Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial.
Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial.
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DOI：
10.1002/ana.21596
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发表时间：
2009-05
影响因子：
11.2
通讯作者：
Foote, Kelly D.
中科院分区：
文献类型：
--
作者：
Okun, Michael S.;Fernandez, Hubert H.;Wu, Samuel S.;Kirsch-Darrow, Lindsey;Bowers, Dawn;Bova, Frank;Suelter, Michele;Jacobson, Charles E.;Wang, Xinping;Gordon, Clifford W., Jr.;Zeilman, Pam;Romrell, Janet;Martin, Pam;Ward, Herbert;Rodriguez, Ramon L.;Foote, Kelly D.
缺乏一级证据来比较DBS和GPi DBS。我们在这项前瞻性盲法随机试验中的目的是比较帕金森病（PD）患者单侧丘脑底核（DBS）与单侧苍白球（GPi）脑深部电刺激（DBS）对认知和情绪的影响。52例中晚期PD受试者随机接受单侧DBS或GPi DBS。选择右侧或左侧刺激，以解决身体最麻烦症状的一侧。共同主要结局指标是与DBS前状态相比，DBS后7个月时在最佳设置下视觉模拟情绪量表（VAMS）的8个分量表的变化以及2个版本的语言流畅性（即语义和字母）的变化。此外，在DBS后7个月，在受试者接受初始评价（停用药物和接受优化DBS治疗）后，在4种随机和平衡条件（最佳DBS、腹侧DBS、背侧DBS和停用DBS）下对受试者进行测试，同时保持停用药物。然后，次要结局指标比较了7个月时4种DBS条件下VAMS项目和言语流畅性分量表的差异，以及VAMS项目和言语流畅性分量表从DBS前状态到其他3种DBS条件（腹侧、背侧和关闭）的变化7个月。45例受试者（23例GPi和22例Patient）完成了方案。该研究显示，在最佳设置中，DBS前后的共同主要情绪和认知结果变化方面，DBS和GPi DBS之间没有显著差异（Hotelling T2检验：p分别为0.16和0.08）。当比较7个月时的4种DBS条件时，当腹侧刺激到最佳刺激部位时，两个目标中的受试者都不太“快乐”，不太“精力充沛”，更“困惑”。当将其他3种DBS条件（腹侧、背侧和关闭DBS）与DBS前状态进行比较时，与GPi组相比，DBS组的字母语言流畅性评分恶化更大，尤其是在关闭DBS状态下。DBS治疗后，观察到ADRS运动子量表平均改善12分，但目标之间无显著差异。在最佳DBS状态下，在情绪和认知的共同主要结局指标方面，TBI和GPi之间无显著差异。然而，不良情绪的影响时，注意到腹刺激的最佳网站在这两个目标。此外，仅在DBS目标中的3个非最佳DBS后状态中观察到字母语言流畅性恶化。在7个月时，在关闭DBS状态下语言流畅性持续恶化，表明在DBS目标处存在手术而非刺激诱导效应。DBS和GPi DBS导致了类似的运动改善。
There is a paucity of level-one evidence comparing STN and GPi DBS. Our aim in this prospective blinded randomized trial was to compare the cognitive and mood effects of unilateral subthalamic nucleus (STN) vs. unilateral globus pallidus interna (GPi) deep brain stimulation (DBS) in patients with Parkinson disease (PD). Fifty-two subjects with moderate-to-advanced PD were randomized to either unilateral STN or GPi DBS. Right or alternatively left sided stimulation was chosen to address the side of the body with the most bothersome symptoms. The co-primary outcome measures were the change in the 8 subscales of the Visual Analog Mood Scale (VAMS), and the change in the 2 versions of verbal fluency (i.e. semantic and letter), at 7 months post-DBS in the optimal setting compared to the pre-DBS state. In addition, at 7 months post-DBS, after subjects underwent initial evaluation off medications and on optimized DBS therapy, they were tested in four randomized and counterbalanced conditions (optimal DBS, ventral DBS, dorsal DBS, and off DBS) while remaining off medication. Secondary outcome measures then compared the differences in the VAMS items and verbal fluency subscales within the 4 DBS conditions at 7 months, and the change in the VAMS items and verbal fluency subscales from the pre-DBS state to the other 3 DBS conditions (ventral, dorsal and off ) at 7 months. Forty-five subjects (23 GPi and 22 STN) completed the protocol. The study revealed no significant difference between STN and GPi DBS in the change of co-primary mood and cognitive outcomes from pre- to post-DBS in the optimal setting (Hotelling's T2 test: p=0.16 and 0.08 respectively). When comparing the 4 DBS conditions at 7 months, subjects in both targets were less “happy”, less “energetic” and more “confused” when stimulated ventrally to the optimal stimulation site. When comparing the other 3 DBS conditions (ventral, dorsal and off DBS) to the pre-DBS state, the STN group showed a larger deterioration of letter verbal fluency scores than the GPi group, especially in the off DBS state. A 12-point mean improvement in the UPDRS motor subscale was seen post DBS, but there was no significant difference between targets. There were no significant differences in in the co-primary outcome measures of mood and cognition between STN and GPi in the optimal DBS state.. However, adverse mood effects were noted when stimulating ventrally to the optimal site in both targets. Furthermore, a worsening for letter verbal fluency was noted in the 3 non-optimal post-DBS states in the STN target only. The persistence of deterioration in verbal fluency in the off DBS state at 7 months is, suggestive of a surgical rather than a stimulation-induced effect at the STN target. STN and GPi DBS resulted in similar motor improvement.
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影响因子：
11
作者：
HUGHES, AJ;DANIEL, SE;LEES, AJ
通讯作者：
LEES, AJ
影响因子：
8.6
作者：
Funkiewiez, A;Ardouin, C;Pollak, P
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影响因子：
158.5
作者：
Obeso, JA;Guridi, J;Wilkinson, S
通讯作者：
Wilkinson, S
影响因子：
4.8
作者：
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通讯作者：
Hammerstad, JP
影响因子：
9.9
作者：
Pillon, B;Ardouin, C;Agid, Y
通讯作者：
Agid, Y