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帕金森病中脑深部电刺激的偏侧化效应:证据与争议

Lateralized effects of deep brain stimulation in Parkinson's disease: evidence and controversies.

作者信息

Lin Zhengyu, Zhang Chencheng, Li Dianyou, Sun Bomin

机构信息

Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

NPJ Parkinsons Dis. 2021 Jul 22;7(1):64. doi: 10.1038/s41531-021-00209-3.

Abstract

The bilateral effects of deep brain stimulation (DBS) on motor and non-motor symptoms of Parkinson's disease (PD) have been extensively studied and reviewed. However, the unilateral effects-in particular, the potential lateralized effects of left- versus right-sided DBS-have not been adequately recognized or studied. Here we summarized the current evidence and controversies in the literature regarding the lateralized effects of DBS on motor and non-motor outcomes in PD patients. Publications in English language before February 2021 were obtained from the PubMed database and included if they directly compared the effects of unilateral versus contralateral side DBS on motor or non-motor outcomes in PD. The current literature is overall of low-quality and is biased by various confounders. Researchers have investigated mainly PD patients receiving subthalamic nucleus (STN) DBS while the potential lateralized effects of globus pallidus interna (GPi) DBS have not been adequately studied. Evidence suggests potential lateralized effects of STN DBS on axial motor symptoms and deleterious effects of left-sided DBS on language-related functions, in particular, the verbal fluency, in PD. The lateralized DBS effects on appendicular motor symptoms as well as other neurocognitive and neuropsychiatric domains remain inconclusive. Future studies should control for varying methodological approaches as well as clinical and DBS management heterogeneities, including symptom laterality, stimulation parameters, location of active contacts, and lead trajectories. This would contribute to improved treatment strategies such as personalized target selection, surgical planning, and postoperative management that ultimately benefit patients.

摘要

脑深部电刺激(DBS)对帕金森病(PD)运动和非运动症状的双侧影响已得到广泛研究和综述。然而,单侧影响——特别是左侧与右侧DBS的潜在侧化效应——尚未得到充分认识或研究。在此,我们总结了文献中关于DBS对PD患者运动和非运动结局的侧化效应的现有证据和争议。从PubMed数据库获取了2021年2月之前的英文出版物,若它们直接比较了单侧与对侧DBS对PD患者运动或非运动结局的影响,则纳入研究。当前文献总体质量较低,且受到各种混杂因素的影响。研究人员主要调查了接受丘脑底核(STN)DBS的PD患者,而苍白球内侧部(GPi)DBS的潜在侧化效应尚未得到充分研究。有证据表明,STN DBS对轴向运动症状可能存在侧化效应,而左侧DBS对语言相关功能,尤其是言语流畅性,可能存在有害影响。DBS对肢体运动症状以及其他神经认知和神经精神领域的侧化效应仍无定论。未来的研究应控制不同的方法学以及临床和DBS管理的异质性,包括症状的侧别、刺激参数、有效触点的位置和电极轨迹。这将有助于改进治疗策略,如个性化靶点选择、手术规划和术后管理,最终使患者受益。

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