Dafsari Haidar S, Dos Santos Ghilardi Maria Gabriela, Visser-Vandewalle Veerle, Rizos Alexandra, Ashkan Keyoumars, Silverdale Monty, Evans Julian, Martinez Raquel C R, Cury Rubens G, Jost Stefanie T, Barbe Michael T, Fink Gereon R, Antonini Angelo, Ray-Chaudhuri K, Martinez-Martin Pablo, Fonoff Erich Talamoni, Timmermann Lars
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.
Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
Brain Stimul. 2020 Nov-Dec;13(6):1697-1705. doi: 10.1016/j.brs.2020.09.019. Epub 2020 Oct 7.
Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects.
To compare nonmotor effects of STN-DBS and GPi-DBS.
In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.
In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.
To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.
丘脑底核（STN）和苍白球内侧核（GPi）深部脑刺激（DBS）可改善晚期帕金森病（PD）患者的生活质量、运动症状和非运动症状（NMS）。然而，很少有研究比较它们的非运动效应。
比较STN-DBS和GPi-DBS的非运动效应。
在这项前瞻性、观察性、多中心研究中，纳入了60例接受双侧STN-DBS（n = 40）或GPi-DBS（n = 20）的PD患者，我们在术前及6个月随访时检查了帕金森病问卷（PDQ）、非运动症状量表（NMSS）、统一帕金森病评定量表-日常生活活动、-运动障碍、-并发症（UPDRS-II、-III、-IV）、Hoehn&Yahr分级、Schwab&England量表以及左旋多巴等效日剂量（LEDD）。如果适用参数检验，随访时组内变化采用Wilcoxon符号秩和检验或配对t检验进行分析，并对多重比较进行校正。组间差异采用Mann-Whitney-U检验/独立样本t检验进行探索。在倾向得分匹配前后进行分析，该匹配平衡了人口统计学和术前临床特征。临床变化的强度采用效应量进行评估。
两组患者在随访时PDQ、UPDRS-II、-IV、Schwab&England量表和NMSS均有显著改善。STN-DBS在降低LEDD方面明显更好，GPi-DBS在改善UPDRS-IV方面更好。虽然NMSS总分结果相似，但探索性的NMSS领域分析显示出不同的特征：两个靶点均改善了睡眠/疲劳和情绪/认知，但只有STN-DBS改善了其他方面（疼痛/嗅觉）以及注意力/记忆，只有GPi-DBS改善了心血管和性功能领域。
据我们所知，这是第一项报告STN-DBS和GPi-DBS在PD中有益非运动效应的不同模式的研究。本研究强调了非运动症状评估对于根据患者个体的运动和非运动特征来调整DBS靶点选择的重要性。
