Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France.
Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France.
J Neurol. 2024 May;271(5):2582-2595. doi: 10.1007/s00415-023-12162-7. Epub 2024 Feb 9.
The impact of subthalamic deep-brain stimulation (STN-DBS) on motor asymmetry and its influence on both motor and non-motor outcomes remain unclear. The present study aims at assessing the role of STN-DBS on motor asymmetry and how its modulation translates into benefits in motor function, activities of daily living (ADLs) and quality of life (QoL).
Postoperative motor asymmetry has been assessed on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson's Disease cohort. Asymmetry was evaluated at both baseline (pre-DBS) and 1 year after STN-DBS. A patient was considered asymmetric when the right-to-left MDS-UPDRS part III difference was ≥ 5. In parallel, analyses have been carried out using the absolute right-to-left difference. The proportion of asymmetric patients at baseline was compared to that in the post-surgery evaluation across different medication/stimulation conditions.
537 PD patients have been included. The proportion of asymmetric patients was significantly reduced after both STN-DBS and medication administration (asymmetric patients: 50% in pre-DBS MedOFF, 35% in MedOFF/StimON, 26% in MedON/StimOFF, and 12% in MedON/StimON state). Older patients at surgery and with higher baseline UPDRS II scores were significantly less likely to benefit from STN-DBS at the level of motor asymmetry. No significant correlation between motor asymmetry and ADLs (UPDRS II) or overall QoL (PDQ-39) score was observed. Asymmetric patients had significantly higher mobility, communication, and daily living PDQ-39 sub-scores.
Both STN-DBS and levodopa lead to a reduction in motor asymmetry. Motor symmetry is associated with improvements in certain QoL sub-scores.
丘脑底核脑深部电刺激（STN-DBS）对运动不对称性的影响及其对运动和非运动结果的影响仍不清楚。本研究旨在评估 STN-DBS 对运动不对称性的作用，以及其调节如何转化为运动功能、日常生活活动（ADL）和生活质量（QoL）的益处。
术后运动不对称性已在多中心、前瞻性预测因素和帕金森病 STN-DBS 队列中进行评估。在 STN-DBS 前后 1 年评估不对称性。当右侧到左侧 MDS-UPDRS 第三部分差异≥5 时，患者被认为是不对称的。同时，还使用绝对右侧到左侧差异进行了分析。在不同的药物/刺激条件下，将基线时不对称患者的比例与手术后评估时的比例进行比较。
共纳入 537 例 PD 患者。STN-DBS 和药物治疗后，不对称患者的比例均显著降低（不对称患者：预刺激 MedOFF 组为 50%，MedOFF/StimON 组为 35%，MedON/StimOFF 组为 26%，MedON/StimON 组为 12%）。手术时年龄较大和基线 UPDRS II 评分较高的患者在运动不对称水平上从 STN-DBS 中获益的可能性较小。运动不对称性与 ADL（UPDRS II）或总体 QoL（PDQ-39）评分无显著相关性。不对称患者的移动性、沟通和日常生活 PDQ-39 亚评分显著较高。
STN-DBS 和左旋多巴均可降低运动不对称性。运动对称性与某些 QoL 亚评分的改善相关。
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