Mazen Kallel, Emmanuel De Schlichting, Valerie Fraix, Anna Castrioto, Elena Moro, Louise Cordier, Eric Seigneuret, Stephan Chabardes
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MDS-UPDRS part III scores, levodopa equivalent daily dose (LEDD), and VTA overlaps using both motor STN region and motor improvement sweet spot volume were compared at 12 months after surgery.</p><p><strong>Results: </strong>There is a significantly higher LEDD reduction in the directional leads group (51.3% reduction vs. 42.7% reduction, p = 0.042) when compared to the omnidirectional group, with similar MDS-UPDRS III motor scores at 12 months. Omnidirectional leads patients had a significantly superior VTA-motor STN overlap volume than directional leads patients (32.01 mm3 vs. 20.38 mm3, p = 0.0226). In directional leads patients, LEDD reduction was correlated to VTA overlap with the overall motor improvement mean map sweet spot (R = 0.36, p = 0.036), which was not the case for omnidirectional leads patients (R = 0.11, p = 0.276). Forty-one percent of patients implanted with directional leads had a directional stimulation setting at 12 months, compared to 33% at 3 months follow-up. In directional leads patient's subgroup analysis, there was no significant difference in MDS UPDRS III scores, LEDD reduction, VTA overlaps with motor STN, or overall motor improvement mean map sweet spot between patients stimulated omnidirectionally and directionally at 12 months.</p><p><strong>Conclusion: </strong>At 12 months, when compared to omnidirectional leads, directional leads manage with smaller VTA-target overlaps to obtain comparable MDS-UPDRS III scores with greater LEDD reduction in STN DBS for PD patients.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"111-123"},"PeriodicalIF":1.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparing Directional and Omnidirectional Deep Brain Stimulation in Parkinson's Disease Patients.\",\"authors\":\"Mazen Kallel, Emmanuel De Schlichting, Valerie Fraix, Anna Castrioto, Elena Moro, Louise Cordier, Eric Seigneuret, Stephan Chabardes\",\"doi\":\"10.1159/000542423\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>In 2015, directional leads have been released in Europe for deep brain stimulation (DBS) and have been particularly used for subthalamic nucleus (STN) DBS for Parkinson's disease (PD). 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引用次数: 0
摘要
导语：2015年，定向导联已经在欧洲发布用于深部脑刺激（DBS），特别是用于治疗帕金森病（PD）的丘脑下核（STN） DBS。在本研究中，我们旨在比较PD患者全向和定向引线队列的临床疗效，并评估其与组织活化靶标重叠量（VTA-target）的相关性。方法：对60例连续患者进行回顾性分析。27例双侧定向导联与33例双侧全向导联进行比较。在手术后12个月比较MDS-UPDRS第三部分评分、左旋多巴当量日剂量（LEDD）和运动STN区域和运动改善甜蜜点体积的VTA重叠。结果：与全向组相比，定向导联组的LEDD减少明显更高（减少51.3%比42.7%,p= 0.042）， 12个月时MDS-UPDRS III运动评分相似。全向导联患者的VTA-motor STN重叠体积明显优于定向导联患者（32.01 mm3 vs 20.38 mm2, p = 0.0226）。在定向导联患者中，LEDD减少与VTA重叠与整体运动改善平均图谱甜蜜点相关（R = 0.36, p = 0.036），而在全向导联患者中则并非如此（R = 0.11, p = 0.276）。植入定向导线的患者在12个月时有41%的定向刺激设置，而在3个月的随访中有33%的定向刺激设置。在定向导联患者亚组分析中，在MDS UPDRS III评分、LEDD减少、VTA与运动STN重叠或整体运动改善方面，全向和定向刺激患者在12个月时的平均图甜蜜点无显著差异。结论：在12个月时，与全向导联相比，定向导联处理更小的vta靶点重叠，以获得可比较的MDS-UPDRS III评分，并在STN DBS中获得更大的LEDD降低。
Comparing Directional and Omnidirectional Deep Brain Stimulation in Parkinson's Disease Patients.
Introduction: In 2015, directional leads have been released in Europe for deep brain stimulation (DBS) and have been particularly used for subthalamic nucleus (STN) DBS for Parkinson's disease (PD). In this study, we aimed to compare an omnidirectional and directional leads cohort of PD patients when it comes to clinical effectiveness and to assess the correlation with volume of tissue activated-target overlap (VTA-target).
Methods: A total of 60 consecutive patients were retrospectively included. Twenty-seven patients with bilateral directional leads were compared to 33 patients with bilateral omnidirectional leads. MDS-UPDRS part III scores, levodopa equivalent daily dose (LEDD), and VTA overlaps using both motor STN region and motor improvement sweet spot volume were compared at 12 months after surgery.
Results: There is a significantly higher LEDD reduction in the directional leads group (51.3% reduction vs. 42.7% reduction, p = 0.042) when compared to the omnidirectional group, with similar MDS-UPDRS III motor scores at 12 months. Omnidirectional leads patients had a significantly superior VTA-motor STN overlap volume than directional leads patients (32.01 mm3 vs. 20.38 mm3, p = 0.0226). In directional leads patients, LEDD reduction was correlated to VTA overlap with the overall motor improvement mean map sweet spot (R = 0.36, p = 0.036), which was not the case for omnidirectional leads patients (R = 0.11, p = 0.276). Forty-one percent of patients implanted with directional leads had a directional stimulation setting at 12 months, compared to 33% at 3 months follow-up. In directional leads patient's subgroup analysis, there was no significant difference in MDS UPDRS III scores, LEDD reduction, VTA overlaps with motor STN, or overall motor improvement mean map sweet spot between patients stimulated omnidirectionally and directionally at 12 months.
Conclusion: At 12 months, when compared to omnidirectional leads, directional leads manage with smaller VTA-target overlaps to obtain comparable MDS-UPDRS III scores with greater LEDD reduction in STN DBS for PD patients.
期刊介绍：
''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.
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