Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Service of Neurology, Villa Margherita-Santo Stefano Private Hospital, Arcugnano, Italy.
Neurol Sci. 2024 Jan;45(1):177-185. doi: 10.1007/s10072-023-06999-z. Epub 2023 Aug 9.
Deep brain stimulation (DBS) is an established therapeutic option in advanced Parkinson's disease (PD). Literature data and recent guidelines remain inconclusive about the best choice as a target between the subthalamic nucleus (STN) and the globus pallidus internus (GPi).
We retrospectively reviewed the clinical efficacy outcomes of 48 DBS-implanted patients (33 STN-DBS and 15 GPi-DBS) at a short- (<1 year from the surgery) and long-term (2-5 years) follow-up. Also, clinical safety outcomes, including postoperative surgical complications and severe side effects, were collected.
We found no difference between STN-DBS and GPi-DBS in improving motor symptoms at short-term evaluation. However, STN-DBS achieved a more prominent reduction in oral therapy (L-DOPA equivalent daily dose, P = .02). By contrast, GPi-DBS was superior in ameliorating motor fluctuations and dyskinesia (MDS-UPDRS IV, P < .001) as well as motor experiences of daily living (MDS-UPDRS II, P = .03). The greater efficacy of GPi-DBS on motor fluctuations and experiences of daily living was also present at the long-term follow-up. We observed five serious adverse events, including two suicides, all among STN-DBS patients.
Both STN-DBS and GPi-DBS are effective in improving motor symptoms severity and complications, but GPi-DBS has a greater impact on motor fluctuations and motor experiences of daily living. These results suggest that the two targets should be considered equivalent in motor efficacy, with GPi-DBS as a valuable option in patients with prominent motor complications. The occurrence of suicides in STN-treated patients claims further attention in target selection.
深部脑刺激（DBS）是治疗晚期帕金森病（PD）的一种成熟疗法。文献数据和最近的指南仍然没有定论，无法确定丘脑底核（STN）和苍白球内节（GPi）哪个是最佳的治疗靶点。
我们回顾性地研究了 48 名接受 DBS 植入术的患者（33 名 STN-DBS 和 15 名 GPi-DBS）的短期（手术<1 年）和长期（2-5 年）随访的临床疗效结果。此外，还收集了包括术后手术并发症和严重副作用在内的临床安全性结果。
我们发现 STN-DBS 和 GPi-DBS 在短期评估中改善运动症状方面没有差异。然而，STN-DBS 可显著减少口服药物（L-DOPA 等效日剂量，P =.02）。相比之下，GPi-DBS 在改善运动波动和运动障碍（MDS-UPDRS IV，P <.001）以及日常生活活动的运动体验（MDS-UPDRS II，P =.03）方面更有优势。GPi-DBS 在改善运动波动和日常生活活动方面的疗效在长期随访中也更为显著。我们观察到 5 例严重不良事件，包括 2 例自杀，均发生在 STN-DBS 患者中。
STN-DBS 和 GPi-DBS 均能有效改善运动症状严重程度和并发症，但 GPi-DBS 对运动波动和日常生活活动的运动体验影响更大。这些结果表明，在运动疗效方面，这两个靶点应被视为等效，而 GPi-DBS 则是运动并发症突出的患者的一个有价值的选择。STN 治疗患者中自杀的发生需要进一步关注靶点选择。
