Tödt Inken, Al-Fatly Bassam, Granert Oliver, Kühn Andrea A, Krack Paul, Rau Joern, Timmermann Lars, Schnitzler Alfons, Paschen Steffen, Helmers Ann-Kristin, Hartmann Andreas, Bardinet Eric, Schuepbach Michael, Barbe Michael T, Dembek Till A, Fraix Valerie, Kübler Dorothee, Brefel-Courbon Christine, Gharabaghi Alireza, Wojtecki Lars, Pinsker Marcus O, Thobois Stephane, Damier Philippe, Witjas Tatiana, Houeto Jean-Luc, Schade-Brittinger Carmen, Vidailhet Marie, Horn Andreas, Deuschl Günther
Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany.
Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany.
Mov Disord. 2022 Feb;37(2):291-301. doi: 10.1002/mds.28952. Epub 2022 Feb 3.
Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL.
The relation between the stimulated part of the STN and clinical outcomes, including the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS) and the quality-of-life questionnaire, was assessed in a subcohort of the EARLYSTIM study.
Sixty-nine patients from the EARLYSTIM cohort who underwent DBS, with a comprehensive clinical characterization before and 24 months after surgery, were included. Intercorrelations of clinical outcome changes, correlation between the affected functional parts of the STN, and changes in clinical outcomes were investigated. We further calculated sweet spots for different clinical parameters.
Improvements in the UPDRS III and Parkinson's Disease Questionnaire (PDQ-39) correlated positively with the extent of the overlap with the sensorimotor STN. The sweet spots for the UPDRS III (x = 11.6, y = -13.1, z = -6.3) and the PDQ-39 differed (x = 14.8, y = -12.4, z = -4.3) ~3.8 mm.
The main influence of DBS on QoL is likely mediated through the sensory-motor basal ganglia loop. The PDQ sweet spot is located in a posteroventral spatial location in the STN territory. For aspects of QoL, however, there was also evidence of improvement through stimulation of the other STN subnuclei. More research is necessary to customize the DBS target to individual symptoms of each patient. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
丘脑底核深部脑刺激（STN-DBS）可有效治疗晚期及症状波动的早期帕金森病的运动症状和生活质量（QoL）。关于电极位置与症状控制变化以及最终生活质量之间的关系，人们了解甚少。
在EARLYSTIM研究的一个亚组中，评估丘脑底核受刺激部分与临床结局之间的关系，包括统一帕金森病评定量表（UPDRS）的运动评分和生活质量问卷。
纳入EARLYSTIM队列中69例接受DBS治疗的患者，这些患者在手术前和术后24个月进行了全面的临床特征分析。研究临床结局变化的相互关系、丘脑底核受影响功能部分之间的相关性以及临床结局的变化。我们还计算了不同临床参数的最佳靶点位置。
UPDRS III和帕金森病问卷（PDQ-39）的改善与感觉运动丘脑底核的重叠程度呈正相关。UPDRS III（x = 11.6，y = -13.1，z = -6.3）和PDQ-39的最佳靶点位置不同（x = 14.8，y = -12.4，z = -4.3），相差约3.8毫米。
DBS对生活质量的主要影响可能是通过感觉运动基底神经节环路介导的。PDQ的最佳靶点位于丘脑底核区域的后腹侧空间位置。然而，对于生活质量的各个方面，也有证据表明通过刺激丘脑底核的其他亚核也可改善。需要更多研究来根据每位患者的个体症状定制DBS靶点。© 2022作者。《运动障碍》由Wiley Periodicals LLC代表国际帕金森和运动障碍协会出版。
