Meng Fangang, Cen Shanshan, Yi Zhiqiang, Li Weiguo, Cai Guoen, Wang Feng, Quintin Stephan S, Hey Grace E, Hernandez Jairo S, Han Chunlei, Fan Shiying, Gao Yuan, Song Zimu, Yi Junfei, Wang Kailiang, Zhang Liangwen, Ramirez-Zamora Adolfo, Zhang Jianguo
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.
Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Brain Sci. 2022 Aug 9;12(8):1054. doi: 10.3390/brainsci12081054.
Deep brain stimulation (DBS) is an effective treatment for dyskinesia in patients with Parkinson’s disease (PD), among which the therapeutic targets commonly used include the subthalamic nucleus (STN) and the globus pallidus internus (GPi). Levodopa-induced dyskinesia (LID) is one of the common motor complications arising in PD patients on chronic treatment with levodopa. In this article, we retrospectively evaluated the outcomes of LID with the Unified Dyskinesia Rating Scale (UDysRS) in patients who underwent DBS in multiple centers with a GPi or an STN target. Meanwhile, the Med off MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-Ⅲ) and the levodopa equivalent daily dose (LEDD) were also observed as secondary indicators. PD patients with a GPi target showed a more significant improvement in the UDysRS compared with an STN target (92.9 ± 16.7% vs. 66.0 ± 33.6%, p < 0.0001). Both the GPi and the STN showed similar improvement in Med off UPDRS-III scores (49.8 ± 22.6% vs. 52.3 ± 29.5%, p = 0.5458). However, the LEDD was obviously reduced with the STN target compared with the GPi target (44.6 ± 28.1% vs. 12.2 ± 45.8%, p = 0.006).
脑深部电刺激（DBS）是治疗帕金森病（PD）患者运动障碍的一种有效方法，其中常用的治疗靶点包括丘脑底核（STN）和苍白球内侧部（GPi）。左旋多巴诱发的运动障碍（LID）是长期接受左旋多巴治疗的PD患者常见的运动并发症之一。在本文中，我们回顾性评估了在多个中心接受以GPi或STN为靶点的DBS治疗的患者，使用统一运动障碍评定量表（UDysRS）评估LID的治疗效果。同时，还观察了关期MDS统一帕金森病评定量表（MDS-UPDRS-Ⅲ）和左旋多巴等效日剂量（LEDD）作为次要指标。与以STN为靶点的患者相比，以GPi为靶点的PD患者在UDysRS上的改善更为显著（92.9±16.7%对66.0±33.6%，p<0.0001）。GPi和STN在关期UPDRS-III评分上的改善相似（49.8±22.6%对52.3±29.5%，p=0.5458）。然而，与以GPi为靶点相比，以STN为靶点时LEDD明显降低（44.6±28.1%对12.2±45.8%，p=0.006）。
