Yan Jiuqi, Sun Jian, Wei Xiang, Qiu Chang, Zhao Liang, Luo Bei, Dong Wenwen, Liu Jingxuan, Lu Guanghan, Zhang Wenbin
Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Front Neurosci. 2025 Apr 28;19:1577588. doi: 10.3389/fnins.2025.1577588. eCollection 2025.
STN-DBS is an effective treatment for Parkinson's disease (PD), improving motor symptoms, but its impact on non-motor symptoms, such as anxiety and depression, remain unclear. This study investigates the relationship between electrode contact locations, their corresponding volume of tissue activated (VTA), and postoperative changes in emotional symptoms. It aims to identify optimal group-level stimulation sites for improving anxiety and depression in PD patients and to develop a structural connectome to explore how cortical regions targeted by fiber projections correlate with mood outcomes.
We retrospectively studied 56 PD patients who underwent bilateral STN-DBS, assessed 6 months post-surgery. Standardized scales evaluated motor, affective, and cognitive symptoms before and after the procedure. Electrode positions were reconstructed using Lead-DBS, and VTAs were calculated. Voxel-wise sweet spot and structural connectivity analyses investigated how stimulation sites influenced clinical outcomes.
Compared to preoperative assessments, postoperative evaluations revealed varying degrees of improvement in motor function, quality of life, and symptoms of anxiety and depression in PD patients ( < 0.05). The amelioration of anxiety and depression was associated with electrode contacts located in the ventral region of the STN. Specifically, improvements in anxiety were positively correlated with the VTA in the limbic region of the right STN. Sweet spot analysis revealed that stimulation of the ventrocentral region of the left STN was significantly associated with emotional improvement. Structural connectivity analysis revealed that fiber tracts to the prefrontal cortex (PFC) were positively associated with anxiety and depression improvement, while those to the sensorimotor cortex (SMC) showed a negative correlation.
STN-DBS markedly improves motor symptoms and quality of life in PD patients while also positively impacting anxiety and depressive symptoms. The ventral STN is likely the optimal stimulation target for ameliorating anxiety and depressive symptoms. The therapeutic effects of STN-DBS electrodes may promote postoperative improvements in anxiety and depression by modulating fiber tracts connected to prefrontal regions. Future research should leverage connectome mapping and isolated fiber tracts to refine electrode placement, using directional leads to target specific STN subregions for improved symptom management.
丘脑底核深部脑刺激（STN-DBS）是治疗帕金森病（PD）的一种有效方法，可改善运动症状，但其对焦虑和抑郁等非运动症状的影响仍不明确。本研究调查电极触点位置、其相应的组织激活体积（VTA）与术后情绪症状变化之间的关系。旨在确定改善PD患者焦虑和抑郁的最佳组水平刺激部位，并构建一个结构连接组，以探索纤维投射靶向的皮质区域与情绪结果之间的相关性。
我们回顾性研究了56例接受双侧STN-DBS的PD患者，在术后6个月进行评估。使用标准化量表评估手术前后的运动、情感和认知症状。使用Lead-DBS重建电极位置，并计算VTA。基于体素的最佳刺激点和结构连接性分析研究了刺激部位如何影响临床结果。
与术前评估相比，术后评估显示PD患者的运动功能、生活质量以及焦虑和抑郁症状有不同程度的改善（<0.05）。焦虑和抑郁的改善与位于丘脑底核腹侧区域的电极触点有关。具体而言，焦虑的改善与右侧丘脑底核边缘区域的VTA呈正相关。最佳刺激点分析显示，刺激左侧丘脑底核的腹中央区域与情绪改善显著相关。结构连接性分析显示，通向前额叶皮质（PFC）的纤维束与焦虑和抑郁的改善呈正相关，而通向感觉运动皮质（SMC）的纤维束则呈负相关。
STN-DBS显著改善PD患者的运动症状和生活质量，同时对焦虑和抑郁症状也有积极影响。丘脑底核腹侧可能是改善焦虑和抑郁症状的最佳刺激靶点。STN-DBS电极的治疗效果可能通过调节与前额叶区域相连的纤维束来促进术后焦虑和抑郁的改善。未来的研究应利用连接组图谱和分离的纤维束来优化电极放置，使用定向导联靶向丘脑底核的特定亚区域以改善症状管理。
