Differential Effects of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation on Motor Subtypes in Parkinson's Disease. 2022

Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.

We investigated the differences in motor symptom change outcomes after bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in well-defined motor subtypes of Parkinson's disease (PD) to improve clinical decision making. We included 114 patients who had undergone STN-DBS and 65 patients who had undergone GPi-DBS. The patients were classified as having akinetic-rigid type (ART), tremor-dominant type (TDT), and mixed type (MT) using the preoperative Movement Disorder Society Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) scores in the no-medication state. The outcome measures included the no-medication MDS-UPDRS-III scores and subscore changes at the last follow-up after surgery. The outcomes were compared among the different motor subtypes and between STN-DBS and GPi-DBS. At the last follow-up (14.92 ± 8.35 months), the TDT patients had had a greater median overall motor improvement in the no-medication MDS-UPDRS-III scores compared with the ART patients (62.90% vs. 46.67%; P < 0.001), regardless of the stimulation target. The ART patients showed greater improvement after STN-DBS than after GPi-DBS (54.44% vs. 37.21%; P < 0.001), with improvements in rigidity, akinesia, and posture and gait disorders accounting for the difference. Our results suggest that the different PD motor subtypes will have differential responses to STN-DBS and GPi-DBS, that TDT patients will experience greater improvement than ART patients, and that STN-DBS provides better effects for ART patients than does GPi-DBS. In addition, different motor symptoms among the different motor subtypes might respond differently to STN-DBS than to GPi-DBS. All these factors could reflect the heterogeneity of PD. Longer-term outcomes across the different motor subtypes and stimulation targets should be studied further.

UI MeSH Term Description Entries
D010300 Parkinson Disease A progressive, degenerative neurologic disease characterized by a TREMOR that is maximal at rest, retropulsion (i.e. a tendency to fall backwards), rigidity, stooped posture, slowness of voluntary movements, and a masklike facial expression. Pathologic features include loss of melanin containing neurons in the substantia nigra and other pigmented nuclei of the brainstem. LEWY BODIES are present in the substantia nigra and locus coeruleus but may also be found in a related condition (LEWY BODY DISEASE, DIFFUSE) characterized by dementia in combination with varying degrees of parkinsonism. (Adams et al., Principles of Neurology, 6th ed, p1059, pp1067-75) Idiopathic Parkinson Disease,Lewy Body Parkinson Disease,Paralysis Agitans,Primary Parkinsonism,Idiopathic Parkinson's Disease,Lewy Body Parkinson's Disease,Parkinson Disease, Idiopathic,Parkinson's Disease,Parkinson's Disease, Idiopathic,Parkinson's Disease, Lewy Body,Parkinsonism, Primary
D005917 Globus Pallidus The representation of the phylogenetically oldest part of the corpus striatum called the paleostriatum. It forms the smaller, more medial part of the lentiform nucleus. Paleostriatum,Pallidum,Pallidums
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D046690 Deep Brain Stimulation Therapy for MOVEMENT DISORDERS, especially PARKINSON DISEASE, that applies electricity via stereotactic implantation of ELECTRODES in specific areas of the BRAIN such as the THALAMUS. The electrodes are attached to a neurostimulator placed subcutaneously. Brain Stimulation, Deep,Electrical Stimulation of the Brain,Brain Stimulations, Deep,Deep Brain Stimulations,Stimulation, Deep Brain,Stimulations, Deep Brain
D020531 Subthalamic Nucleus Lens-shaped structure on the inner aspect of the INTERNAL CAPSULE. The SUBTHALAMIC NUCLEUS and pathways traversing this region are concerned with the integration of somatic motor function. Nucleus Subthalamicus,Body of Luys,Corpus Luysi,Nucleus of Luys,Subthalamic Nucleus of Luys,Luys Body,Luys Nucleus,Luys Subthalamic Nucleus,Luysi, Corpus,Nucleus, Subthalamic,Subthalamicus, Nucleus

Related Publications

Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
August 2023, Revista de neurologia,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
April 2001, Journal of neurology, neurosurgery, and psychiatry,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
January 2012, Stereotactic and functional neurosurgery,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
January 2022, Parkinson's disease,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
January 2018, Progress in neurological surgery,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
March 2020, World neurosurgery,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
March 2003, Journal of neurosurgical sciences,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
March 2019, Journal of neurosurgery,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
January 2024, Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology,
Shiying Fan, and Defeng Liu, and Lin Shi, and Fangang Meng, and Huaying Fang, and Huanguang Liu, and Hua Zhang, and Anchao Yang, and Jianguo Zhang
April 2004, Gait & posture,
Copied contents to your clipboard!