Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease

脑深部刺激 丘脑底核 帕金森病 评定量表 物理医学与康复 苍白球 刺激 步态 心理学 肌张力障碍 医学 运动症状 物理疗法 基底神经节 疾病 神经科学 内科学 中枢神经系统 发展心理学
作者
Maya Katz,Marta San Luciano,Kimberly M. Carlson,Ping Luo,William J. Marks,Paul S. Larson,Philip A. Starr,Kenneth A. Follett,Frances M. Weaver,Matthew B. Stern,Domenic J. Reda,Jill L. Ostrem
出处
期刊:Annals of Neurology [Wiley]
卷期号:77 (4): 710-719 被引量:61
标识
DOI:10.1002/ana.24374
摘要

The Veterans Administration Cooperative Studies Program #468, a multicenter study that randomized Parkinson's disease (PD) patients to either subthalamic nucleus (STN) or globus pallidus internus (GPi) deep brain stimulation (DBS), found that stimulation at either target provided similar overall motoric benefits. We conducted an additional analysis of this data set to evaluate whether PD motor subtypes responded differently to the 2 stimulation targets.We classified 235 subjects by motor subtype: tremor dominant (TD), intermediate (I), or postural instability gait difficulty (PIGD), based on pre-DBS baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores off-medication. The primary outcome was change in UPDRS part III (UPDRS-III) off-medication scores from baseline to 24 months post-DBS, compared among subjects with particular PD motor subtypes and by DBS target (STN vs GPi). Changes in tremor, rigidity, akinesia, and gait scores were also assessed using the UPDRS.TD patients had greater mean overall motor improvement, measured by UPDRS-III, after GPi DBS, compared to STN DBS (17.5 ± 13.0 vs 14.6 ± 14.9, p = 0.02), with improvement in gait accounting for this difference. Regardless of stimulation target, PIGD subjects had lower mean overall improvement in UPDRS-III scores compared with I or TD subjects (8.7 ± 12.2 vs 21.7 ± 11.2 vs 16.3 ± 13.8, p = 0.001).Our results suggest that responsiveness to both GPi and STN DBS is similar among different PD motor subtypes, although the TD motor subtype may have a greater response to GPi DBS with respect to gait. PIGD patients obtained less overall benefit from stimulation.
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