Pallidal or subthalamic DBS for advanced Parkinson’s disease in the era of high-resolution MRI

Gamaleya, A.; Asriants, S.; Poddubskaya, A.; Dekopov, A.; Tomskiy, A.

Авторы: Gamaleya A., Asriants S., Poddubskaya A., Dekopov A., Tomskiy A.
Журнал: Movement Disorders
Том: 38
Номер: Suppl. 1
Год издания: 2023
Издательство: John Wiley & Sons Inc.
Местоположение издательства: United States
Первая страница: S752
Последняя страница: S753
Номер статьи: 1695
DOI: 10.1002/mds.29546
Аннотация: Objective: We aimed to assess the outcome of GPi-DBS and STNDBS implanted based on high-resolution MRI.Background: Both GPi-DBS and STN-DBS are effective for treatmentof PD with medically unresponsive fluctuations. There is no definitiveconsensus on target selection. Generally, STN-DBS allows greater dosereduction of antiparkinsonian drugs and is used more frequently worldwide. GPi-DBS has pronounced direct anti-dyskinetic effect, compromisescognitive and affective state to a lesser extent, and is easier in postoperative programming and management [1,2,3,4,5].Methods: Thirty-two advanced PD-patients were scheduled for receiving GPi-DBS (age at surgery 60.58.5 years; PD-duration13.04.3 years). 25 patients received STN-DBS during the same timeperiod (age at surgery 58.05.4 years; PD-duration 13.23.0 years).Groups shared similar clinical features except for dyskinesia severity(mean UPDRS-4 12.0 versus 10.2, respectively), and MMSE/MoCA score(greater cognitive impairment in GPi-DBS). Preoperative LEDD andL-dopa dose were comparable. Stereotactic planning was performed usinghigh-resolution 3T MRI. We evaluated outcome (UPDRS, ADLs), qualityof life (QoL,PDQ-39), antiparkinsonian medication, cognitive and affective state under continuous DBS through 1 year postoperatively.Results: Both targets alleviated significantly PD motor symptoms andADLs in OFF-state, reduced medication dose, and increased QoL, withsuperiority for STN-DBS. In GPi-DBS, reduction in UPDRS-3 was 55%,in UPDRS-2 – 35%, in Schwab&England – 23% (OFF), in LEDD – 30%compared to 62, 51, 22, and 51%, respectively, in STN-DBS group. OnlySTN-DBS ameliorated ON-state quality. GPi-DBS had greater influenceon L-dopa therapy complications (dyskinesia). No significant cognitivechanges occur in both groups. Psychotic symptoms in early postoperativeperiod were noted more often in STN-DBS (2 vs. 1). Anxiety and depression scores appeared slightly improved in STN-DBS [figure 1,2,3,4,5].Conclusions: STN-DBS seems to act more comprehensive for PDpatients. Despite a greater number of perioperative psychotic reactions, inlong-term follow-up STN-DBS has a beneficial effect on affective stateand QoL. Nevertheless, GPi-DBS allows performing surgery in patientswith poorer cognitive state and severe dyskinesia at low L-dopa doses.When choosing target DBS-structure, a detailed analysis of patient clinicalcharacteristics and individual treatment goals is necessary.
Добавил в систему: Гамалея Анна Александровна

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