Eguchi Katsuki, Shirai Shinichi, Matsushima Masaaki, Kano Takahiro, Yamazaki Kazuyoshi, Hamauchi Shuji, Sasamori Toru, Seki Toshitaka, Hirata Kenji, Kitagawa Mayumi, Otsuki Mika, Shiga Tohru, Houkin Kiyohiro, Sasaki Hidenao, Yabe Ichiro
Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan.
Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan.
BMC Neurol. 2021 Sep 13;21(1):351. doi: 10.1186/s12883-021-02383-6.
Weight gain (WG) is a frequently reported side effect of subthalamic deep brain stimulation; however, the underlying mechanisms remain unclear. The active contact locations influence the clinical outcomes of subthalamic deep brain stimulation, but it is unclear whether WG is directly associated with the active contact locations. We aimed to determine whether WG is associated with the subthalamic deep brain stimulation active contact locations.
We enrolled 14 patients with Parkinson's disease who underwent bilateral subthalamic deep brain stimulation between 2013 and 2019. Bodyweight and body mass index were measured before and one year following the surgery. The Lead-DBS Matlab toolbox was used to determine the active contact locations based on magnetic resonance imaging and computed tomography. We also created sweet spot maps for WG using voxel-wise statistics, based on volume of tissue activation and the WG of each patient. Fluorodeoxyglucose-positron emission tomography data were also acquired before and one year following surgery, and statistical parametric mapping was used to evaluate changes in brain metabolism. We examined which brain regions' metabolism fluctuation significantly correlated with increased body mass index scores and positron emission tomography data.
One year after surgery, the body mass index increase was 2.03 kg/m. The sweet spots for WG were bilateral, mainly located dorsally outside of the subthalamic nucleus (STN). Furthermore, WG was correlated with increased metabolism in the left limbic and associative regions, including the middle temporal gyrus, inferior frontal gyrus, and orbital gyrus.
Although the mechanisms underlying WG following subthalamic deep brain stimulation are possibly multifactorial, our findings suggest that dorsal stimulation outside of STN may lead to WG. The metabolic changes in limbic and associative cortical regions after STN-DBS may also be one of the mechanisms underlying WG. Further studies are warranted to confirm whether dorsal stimulation outside of STN changes the activities of these cortical regions.
体重增加（WG）是丘脑底核深部脑刺激常见的副作用；然而，其潜在机制尚不清楚。有源触点位置会影响丘脑底核深部脑刺激的临床效果，但尚不清楚体重增加是否与有源触点位置直接相关。我们旨在确定体重增加是否与丘脑底核深部脑刺激的有源触点位置有关。
我们纳入了14例在2013年至2019年间接受双侧丘脑底核深部脑刺激的帕金森病患者。在手术前和手术后一年测量体重和体重指数。使用Lead-DBS Matlab工具箱根据磁共振成像和计算机断层扫描确定有源触点位置。我们还基于组织激活体积和每位患者的体重增加情况，使用体素统计方法创建了体重增加的“最佳点”图。在手术前和手术后一年还采集了氟脱氧葡萄糖正电子发射断层扫描数据，并使用统计参数映射来评估脑代谢变化。我们检查了哪些脑区的代谢波动与体重指数得分增加和正电子发射断层扫描数据显著相关。
手术后一年，体重指数增加了2.03kg/m²。体重增加的“最佳点”在双侧，主要位于丘脑底核（STN）背侧外部。此外，体重增加与左侧边缘和联合区域（包括颞中回、额下回和眶回）的代谢增加相关。
虽然丘脑底核深部脑刺激后体重增加的机制可能是多因素的，但我们的研究结果表明，STN背侧外部的刺激可能导致体重增加。STN-DBS后边缘和联合皮质区域的代谢变化也可能是体重增加的潜在机制之一。有必要进一步研究以确认STN背侧外部的刺激是否会改变这些皮质区域的活动。
