Eskisehir City Hospital, Neurosurgery Department, 1st floor Eskisehir, Turkey.
Private Hospital, Istanbul, Turkey.
Clin Neurol Neurosurg. 2024 Sep;244:108439. doi: 10.1016/j.clineuro.2024.108439. Epub 2024 Jul 10.
OBJECTIVE: Parkinson's disease (PD) as a neurodegenerative disorder characterized by a reduction in both the quantity and functionality of dopaminergic neurons. This succinctly highlights the central pathological feature of PD and its association with dopaminergic neuron degeneration, which underlies the motor and non-motor symptoms of the disease. This study aims to elucidate the nuances of apparent diffusion coefficient (ADC) changes in different cerebral regions by after the bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery of PD, as well as to investigate their potential interactions with the motor and neuropsychiatric spectrum. METHODS: Patients who underwent STN-DBS surgery for PD between 2017 and 2019 were included in this study. The results of diffusion magnetic resonance imaging (MRI), Unified Parkinson Disease Rating Scale (UPDRS) III scores, Beck and Hamilton depression tests were recorded before and at the 3rd month of postoperative stimulation. The data obtained were evaluated with the Wilcoxon signed rank test. Result of the statistical tests were within the 95 % confidence interval and p values were significant below 0.05. RESULTS: Our study was conducted with a total of 13 patients, 8 men and 5 women. As a result of measurements made in a total of 32 different regions, especially in the motor and neuropsychiatric areas of the brain, an increase in ADC values was found in all areas. ADC changes of eight localizations such as left corpus callosum, right corona radiata, left corona radiata, hippocampus, right insula, left superior cerebellar peduncle, left caudate nucleus and left putamen were statistically significant. UPDRS III scores improved by 57 % (p <0.05), and Beck and Hamilton depression scores by 25 % and 33 %, respectively (p> 0.05). CONCLUSIONS: This article implicate that bilateral STN-DBS surgery potentially exerts beneficial effects on both motor and neuropsychiatric symptomatology in individuals with PD. We believe that this therapeutic mechanism is hypothesized to involve modulation of diffusion alterations within distinct cerebral tissues.
目的：帕金森病（PD）是一种神经退行性疾病，其特征是多巴胺能神经元的数量和功能均减少。这简洁地突出了 PD 的主要病理学特征及其与多巴胺能神经元退化的关联，这是该疾病运动和非运动症状的基础。本研究旨在阐明 PD 患者双侧丘脑底核（STN）深部脑刺激（DBS）手术后不同脑区表观扩散系数（ADC）变化的细微差别，并研究其与运动和神经精神谱的潜在相互作用。
方法：纳入 2017 年至 2019 年间接受 STN-DBS 手术治疗的 PD 患者。记录扩散磁共振成像（MRI）、统一帕金森病评定量表（UPDRS）III 评分、贝克和汉密尔顿抑郁测试的结果，分别在术前和术后 3 个月的刺激时进行。采用 Wilcoxon 符号秩检验对获得的数据进行评估。统计检验结果在 95%置信区间内，p 值低于 0.05 时具有统计学意义。
结果：本研究共纳入 13 例患者，其中 8 例为男性，5 例为女性。对总共 32 个不同区域进行测量后，发现所有区域的 ADC 值均增加。左胼胝体、右放射冠、左放射冠、海马、右岛叶、左小脑上脚、左尾状核和左壳核等 8 个局部区域的 ADC 变化具有统计学意义。UPDRS III 评分改善 57%（p<0.05），贝克和汉密尔顿抑郁评分分别改善 25%和 33%（p>0.05）。
结论：本研究表明，双侧 STN-DBS 手术可能对 PD 患者的运动和神经精神症状均有有益影响。我们认为，这种治疗机制可能涉及对不同脑组织结构中扩散改变的调节。
Acta Neurochir (Wien). 2024-9-16
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