目的:针对苍白球(GPi)的深部脑刺激(DBS)已被证明可以显着改善运动症状,以治疗难治性帕金森病。然而,临床结果的异质性仍然存在,可能是由于GPi内的次优目标识别。通过利用GPi和术后6个月结局的稳健抽样,本研究旨在确定最佳的症状特异性GPiDBS目标.
方法:在本研究中,作者分析了解剖导联位置和术后6个月,86例接受双侧GPiDBS的患者的双盲结局指标.这些患者是从多中心退伍军人事务部(VA)/美国国家神经疾病和中风研究所(NINDS)合作研究计划(CSP)468研究中选择的,以确定控制整体运动的最佳目标区域(“最佳点”)(联合帕金森氏症评定量表[UPDRS]-III),轴向,震颤,刚性,和运动迟缓症状。将铅坐标归一化到蒙特利尔神经病学研究所空间,并使用留一病人方法确定和验证最佳目标区。
结果:作者的研究结果表明,UPDRS-III的最佳目标区域具有统计学意义(R=0.37,p<0.001),轴向(R=0.22,p=0.042),刚度(R=0.20,p=0.021),和运动迟缓(R=0.23,p=0.004)症状。这些区域位于GPi的主电机和前电机分区内。有趣的是,这些区域延伸到GPi横向边界之外,进入GPi-苍白球(GPe)层并进入GPe,但是他们没有到达GPI腹侧边界,挑战传统的手术方法基于苍白球切开术。
结论:利用稳健的数据集,这项研究不仅有效地描述了整体运动改善的特定最佳目标区域,而且还描述了症状子评分。这些见解具有在随后的双侧GPiDBS外科手术中提高靶向精度的潜力。
OBJECTIVE: Deep brain stimulation (DBS) targeting the globus pallidus interna (GPi) has been shown to significantly improve motor symptoms for the treatment of medication-refractory Parkinson\'s disease. Yet, heterogeneity in clinical outcomes persists, possibly due to suboptimal target identification within the GPi. By leveraging robust sampling of the GPi and 6-month postsurgical outcomes, this study aims to determine optimal symptom-specific GPi DBS targets.
METHODS: In this study, the authors analyzed the anatomical lead location and 6-month postsurgical, double-blinded outcome measures of 86 patients who underwent bilateral GPi DBS. These patients were selected from the multicenter Veterans Affairs (VA)/National Institutes of Neurological Disorders and Stroke (NINDS) Cooperative Studies Program (CSP) 468 study to identify the optimal target zones (\"sweet spots\") for the control of overall motor (United Parkinson\'s Disease Rating Scale [UPDRS]-III), axial, tremor, rigidity, and bradykinesia symptoms. Lead coordinates were normalized to Montreal Neurological Institute space and the optimal target zones were identified and validated using a leave-one-patient-out approach.
RESULTS: The authors\' findings revealed statistically significant optimal target zones for UPDRS-III (R = 0.37, p < 0.001), axial (R = 0.22, p = 0.042), rigidity (R = 0.20, p = 0.021), and bradykinesia (R = 0.23, p = 0.004) symptoms. These zones were localized within the primary motor and premotor subdivisions of the GPi. Interestingly, these zones extended beyond the GPi lateral border into the GPi-globus pallidus externa (GPe) lamina and into the GPe, but they did not reach the GPi ventral border, challenging traditional surgical approaches based on pallidotomies.
CONCLUSIONS: Drawing upon a robust dataset, this research effectively delineates specific optimal target zones for not only overall motor improvement but also symptom subscores. These insights hold the potential to enhance the precision of targeting in subsequent bilateral GPi DBS surgical procedures.