Pointing in the right direction: Greater motor improvements with directional versus circular subthalamic nucleus deep brain stimulation for Parkinson's disease.

IF 4 3区 医学 Q2 NEUROSCIENCES
Journal of Parkinson's disease Pub Date : 2025-02-01 Epub Date: 2024-12-27 DOI:10.1177/1877718X241301071
Christopher P Hurt, Daniel J Kuhman, Alyson Moll, Barton L Guthrie, Joseph W Olson, Arie Nakhmani, Melissa Wade, Sarah A Brinkerhoff, Marshall T Holland, Harrison C Walker
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引用次数: 0

Abstract

BackgroundDirectional deep brain stimulation (DBS) provides more precise control of current spread than conventional ring-shaped electrodes. Whether this enhanced flexibility improves motor function is unclear.ObjectiveHere we examine whether directional and circular stimulation differentially impact motor performance in patients with Parkinson's disease.MethodsMotor behaviors were assessed in 31 patients who underwent unilateral subthalamic nucleus brain stimulation surgery (SUNDIAL, NCT03353688). Eight configurations, including 6 directional contacts and their corresponding rings), were evaluated during device activation. Objective measures of motor performance related to limb dexterity, gait, and overall mobility were evaluated in a double-blind fashion in the "off" medication state versus preoperative baseline, with stimulus amplitude at the center of the therapeutic window.ResultsSignificant changes in performance were observed across each of five motor tasks between the best and worst directional contacts on a given DBS row (p < 0.001 each task). Certain stimulation directions led to functional declines versus baseline, whereas the best direction yields greater improvement than ring stimulation (p = 0.005, p = 0.001, p = 0.007, p < 0.001, respectively, across tasks). Directional DBS improves therapeutic window and side effect thresholds versus ring stimulation (0.40 ± 0.94 and 0.35 ± 0.51 mA, p < 0.001, respectively), but these variables correlated only modestly with motor performance at a given stimulation site.ConclusionsOptimized directional subthalamic nucleus DBS yields better group-level motor performance than ring stimulation, in addition to its known advantages related to tolerability. Prospective studies should evaluate whether these improvements persist over longer time intervals.

指向正确的方向:定向与圆形丘脑下核深部脑刺激对帕金森病的运动改善更大。
背景:定向脑深部刺激(DBS)比传统的环形电极提供更精确的电流传播控制。这种增强的灵活性是否能改善运动功能尚不清楚。目的:研究定向刺激和循环刺激对帕金森病患者运动表现的影响。方法:对31例接受单侧丘脑下核脑刺激手术的患者进行运动行为评估(SUNDIAL, NCT03353688)。在设备激活过程中评估了8种配置(包括6个定向触点及其相应的环)。在“关闭”药物状态与术前基线相比,以双盲方式评估与肢体灵活性、步态和整体活动能力相关的运动表现的客观测量,刺激幅度位于治疗窗口的中心。结果:在给定的DBS行上,在最佳和最差的方向接触之间,在五个运动任务中观察到显著的表现变化(p结论:优化的定向丘脑下核DBS除了具有已知的耐受性优势外,还能产生比环刺激更好的组水平运动表现。前瞻性研究应评估这些改善是否在较长的时间间隔内持续存在。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.40
自引率
5.80%
发文量
338
审稿时长
>12 weeks
期刊介绍: The Journal of Parkinson''s Disease (JPD) publishes original research in basic science, translational research and clinical medicine in Parkinson’s disease in cooperation with the Journal of Alzheimer''s Disease. It features a first class Editorial Board and provides rigorous peer review and rapid online publication.
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