical improvement of parkinsonian motor symptoms across cohorts based on local DBS effects only. The new approach revealed a distinct sweet spot for STN DBS in PD. Stimulation overlap with the sweet spot can predict short- and long-term motor outcome and may be used to guide DBS programming. ANN NEUROL 2019;86:527-538.
研究丘脑底核（STN）深部脑刺激（DBS）的功能“甜区”是否能预测帕金森病（PD）患者的运动改善。
通过标准化单极审查对 21 名 PD 患者的 449 个 DBS 设置进行临床和定量评估，并将其映射到标准空间。使用体素和非参数置换统计来确定最佳运动结果的“甜区”。使用两个独立的队列来研究刺激与“甜区”的重叠是否可以预测急性运动结果（10 名患者，163 个设置）和长期整体帕金森病评定量表第三部分（UPDRS-III）改善（63 名患者）。
抑制僵硬和运动不能以及整体运动改善的显著簇位于 STN 的背外侧边界周围。整体运动改善的“甜区”激活组织体积的重叠解释了急性运动改善的方差的 37%，是与 STN（R = 9%）及其感觉运动亚区（R = 10%）重叠的三倍多。在第二个独立队列中，“甜区”重叠解释了长期 UPDRS-III 改善方差的 20%，与与 STN（R = 21%）和感觉运动 STN（R = 19%）重叠解释的方差相当。
本研究首次仅基于局部 DBS 效应，在队列间预测帕金森运动症状的临床改善。新方法揭示了 PD 中 STN DBS 的独特“甜区”。与“甜区”的刺激重叠可以预测短期和长期运动结果，并可能用于指导 DBS 编程。
