Zhao Guangrui, Cheng Yifeng, Li Guangfeng, Li Lanxin, Li Feng, Wu Yuzhang, Du Chuan, Yan Jingtao, Cong Guangyan, Zhao Qiyuan, Wang Min, Feng Keke, Yin Shaoya
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Department of Neurosurgery, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, China.
Mov Disord Clin Pract. 2024 Dec;11(12):1478-1488. doi: 10.1002/mdc3.14195. Epub 2024 Sep 11.
Currently, the conclusions of studies on subthalamic nucleus (STN) deep brain stimulation (DBS) for improving Parkinson's disease (PD) with depression are inconsistent, and the reasons for improvement or deterioration remain unclear.
The aim was to investigate the prognosis of PD with depression after bilateral STN-DBS and the factors related to the improvement in depression. The local and network effects of DBS on depression in PD (DPD) were further explored based on the volume of tissue activation (VTA). The study analyzed 80 primary PD patients who had undergone bilateral STN-DBS, comprising 47 patients with improved depression and 33 patients without improvement. Two groups of clinical profiles and stimulation parameters were compared, and the network models for improving depression were constructed.
The improvement in depression was closely associated with improvement in anxiety (odd rate [OR] = 1.067, P = 0.006) and the standardized space left y-coordinate (OR = 0.253, P = 0.005). The VTA overlapping with the left motor STN subregion is most significantly associated with improvement in depression (R = 0.53, P < 0.001; R = 0.43, P < 0.001). The y-coordinates in the improvement group were closer to the optimal stimulation site for improving motor symptoms. Finally, both the structural and functional network models indicate a positive correlation between depression improvement and the connectivity of the sensorimotor cortex.
The amelioration of DPD is primarily attributed to the stimulation of bilateral motor STN, particularly on the left. However, this stimulatory effect manifests as an indirect influence.
目前，关于丘脑底核（STN）深部脑刺激（DBS）改善帕金森病（PD）伴发抑郁的研究结论并不一致，改善或恶化的原因仍不明确。
目的是研究双侧STN-DBS术后PD伴发抑郁的预后以及与抑郁改善相关的因素。基于组织激活体积（VTA）进一步探讨DBS对PD伴抑郁（DPD）患者抑郁的局部和网络效应。该研究分析了80例接受双侧STN-DBS的原发性PD患者，其中47例抑郁改善，33例未改善。比较两组的临床特征和刺激参数，并构建改善抑郁的网络模型。
抑郁的改善与焦虑的改善密切相关（比值比[OR]=1.067，P=0.006）以及标准化空间左纵坐标（OR=0.253，P=0.005）。与左侧运动STN亚区域重叠的VTA与抑郁改善最显著相关（R=0.53，P<0.001；R=0.43，P<0.001）。改善组的纵坐标更接近改善运动症状的最佳刺激部位。最后，结构和功能网络模型均表明抑郁改善与感觉运动皮层的连通性之间存在正相关。
DPD的改善主要归因于双侧运动STN的刺激，尤其是左侧。然而，这种刺激作用表现为间接影响。
