Efficacy comparison of subthalamic and globus pallidus internus deep brain stimulation in Parkinson′s disease with dyskinesia

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-10-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.10.004

Shiying Fan, Kailiang Wang, Fangang Meng, Huimin Wang, Huan-Guang Liu, A. Yang, Feng Wang, Jian-Guo Zhang

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Abstract

Objective To compare the therapeutic effects of subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) on Parkinson′s disease (PD) with levodopa-induced dyskinesia (LID), and to explore the possible underlying mechanism. Methods A total of 27 PD patients with LID treated with STN and GPi-DBS from August 2015 to October 2017 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were retrospectively enrolled. Among them, 14 underwent STN-DBS and 13 underwent GPi-DBS. Patients were evaluated preoperatively and every 6, 12, 18 months after surgery. The primary outcome was assessed based on the Unified Dyskinesia Rating Scale (UDysRS). The secondary outcome was investigated according to the Unified Parkinson Disease Rating Scale part Ⅲ (UPDRS-Ⅲ), levodopa equivalent dose (LED), stimulation parameters and side effects. Results Both STN-DBS and GPi-DBS group showed significant improvement in LID, while GPi-DBS exerted higher LID improvement (F=15.326, P 0.05). The improvement of UPDRS-Ⅲ at the 18 month follow-up was 44.7%±20.0% and 45.7%±17.1%, respectively for STN and GPi-DBS. The LED reduction rate was higher in STN-DBS group (F=4.693, P<0.05). The LED reduction rate at the 18 month follow-up was[M(P25, P75)] 44.8(26.7, 80.2)%and 14.0(0, 41.3)%, respectively for STN and GPi-DBS.The stimulation voltage and pulse width of the GPi-DBS group were higher than those of the STN-DBS group (F values were 4.435 and 21.415 respectively, P<0.05). In the STN-DBS group, there were 5 cases of stimulation induced dyskinesia (SID), 1 case of electrode fracture, and 1 case of incision infection.There were 1 case of SID and 1 case of bradykinesia in the GPi-DBS group. Conclusions Both STN and GPi-DBS could improve dyskinesia. Compared with STN-DBS, GPi-DBS seems to have a stronger effect on improvement of LID. The anti-dyskinesia effect of STN-DBS may be related to drug reduction and adjustment of stimulation sites, while GPi-DBS might exert a direct anti-dyskinesia effect. Key words: Deep brain stimulation; Subthalamic nucleus; Globus pallidus internus; Levodopa-induced dyskinesia; Levodopa equivalent dose

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丘脑底和苍白球脑内深部刺激治疗帕金森病伴运动障碍的疗效比较

目的比较丘脑下核(STN)和内白球(GPi)深部脑刺激(DBS)对左旋多巴诱导的帕金森病(PD)运动障碍(LID)的治疗效果，并探讨其可能的机制。方法回顾性分析2015年8月至2017年10月首都医科大学附属北京天坛医院神经外科接受STN联合GPi-DBS治疗的PD合并LID患者27例。其中STN-DBS 14例，GPi-DBS 13例。术前、术后6个月、12个月、18个月对患者进行评估。主要结果根据统一运动障碍评定量表(UDysRS)进行评估。根据统一帕金森病评定量表Ⅲ(UPDRS-Ⅲ)、左旋多巴当量剂量(LED)、刺激参数和副作用对次要结局进行调查。结果STN-DBS组和GPi-DBS组的LID均有显著改善，GPi-DBS组的LID改善程度更高(F=15.326, P < 0.05)。在18个月的随访中，STN和GPi-DBS的UPDRS-Ⅲ改善率分别为44.7%±20.0%和45.7%±17.1%。STN-DBS组LED降低率较高(F=4.693, P<0.05)。随访18个月时，STN和GPi-DBS的LED降低率分别为44.8(26.7,80.2)%和14.0(0,41.3)%。GPi-DBS组刺激电压和脉宽均高于STN-DBS组(F值分别为4.435和21.415,P<0.05)。STN-DBS组刺激性运动障碍(SID) 5例，电极断裂1例，切口感染1例。GPi-DBS组出现SID 1例，运动迟缓1例。结论STN和GPi-DBS均能改善运动障碍。与STN-DBS相比，GPi-DBS对LID的改善作用似乎更强。STN-DBS的抗运动障碍作用可能与药物减量和刺激部位的调节有关，而GPi-DBS可能具有直接的抗运动障碍作用。关键词:脑深部电刺激;丘脑核;内苍白球;Levodopa-induced运动障碍;左旋多巴当量剂量

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.