Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
Parkinsonism Relat Disord. 2020 Jun;75:7-13. doi: 10.1016/j.parkreldis.2020.05.004. Epub 2020 May 11.
We aimed to explore the differences in motor symptoms and quality of life (QOL) outcomes following bilateral globus pallidus internus deep brain stimulation (GPi DBS), across well-defined motor subtypes of Parkinson's disease (PD), to improve clinical decision making.
This single-center retrospective study investigated bilateral GPi DBS outcomes in 65 PD patients. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Questionnaire (PDQ-39) before and one year after surgery. Outcomes were compared between the tremor-dominant (TD) and postural instability and gait difficulty (PIGD) subtypes and between the TD and akinetic-rigid (AR) subtypes.
For the entire cohort, motor function (UPDRS III) in the Off-medication state, motor complications (UPDRS IV), activities of daily living (ADL, UPDRS II), and the ADL and discomfort domains of PDQ-39 significantly improved one year following GPi implantation compared to baseline (effect size = 1.32, 1.15, 0.25, 0.45, and 0.34, respectively). GPi DBS improved the Off-medication UPDRS III scores regardless of the motor subtypes. However, compared to the PIGD and AR patients, the TD patients showed greater improvement in overall UPDRS III postoperatively primarily due to greater tremor improvement in the Off-medication state. The outcomes in akinesia, rigidity, axial symptoms and QOL were similar among all subtypes.
Bilateral GPi DBS was effective for advanced PD patients regardless of motor subtypes. Greater tremor improvement in the TD patients accounted for greater Off-medication motor improvement. Longer-term GPi DBS outcomes across different motor subtypes and brain targets should be further studied.
我们旨在探索在帕金森病（PD）的明确运动亚型中，双侧苍白球内侧核深部脑刺激（GPi DBS）后的运动症状和生活质量（QOL）结果的差异，以改善临床决策。
本单中心回顾性研究调查了 65 例 PD 患者的双侧 GPi DBS 结果。在手术前和手术后一年，使用统一帕金森病评定量表（UPDRS）和帕金森病问卷（PDQ-39）进行评估。比较了震颤为主型（TD）和姿势不稳与步态困难型（PIGD）亚型以及震颤为主型和无动僵直型（AR）亚型之间的结果。
对于整个队列，在未用药状态下的运动功能（UPDRS III）、运动并发症（UPDRS IV）、日常生活活动（ADL，UPDRS II）以及 PDQ-39 的 ADL 和不适域显著改善了一年后与基线相比（效应量分别为 1.32、1.15、0.25、0.45 和 0.34）。GPi DBS 改善了无论运动亚型如何，在未用药状态下的 UPDRS III 评分。然而，与 PIGD 和 AR 患者相比，TD 患者术后总体 UPDRS III 的改善更大，主要是由于未用药状态下的震颤改善更大。在运动迟缓、僵硬、轴性症状和 QOL 方面，所有亚型的结果相似。
双侧 GPi DBS 对无论运动亚型如何的晚期 PD 患者都有效。TD 患者的震颤改善更大，导致未用药状态下的运动改善更大。应进一步研究不同运动亚型和脑靶点的长期 GPi DBS 结果。
