丘脑底核脑深部电刺激术的电极激活触点位置与帕金森病运动症状疗效的关系

Relationship between position of electrode active contacts of deep brain stimulation targeting subthalamic nucleus and effects on motor symptoms of Parkinson′s disease

目的:探讨双侧丘脑底核脑深部电刺激术(STN-DBS)的电极激活触点位置与STN-DBS对帕金森病(PD)患者运动症状疗效的关系。方法:回顾性分析2018年3—12月首都医科大学附属北京天坛医院神经外科(49例)、河北医科大学第一医院神经外科(3例)和宁夏医科大学总医院神经外科(5例)接受双侧STN-DBS治疗的PD患者的临床资料。评估患者术前、术后6个月内的统一帕金森病评定量表第三部分(UPDRS-Ⅲ)评分、左旋多巴等效剂量(LEDD)和帕金森病生活质量量表(PDQ-39)评分。明确蒙特利尔神经研究所(MNI)标准空间中STN-DBS激活触点的位置以及激活组织体积(VTA),分析其与PD患者运动症状的改善率(UPDRS-Ⅲ评分的改善率)的相关性。结果:与术前相比,术后6个月57例患者的UPDRS-Ⅲ评分改善率(药物关期)为(55.4±18.9)%(P<0.001),PDQ-39评分的改善率为(47.4±23.2)%(P<0.01),LEDD的下降比率为(40.1±24.3)%(P<0.01)。术后6个月PDQ-39评分的改善率和LEDD的下降比率与UPDRS-Ⅲ评分的改善率(药物关期)均呈正相关(PDQ-39评分:r=0.461,P<0.001;LEDD:r=0.354,P=0.007);UPDRS-Ⅲ评分的改善率(药物关期)与MNI标准空间中激活触点的Z轴坐标值均呈正相关(左侧:r=0.349,P=0.008;右侧:r=0.369,P=0.005)。MNI空间中,57例患者电极激活触点在双侧STN运动区、联络区及边缘区的VTA与术后6个月UPDRS-Ⅲ评分改善率(药物关期)之间均无相关性(均P>0.05)。术后6个月,运动症状改善率<25%组、25%~50%组、>50%组在MNI空间中,双侧Z轴坐标值之间的差异均有统计学意义(左侧:P=0.030;右侧:P=0.024);而3组在MNI空间中电极激活触点的VTA之间的差异均无统计学意义(均P>0.05)。结论:STN-DBS可改善PD患者的运动症状,提高其生命质量。DBS激活触点越靠近STN背外侧感觉运动区,则DBS改善PD患者的运动症状效果越好。

Objectives To investigate the relationship between the position of active contacts of deep brain stimulation targeting bilateral subthalamic nucleus(STN-DBS)and its clinical effects on motor symptoms in Parkinson′s disease(PD)patients.Methods We retrospectively analyzed the clinical data of 57 patients with PD admitted to Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University(49 cases),Department of Neurosurgery,the First Hospital of Hebei Medical University(3 cases),and Department of Neurosurgery,General Hospital of Ningxia Medical University(5 cases)from March 2018 to December 2018.All patients underwent bilateral STN-DBS.Unified Parkinson′s disease rating scale-partⅢ(UPDRS-Ⅲ)scores,levodopa equivalent daily dose(LEDD),Parkinson′s disease questionnaire-39(PDQ-39)scores before operation and within 6 months after operation were determined.The location of active contacts and volume of tissue activated(VTA)in the Montreal Neurological Institute(MNI)space,and their correlation with the rate of improvement of motor symptoms(UPDRS-Ⅲscore improvement rate)were examined.Results At 6 months post operation,the UPDRS-Ⅲscores of 57 patients(Med-off)were improved by 55.4±18.9%(P<0.001)compared with that before operation.The improvement rate of PDQ-39 score(47.4%±23.2%,P<0.01)and the reduction rate of LEDD(40.1%±24.3%,P<0.01)at 6 months post surgery were positively correlated with the improvement rate of motor symptoms(Med-off)(PDQ-39:r=0.461,P<0.001;LEDD:r=0.354,P=0.007).The rate of improvement of UPDRSⅢ(Med-off)and the Z-axis coordinate of the active contacts in the MNI space were positively correlated(left side:r=0.349,P=0.008;right side:r=0.369,P=0.005).In the MNI space,there was no correlation between the UPDRS-Ⅲscore improvement rate(Med-off)at 6 months after operation and bilateral VTA in the STN motor subregion,STN associative subregion and STN limbic subregion of the active electrode contacts of 57 patients(all P>0.05).At 6 months after surgery,the differences between the Z-axis coordinate in the different improvement rate subgroups(<25%,25%-50%,and>50%)in the MNI space were statistically significant(left side:P=0.030;right side:P=0.024).In the MNI space,there were no statistically significant differences between the 3 groups in the VTA of the active electrode contacts(all P>0.05).Conclusions STN-DBS could improve the motor symptoms of PD patients and their quality of life.The closer the active contact is to the dorsolateral sensorimotor area of STN,the better effect the DBS has on the motor symptoms of PD patients.