行脑深部电刺激的帕金森病患者非运动症状预后的影响因素

Influential factors of non-motor symptoms prognosis in Parkinson′s disease patients undergoing deep brain stimulation

目的探讨在行脑深部电刺激(DBS)的帕金森病(PD)患者中电极激活触点位置、激活组织体积(VTA)以及年龄等因素对患者情绪症状和认知功能等非运动症状的影响。方法回顾性纳入2020年9月1日至2022年8月31日在北京天坛医院功能神经外科行丘脑底核(STN)DBS的PD患者,分别于术前、术后1个月、12个月采用国际帕金森和运动障碍协会统一帕金森病评定量表(MDS-UPDRS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)对患者进行评估。将患者分为中年组(年龄<60岁,39例)和老年组(年龄≥60岁,62例)探究年龄因素对手术临床疗效的影响。使用Lead-DBS软件将患者的电极重建结果转化到蒙特利尔标准空间中,根据激活触点位置在STN的亚区分布情况,将患者分为感觉运动区组(43例)和联合区组(53例);此外,根据患者12个月时的MoCA量表评估结果,将患者分为了认知功能改善组(57例)和认知功能恶化组(44例),统计不同分组之间的电极激活触点的位置信息并计算VTA,分析电极激活触电位置以及激活组织体积对患者非运动症状的影响。结果共纳入101例PD患者,其中男46例,女55例,年龄(62.6±8.4)岁。中年患者术后12个月时的MoCA评分、延迟回忆评分、注意力评分、命名评分显著高于老年患者(均P<0.05)。感觉运动区组患者12个月随访时的MoCA评分改善率为-1.77%±20.36%,HAMA评分改善率为39.65%±42.91%,HAMD评分改善率为36.23%±45.45%;联合区组患者12个月随访时的MoCA评分改善率为11.69%±22.24%,HAMA评分改善率为16.62%±68.10%,HAMD评分改善率为2.30%±95.04%,两组患者量表评分之间差异有统计学意义(MoCA:P=0.002;HAMA:P=0.040;HAMD:P=0.033)。认知功能改善组患者的VTA在左侧大脑半球STN感觉运动区和边缘区的分布明显小于认知功能恶化组[(60.53±52.04)mm^(3)比(84.55±61.00)mm^(3),P=0.035;(41.81±33.36)mm^(3)比(59.05±45.46)mm^(3),P=0.030]。结论STN-DBS对于PD患者情绪症状和认知功能的作用受到多种因素的影响,与患者的年龄、电极激活触点位置和VTA相关。

Objective To investigate the effects of electrode activated contact location,volume of tissue activated(VTA)and age on non-motor symptoms,such as emotional symptoms and cognitive function,in Parkinson′s disease(PD)patients with deep brain stimulation(DBS).Methods PD patients who underwent DBS of subthalamic nucleus(STN)at the Department of Functional Neurosurgery of Beijing Tiantan Hospital from September 1,2020 to August 31,2022 were retrospectively enrolled.The International Parkinson and Movement Disorder Society-Unified Parkinson′s Disease Rating Scale(MDS-UPDRS),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Montreal Cognitive Assessment(MoCA),and Mini-Mental State Examination Scales(MMSE)were used at the preoperative,1-month and 12-month postoperative time points.In this study,patients were divided into middle-aged(age<60 years,n=39)and elderly(age≥60 years,n=62)groups to investigate the effect of age factor on the clinical outcome of surgery.Lead-DBS software was used to convert the patients′electrode reconstruction results into Montreal standard space,and the patients were divided into sensorimotor(n=43)and combined groups(n=53)according to the distribution of activation contact locations in the subzones of the STN.In addition,the patients were divided into a cognitive improvement group(n=57)and a cognitive deterioration group(n=44)based on the results of MoCA at 12 months.The positional information of the electrode activation contacts was collected and the VTA was calculated to analyze the effects on electrode activation electroshock location and activated tissue volume on patients′non-motor symptoms.Results A total of 101 patients with PD were enrolled,including 46 males and 55 females,aged(62.6±8.4)years.Middle-aged patients had significantly higher MoCA scores,delayed recall scores,attention scores,and naming scores than older patients at 12 months postoperatively(all P<0.05).At 12-month follow-up,the improvement rate of MoCA score,HAMA score and HAMD score were-1.77%±20.36%,39.65%±42.91%and 36.23%±45.45%respectively in sensorimotor group.At 12-month follow-up,the improvement rate of MoCA score,HAMA score and HAMD score was 11.69%±22.24%,16.62%±68.10%and 2.30%±95.04%respectively in the combined group,and the difference between the two groups was statistically significant(MoCA:P=0.002;HAMA:P=0.040;HAMD:P=0.033)The distribution of VTA in the sensory motor area and marginal area of the left hemisphere STN in patients with improved cognitive function was significantly smaller than that in the deterioration group[(60.53±52.04)mm^(3)vs(84.55±61.00)mm^(3),P=0.035;(41.81±33.36)mm^(3)vs(59.05±45.46)mm^(3),P=0.030].Conclusion The effect of STN-DBS on emotional symptoms and cognitive function in PD patients is influenced by various factors and is closely related to the patient′s age,electrode activation contact location and VTA.