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Pallidal versus subthalamic nucleus deep brain stimulation for levodopa-induced dyskinesia

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机构： [a]Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China [b]Beijing Key Laboratory of Neurostimulation, Beijing, China [c]Department of Neurology, Fixel Center for Neurological Diseases, Program in Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32607, United States [d]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [e]Departments of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China

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Objective: To compare the efficacy of subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) on reducing levodopa-induced dyskinesia (LID) in Parkinson’s disease, and to explore the potential underlying mechanisms. Methods: We retrospectively assessed clinical outcomes in 43 patients with preoperative LID who underwent DBS targeting the STN (20/43) or GPi (23/43). The primary clinical outcome was the change from baseline in the Unified Dyskinesia Rating Scale (UDysRS) and secondary outcomes included changes in the total daily levodopa equivalent dose, the drug-off Unified Parkinson Disease Rating Scale Part Ⅲ at the last follow-up (median, 18 months), adverse effects, and programming settings. Correlation analysis was used to find potential associated factors that could be used to predict the efficacy of DBS for dyskinesia management. Results: Compared to baseline, both the STN group and the GPi group showed significant improvement in LID with 60.73 ± 40.29% (mean ± standard deviation) and 93.78 ± 14.15% improvement, respectively, according to the UDysRS score. Furthermore, GPi-DBS provided greater clinical benefit in the improvement of dyskinesia (P < 0.05) compared to the STN. Compared to the GPi group, the levodopa equivalent dose reduction was greater in the STN group at the last follow-up (43.81% vs. 13.29%, P < 0.05). For the correlation analysis, the improvement in the UDysRS outcomes were significantly associated with a reduction in levodopa equivalent dose in the STN group (r = 0.543, P = 0.013), but not in the GPi group (r = −0.056, P = 0.801). Interpretation: Both STN and GPi-DBS have a beneficial effect on LID but GPi-DBS provided greater anti-dyskinetic effects. Dyskinesia suppression for STN-DBS may depend on the reduction of levodopa equivalent dose. Unlike the STN, GPi-DBS might exert a direct and independent anti-dyskinesia effect. © 2019 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.

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出版当年[2018]版：

大类 | 2 区医学

小类 | 2 区临床神经病学 2 区神经科学

最新[2023]版：

大类 | 2 区医学

小类 | 2 区临床神经病学 2 区神经科学

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出版当年[2017]版：

Q1 NEUROSCIENCES Q1 CLINICAL NEUROLOGY

最新[2023]版：

Q1 CLINICAL NEUROLOGY Q1 NEUROSCIENCES

影响因子： 4.4 最新[2023版] 5.1 最新五年平均 4.649 出版当年[2017版] 4.336 出版当年五年平均 3.901 出版前一年[2016版] 4.656 出版后一年[2018版]

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