Inken Tödt1, Bassam Al-Fatly2, Oliver Granert1, Andrea A Kühn2, Paul Krack3, Joern Rau4, Lars Timmermann5, Alfons Schnitzler6, Steffen Paschen1, Ann-Kristin Helmers7, Andreas Hartmann8,9, Eric Bardinet10,11, Michael Schuepbach3,8,9,12, Michael T Barbe13, Till A Dembek13, Valerie Fraix14,15, Dorothee Kübler2, Christine Brefel-Courbon16, Alireza Gharabaghi17, Lars Wojtecki18, Marcus O Pinsker19, Stephane Thobois20,21, Philippe Damier22, Tatiana Witjas23, Jean-Luc Houeto20, Carmen Schade-Brittinger4, Marie Vidailhet24, Andreas Horn2, Günther Deuschl1. 1. Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany. 2. Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany. 3. Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland. 4. Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany. 5. Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany. 6. Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany. 7. Department of Neurosurgery, University Hospital Schleswig Holstein, Kiel, Germany. 8. Assistance-Publique Hôpitaux de Paris, Center d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Paris, France. 9. Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, Paris, France. 10. Department of Neurology, NS-PARK/F-CRIN, University Hospital of Besançon, Besançon, France. 11. Center de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle (ICM), Paris, France. 12. Institute of Neurology, Konolfingen, Switzerland. 13. Department of Neurology, University of Cologne, Faculty of Medicine, Cologne, Germany. 14. Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France. 15. Neurology Department, Grenoble University Hospital, Grenoble, France. 16. Department of Neurology, INSERM Unite 1214, University Hospital Toulouse, Toulouse, France. 17. Department of Neurosurgery and Neurotechnology Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany. 18. Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist GmbH & Co.KG Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf Von-Broichhausen-Allee 1, Kempen, Germany. 19. Department of Neurosurgery, University of Freiburg, Freiburg, Germany. 20. Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Center Expert Parkinson, Bron, France. 21. Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France. 22. CHU Nantes, INSERM CIC1413, Hôpital Laënnec, Nantes, France. 23. Department of Neurology, Timone University Hospital UMR 7289, CNRS Marseille, Marseille, France. 24. Department of Neurology, Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Salpêtriere University Hospital AP-HP, Paris, France.
Abstract
BACKGROUND: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL. OBJECTIVES: The relation between the stimulated part of the STN and clinical outcomes, including the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS) and the quality-of-life questionnaire, was assessed in a subcohort of the EARLYSTIM study. METHODS: Sixty-nine patients from the EARLYSTIM cohort who underwent DBS, with a comprehensive clinical characterization before and 24 months after surgery, were included. Intercorrelations of clinical outcome changes, correlation between the affected functional parts of the STN, and changes in clinical outcomes were investigated. We further calculated sweet spots for different clinical parameters. RESULTS: Improvements in the UPDRS III and Parkinson's Disease Questionnaire (PDQ-39) correlated positively with the extent of the overlap with the sensorimotor STN. The sweet spots for the UPDRS III (x = 11.6, y = -13.1, z = -6.3) and the PDQ-39 differed (x = 14.8, y = -12.4, z = -4.3) ~3.8 mm. CONCLUSIONS: The main influence of DBS on QoL is likely mediated through the sensory-motor basal ganglia loop. The PDQ sweet spot is located in a posteroventral spatial location in the STN territory. For aspects of QoL, however, there was also evidence of improvement through stimulation of the other STN subnuclei. More research is necessary to customize the DBS target to individual symptoms of each patient.
BACKGROUND: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL. OBJECTIVES: The relation between the stimulated part of the STN and clinical outcomes, including the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS) and the quality-of-life questionnaire, was assessed in a subcohort of the EARLYSTIM study. METHODS: Sixty-nine patients from the EARLYSTIM cohort who underwent DBS, with a comprehensive clinical characterization before and 24 months after surgery, were included. Intercorrelations of clinical outcome changes, correlation between the affected functional parts of the STN, and changes in clinical outcomes were investigated. We further calculated sweet spots for different clinical parameters. RESULTS: Improvements in the UPDRS III and Parkinson's Disease Questionnaire (PDQ-39) correlated positively with the extent of the overlap with the sensorimotor STN. The sweet spots for the UPDRS III (x = 11.6, y = -13.1, z = -6.3) and the PDQ-39 differed (x = 14.8, y = -12.4, z = -4.3) ~3.8 mm. CONCLUSIONS: The main influence of DBS on QoL is likely mediated through the sensory-motor basal ganglia loop. The PDQ sweet spot is located in a posteroventral spatial location in the STN territory. For aspects of QoL, however, there was also evidence of improvement through stimulation of the other STN subnuclei. More research is necessary to customize the DBS target to individual symptoms of each patient.
Authors: Ondrej Bezdicek; Josef Mana; Filip Růžička; Filip Havlik; Anna Fečíková; Tereza Uhrová; Evžen Růžička; Dušan Urgošík; Robert Jech Journal: Front Aging Neurosci Date: 2022-06-17 Impact factor: 5.702