Lang Stefan, Vetkas Artur, Conner Christopher, Kalia Lorraine V, Lozano Andres M, Kalia Suneil K
Division of Neurosurgery, Department of Surgery University of Toronto Toronto Ontario Canada.
Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.
Mov Disord Clin Pract. 2023 Apr 20;10(6):933-942. doi: 10.1002/mdc3.13747. eCollection 2023 Jun.
Deep brain stimulation (DBS) surgery is offered to a subset of Parkinson's disease (PD) patients. It is unclear if there are features at diagnosis that predict future DBS surgery.
To assess predictors of eventual DBS surgery in de novo PD patients.
Subjects from the Parkinson's Progression Marker Initiative (PPMI) database with newly diagnosed, sporadic PD ( = 416) were identified and stratified by their eventual DBS status (DBS+, = 43; DBS-, = 373). A total of 50 baseline clinical, imaging, and biospecimen features were extracted for each subject and cross-validated lasso regression was used for feature reduction. Multivariate logistic regression assessed their relationship with DBS status and a receiver operating characteristic curve evaluated model performance. Linear mixed effect models assessed disease progression over 4 years in DBS+ and DBS- patients.
Age at symptom onset, Hoehn and Yahr (H&Y) stage, tremor score, and ratio of CSF Tau to amyloid-beta 1-42 (Tau: Ab) were identified as important baseline features for predicting DBS surgery. Each independently predicted DBS surgery (area under the curve = 0.83). DBS- patients had faster memory decline ( < 0.05), while DBS+ patients had faster decline in H&Y stage ( < 0.001) and motor scores ( < 0.05) prior to surgery.
The identified features may be used for early identification of patients who may be surgical candidates during the course of their disease. Disease progression in these groups reflects surgical eligibility criteria, with DBS- patients having more rapid decline in memory while DBS+ patients experienced a faster decline in motor scores prior to DBS surgery.
深部脑刺激（DBS）手术适用于一部分帕金森病（PD）患者。目前尚不清楚在诊断时是否存在能够预测未来DBS手术的特征。
评估初发PD患者最终接受DBS手术的预测因素。
从帕金森病进展标记物倡议（PPMI）数据库中识别出416例新诊断的散发性PD患者，并根据其最终的DBS状态进行分层（DBS+组，43例；DBS-组，373例）。为每位受试者提取了总共50项基线临床、影像和生物样本特征，并使用交叉验证的套索回归进行特征约简。多变量逻辑回归评估这些特征与DBS状态的关系，受试者工作特征曲线评估模型性能。线性混合效应模型评估了DBS+组和DBS-组患者4年的疾病进展情况。
症状发作年龄、Hoehn和Yahr（H&Y）分期、震颤评分以及脑脊液 Tau 蛋白与β淀粉样蛋白1-42的比值（Tau:Ab）被确定为预测DBS手术的重要基线特征。每项特征均能独立预测DBS手术（曲线下面积 = 0.83）。DBS-组患者记忆衰退更快（P < 0.05），而DBS+组患者在手术前H&Y分期（P < 0.001）和运动评分（P < 0.05）衰退更快。
所识别出的特征可用于在疾病过程中早期识别可能适合手术的患者。这些组别的疾病进展反映了手术适应证标准，DBS-组患者记忆衰退更快，而DBS+组患者在DBS手术前运动评分衰退更快。
