丘脑底核和苍白球内侧部脑深部电刺激对帕金森病运动亚型的差异影响。

Differential Effects of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation on Motor Subtypes in Parkinson's Disease.

机构信息

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.

Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.

出版信息

World Neurosurg. 2022 Aug;164:e245-e255. doi: 10.1016/j.wneu.2022.04.084. Epub 2022 Apr 27.

DOI:10.1016/j.wneu.2022.04.084

PMID:35489598

Abstract

OBJECTIVE

We investigated the differences in motor symptom change outcomes after bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in well-defined motor subtypes of Parkinson's disease (PD) to improve clinical decision making.

METHODS

We included 114 patients who had undergone STN-DBS and 65 patients who had undergone GPi-DBS. The patients were classified as having akinetic-rigid type (ART), tremor-dominant type (TDT), and mixed type (MT) using the preoperative Movement Disorder Society Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) scores in the no-medication state. The outcome measures included the no-medication MDS-UPDRS-III scores and subscore changes at the last follow-up after surgery. The outcomes were compared among the different motor subtypes and between STN-DBS and GPi-DBS.

RESULTS

At the last follow-up (14.92 ± 8.35 months), the TDT patients had had a greater median overall motor improvement in the no-medication MDS-UPDRS-III scores compared with the ART patients (62.90% vs. 46.67%; P < 0.001), regardless of the stimulation target. The ART patients showed greater improvement after STN-DBS than after GPi-DBS (54.44% vs. 37.21%; P < 0.001), with improvements in rigidity, akinesia, and posture and gait disorders accounting for the difference.

CONCLUSIONS

Our results suggest that the different PD motor subtypes will have differential responses to STN-DBS and GPi-DBS, that TDT patients will experience greater improvement than ART patients, and that STN-DBS provides better effects for ART patients than does GPi-DBS. In addition, different motor symptoms among the different motor subtypes might respond differently to STN-DBS than to GPi-DBS. All these factors could reflect the heterogeneity of PD. Longer-term outcomes across the different motor subtypes and stimulation targets should be studied further.

摘要

目的

我们研究了在明确的帕金森病（PD）运动亚型中，双侧丘脑底核（STN）和苍白球内（GPi）深部脑刺激（DBS）后运动症状改善结果的差异，以改善临床决策。

方法

我们纳入了 114 例接受 STN-DBS 和 65 例接受 GPi-DBS 的患者。根据术前无药物状态下运动障碍协会统一帕金森病评定量表第三部分（MDS-UPDRS-III）评分，将患者分为僵硬型（ART）、震颤为主型（TDT）和混合型（MT）。主要观察指标包括术后最后一次随访时的无药物 MDS-UPDRS-III 评分和亚评分变化。比较不同运动亚型和 STN-DBS 与 GPi-DBS 之间的结果。

结果

在最后一次随访（14.92±8.35 个月）时，与 ART 患者相比，TDT 患者的无药物 MDS-UPDRS-III 评分的总体运动改善更明显（62.90%比 46.67%；P<0.001），而不论刺激靶点如何。ART 患者在 STN-DBS 后改善优于 GPi-DBS（54.44%比 37.21%；P<0.001），僵硬、运动不能和姿势步态障碍的改善导致了这种差异。

结论

我们的研究结果表明，不同的 PD 运动亚型对 STN-DBS 和 GPi-DBS 有不同的反应，TDT 患者的改善程度大于 ART 患者，STN-DBS 对 ART 患者的疗效优于 GPi-DBS。此外，不同运动亚型的不同运动症状对 STN-DBS 的反应可能与 GPi-DBS 不同。所有这些因素都可能反映了 PD 的异质性。需要进一步研究不同运动亚型和刺激靶点之间的长期结果。