{"title":"适应性与常规丘脑下核深部脑刺激治疗帕金森病：一项多中心回顾性研究","authors":"Qinghua Li, Kailiang Wang, Jiping Li, Penghu Wei, Yongzhi Shan, Jianyu Li, Junming Zhu, Zhe Zheng, Chaoshi Niu, Chi Xiong, Weiguo Li, Qianqian Wu, Qihua Xiao, Guiyun Cui, Xiongfei Wang, Yuguang Guan, Guoming Luan, Baohui Liu, Huimin Dong, Siquan Liang, Haitao Li, Wenwen Xu, Guoguang Zhao, Yuqing Zhang","doi":"10.1016/j.neurom.2025.04.011","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Conventional deep brain stimulation (cDBS) is an established treatment for Parkinson's disease (PD), whereas adaptive DBS (aDBS) represents a promising approach with potential advantages in minimizing stimulation-induced side effects and enhancing quality of life. This study evaluated the safety and efficacy of a newly developed aDBS closed-loop neurostimulation (CNS) device for one year across multiple centers, with the primary objective of comparing the outcomes of aDBS and cDBS.</p><p><strong>Materials and methods: </strong>This retrospective study included 62 patients with PD who underwent bilateral subthalamic nucleus (STN) DBS. Outcomes were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities Scale, whereas the levodopa-equivalent daily dose (LEDD) and adverse events were monitored. This two-phase trial randomized participants into Stim-on or Stim-off groups for 90-day postoperative comparison followed by nonrandomized evaluation of aDBS vs cDBS at 360 days after surgery.</p><p><strong>Results: </strong>At 90 days postoperatively, the Stim-on group exhibited superior outcomes to those in the Stim-off group except for LEDD and speech in the medication-on state. At the 360-day postoperative assessment, the aDBS group showed significantly greater improvements than did the cDBS group in MDS-UPDRS II (57.29% vs 33.02%, p = 0.022), MDS-UPDRS IV (59.83% vs 36.69%, p = 0.026), PDQ-39 (56.91% vs 27.37%, p = 0.031), and LEDD reduction (53.35% vs 29.16%, p = 0.002). CNS aDBS recorded clear STN-beta signals, which could be adopted as a biomarker.</p><p><strong>Conclusions: </strong>Both aDBS and cDBS significantly alleviate motor symptoms and enhance quality of life in patients with PD. Although comparable in motor symptom control, aDBS indicated advantages over cDBS across LEDD reduction, MDS-UPDRS II, MDS-UPDRS IV, and PDQ-39 over the long term. Further studies with extended follow-up and larger sample sizes are required to validate these results.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Adaptive vs Conventional Deep Brain Stimulation of the Subthalamic Nucleus for Treatment of Parkinson's Disease: A Multicenter Retrospective Study.\",\"authors\":\"Qinghua Li, Kailiang Wang, Jiping Li, Penghu Wei, Yongzhi Shan, Jianyu Li, Junming Zhu, Zhe Zheng, Chaoshi Niu, Chi Xiong, Weiguo Li, Qianqian Wu, Qihua Xiao, Guiyun Cui, Xiongfei Wang, Yuguang Guan, Guoming Luan, Baohui Liu, Huimin Dong, Siquan Liang, Haitao Li, Wenwen Xu, Guoguang Zhao, Yuqing Zhang\",\"doi\":\"10.1016/j.neurom.2025.04.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Conventional deep brain stimulation (cDBS) is an established treatment for Parkinson's disease (PD), whereas adaptive DBS (aDBS) represents a promising approach with potential advantages in minimizing stimulation-induced side effects and enhancing quality of life. This study evaluated the safety and efficacy of a newly developed aDBS closed-loop neurostimulation (CNS) device for one year across multiple centers, with the primary objective of comparing the outcomes of aDBS and cDBS.</p><p><strong>Materials and methods: </strong>This retrospective study included 62 patients with PD who underwent bilateral subthalamic nucleus (STN) DBS. Outcomes were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities Scale, whereas the levodopa-equivalent daily dose (LEDD) and adverse events were monitored. This two-phase trial randomized participants into Stim-on or Stim-off groups for 90-day postoperative comparison followed by nonrandomized evaluation of aDBS vs cDBS at 360 days after surgery.</p><p><strong>Results: </strong>At 90 days postoperatively, the Stim-on group exhibited superior outcomes to those in the Stim-off group except for LEDD and speech in the medication-on state. At the 360-day postoperative assessment, the aDBS group showed significantly greater improvements than did the cDBS group in MDS-UPDRS II (57.29% vs 33.02%, p = 0.022), MDS-UPDRS IV (59.83% vs 36.69%, p = 0.026), PDQ-39 (56.91% vs 27.37%, p = 0.031), and LEDD reduction (53.35% vs 29.16%, p = 0.002). CNS aDBS recorded clear STN-beta signals, which could be adopted as a biomarker.</p><p><strong>Conclusions: </strong>Both aDBS and cDBS significantly alleviate motor symptoms and enhance quality of life in patients with PD. Although comparable in motor symptom control, aDBS indicated advantages over cDBS across LEDD reduction, MDS-UPDRS II, MDS-UPDRS IV, and PDQ-39 over the long term. Further studies with extended follow-up and larger sample sizes are required to validate these results.</p>\",\"PeriodicalId\":19152,\"journal\":{\"name\":\"Neuromodulation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-06-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuromodulation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.neurom.2025.04.011\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuromodulation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.neurom.2025.04.011","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：常规脑深部电刺激（cDBS）是帕金森病（PD）的一种既定治疗方法，而适应性脑深部电刺激（aDBS）在减少刺激引起的副作用和提高生活质量方面具有潜在优势，是一种有前景的治疗方法。本研究评估了新开发的aDBS闭环神经刺激（CNS）装置在多个中心为期一年的安全性和有效性，主要目的是比较aDBS和cDBS的结果。材料和方法：本回顾性研究包括62例接受双侧丘脑下核（STN） DBS治疗的PD患者。使用运动障碍学会统一帕金森病评定量表（MDS-UPDRS）、帕金森病问卷-39 （PDQ-39）和Schwab和England活动量表评估结果，同时监测左旋多巴当量日剂量（LEDD）和不良事件。这项两期试验将参与者随机分为刺激启动组或刺激关闭组，进行90天的术后比较，然后在手术后360天对aDBS和cDBS进行非随机评估。结果：在术后90天，除了在药物状态下的led和言语外，刺激组的结果优于刺激组。在术后360天的评估中，aDBS组在MDS-UPDRS II （57.29% vs 33.02%, p = 0.022）、MDS-UPDRS IV （59.83% vs 36.69%, p = 0.026）、PDQ-39 （56.91% vs 27.37%, p = 0.031）和LEDD减少（53.35% vs 29.16%, p = 0.002）方面的改善明显大于cDBS组。CNS aDBS记录了清晰的stn - β信号，可作为生物标志物。结论：aDBS和cDBS均可显著缓解PD患者的运动症状，提高患者的生活质量。虽然aDBS在运动症状控制方面具有可比性，但从长期来看，aDBS在降低LEDD、MDS-UPDRS II、MDS-UPDRS IV和PDQ-39方面优于cDBS。需要进一步的研究和更大的样本量来验证这些结果。
Adaptive vs Conventional Deep Brain Stimulation of the Subthalamic Nucleus for Treatment of Parkinson's Disease: A Multicenter Retrospective Study.
Objectives: Conventional deep brain stimulation (cDBS) is an established treatment for Parkinson's disease (PD), whereas adaptive DBS (aDBS) represents a promising approach with potential advantages in minimizing stimulation-induced side effects and enhancing quality of life. This study evaluated the safety and efficacy of a newly developed aDBS closed-loop neurostimulation (CNS) device for one year across multiple centers, with the primary objective of comparing the outcomes of aDBS and cDBS.
Materials and methods: This retrospective study included 62 patients with PD who underwent bilateral subthalamic nucleus (STN) DBS. Outcomes were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities Scale, whereas the levodopa-equivalent daily dose (LEDD) and adverse events were monitored. This two-phase trial randomized participants into Stim-on or Stim-off groups for 90-day postoperative comparison followed by nonrandomized evaluation of aDBS vs cDBS at 360 days after surgery.
Results: At 90 days postoperatively, the Stim-on group exhibited superior outcomes to those in the Stim-off group except for LEDD and speech in the medication-on state. At the 360-day postoperative assessment, the aDBS group showed significantly greater improvements than did the cDBS group in MDS-UPDRS II (57.29% vs 33.02%, p = 0.022), MDS-UPDRS IV (59.83% vs 36.69%, p = 0.026), PDQ-39 (56.91% vs 27.37%, p = 0.031), and LEDD reduction (53.35% vs 29.16%, p = 0.002). CNS aDBS recorded clear STN-beta signals, which could be adopted as a biomarker.
Conclusions: Both aDBS and cDBS significantly alleviate motor symptoms and enhance quality of life in patients with PD. Although comparable in motor symptom control, aDBS indicated advantages over cDBS across LEDD reduction, MDS-UPDRS II, MDS-UPDRS IV, and PDQ-39 over the long term. Further studies with extended follow-up and larger sample sizes are required to validate these results.
期刊介绍：
Neuromodulation: Technology at the Neural Interface is the preeminent journal in the area of neuromodulation, providing our readership with the state of the art clinical, translational, and basic science research in the field. For clinicians, engineers, scientists and members of the biotechnology industry alike, Neuromodulation provides timely and rigorously peer-reviewed articles on the technology, science, and clinical application of devices that interface with the nervous system to treat disease and improve function.
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