Butler Madison, Askari Asra, Zhu Brandon, Wyant Kara, Leventhal Daniel, Patil Parag G, Chou Kelvin L
University of Michigan, Neurology, Ann Arbor, MI, 48105, USA.
University of Michigan, Neurosurgery, Ann Arbor, USA.
J Neural Transm (Vienna). 2025 Apr 24. doi: 10.1007/s00702-025-02931-1.
Subthalamic nucleus (STN) deep brain stimulation (DBS) is well-established for improving appendicular motor signs but its effect on axial motor signs is less clear. Additionally, the location of active electrode contact within the STN has been shown to differentially affect motor outcomes. We investigate the effect of STN DBS and the role of active electrode contact location on axial motor outcomes. Axial scores were assessed in 70 patients with advanced PD between 6 and 12 months after bilateral STN DBS. Repeated measures one-way ANOVA was performed to compare the mean axial motor scores between different medication and stimulation treatment conditions. Multiple linear regression was performed to determine the association between electrode contact location and axial motor score. The mean duration of follow-up was 7.37 ± 2.49 months. The mean total axial score was improved with STN DBS compared to the OFF MED-OFF STIM condition (6.36 ± 4.50 vs. 8.91 ± 5.49, p < 0.0001). A more dorsal electrode contact location on the right was associated with increased (worsened) total axial score (slope = 0.407, p = 0.0047). Total axial score was also lower (improved) in the anterior ventral STN region but not the posterior ventral STN region on the right. STN DBS improves total axial score and several axial subscores in patients with PD 6-12 months postoperatively. A more ventral electrode contact location on the right was associated with improved axial score. Additional research is warranted to determine if this is the optimal stimulation location to improve axial signs in other DBS cohorts.
丘脑底核(STN)深部脑刺激(DBS)在改善肢体运动症状方面已得到充分证实,但其对轴性运动症状的影响尚不清楚。此外,已表明STN内有源电极触点的位置对运动结果有不同影响。我们研究了STN DBS的效果以及有源电极触点位置对轴性运动结果的作用。对70例晚期帕金森病(PD)患者在双侧STN DBS术后6至12个月评估轴性评分。采用重复测量单因素方差分析比较不同药物和刺激治疗条件下的平均轴性运动评分。进行多元线性回归以确定电极触点位置与轴性运动评分之间的关联。平均随访时间为7.37±2.49个月。与关药-关刺激状态相比,STN DBS使平均总轴性评分得到改善(6.36±4.50对8.91±5.49,p<0.0001)。右侧更靠背侧的电极触点位置与总轴性评分增加(恶化)相关(斜率=0.407,p=0.0047)。右侧前腹侧STN区域的总轴性评分也较低(改善),但后腹侧STN区域并非如此。STN DBS可改善PD患者术后6至12个月的总轴性评分和几个轴性子评分。右侧更靠腹侧的电极触点位置与轴性评分改善相关。有必要进行进一步研究以确定这是否是改善其他DBS队列中轴性症状的最佳刺激位置。