Zhang Xiaoxiao, Zhang Huiwei, Lin Zhengyu, Barbosa Daniel A N, Lai Yijie, Halpern Casey H, Voon Valerie, Li Dianyou, Zhang Chencheng, Sun Bomin
Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
PET Center, Huashan Hospital, Fudan University, Shanghai, China.
Front Neurosci. 2022 Jun 1;16:843667. doi: 10.3389/fnins.2022.843667. eCollection 2022.
Subthalamic nucleus (STN) deep brain stimulation (DBS) can improve motor symptoms in Parkinson's disease (PD), as well as potentially improving otherwise intractable comorbid depressive symptoms. To address the latter issue, we evaluated the severity of depressive symptoms along with the severity of motor symptoms in 18 PD patients (mean age, 58.4 ± 5.4 years; 9 males, 9 females; mean PD duration, 9.4 ± 4.4 years) with treatment-resistant depression (TRD) before and after approximately 1 year of STN-DBS treatment. Moreover, to gain more insight into the brain mechanism mediating the therapeutic action of STN-DBS, we utilized F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to assess cerebral regional glucose metabolism in the patients at baseline and 1-year follow-up. Additionally, the baseline PET data from patients were compared with PET data from an age- and sex-matched control group of 16 healthy volunteers. Among them, 12 PD patients underwent post-operative follow-up PET scans. Results showed that the severity of both motor and depressive symptoms in patients with PD-TRD was reduced significantly at 1-year follow-up. Also, patients used significantly less antiparkinsonian medications and antidepressants at 1-year follow-up, as well as experiencing improved daily functioning and a better quality of life. Moreover, relative to the PET data from healthy controls, PD-TRD patients displayed widespread abnormalities in cerebral regional glucose metabolism before STN-DBS treatment, which were partially recovered at 1-year follow-up. Additionally, significant correlations were observed between the patients' improvements in depressive symptoms following STN-DBS and post-operative changes in glucose metabolism in brain regions implicated in emotion regulation. These results support the view that STN-DBS provides a promising treatment option for managing both motor and depressive symptoms in patients who suffer from PD with TRD. However, the results should be interpreted with caution due to the observational nature of the study, small sample size, and relatively short follow-up.
丘脑底核（STN）深部脑刺激（DBS）可改善帕金森病（PD）的运动症状，还可能改善原本难以治疗的共病抑郁症状。为解决后一个问题，我们评估了18例难治性抑郁症（TRD）的PD患者（平均年龄58.4±5.4岁；男性9例，女性9例；平均PD病程9.4±4.4年）在接受STN-DBS治疗约1年前后的抑郁症状严重程度以及运动症状严重程度。此外，为更深入了解介导STN-DBS治疗作用的脑机制，我们利用F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在基线和1年随访时评估患者的脑区葡萄糖代谢。另外，将患者的基线PET数据与16名年龄和性别匹配的健康志愿者对照组的PET数据进行比较。其中，12例PD患者接受了术后随访PET扫描。结果显示，在1年随访时，PD-TRD患者的运动和抑郁症状严重程度均显著降低。此外，患者在1年随访时使用的抗帕金森药物和抗抑郁药物显著减少，日常功能得到改善且生活质量提高。而且，相对于健康对照的PET数据，PD-TRD患者在STN-DBS治疗前脑区葡萄糖代谢存在广泛异常，在1年随访时部分得到恢复。此外，观察到STN-DBS后患者抑郁症状改善与涉及情绪调节的脑区葡萄糖代谢术后变化之间存在显著相关性。这些结果支持这样的观点，即STN-DBS为治疗患有TRD的PD患者的运动和抑郁症状提供了一种有前景的治疗选择。然而，由于本研究为观察性研究、样本量小且随访时间相对较短，对结果的解释应谨慎。
