Low Pulvinar Intensity in Susceptibility-Weighted Imaging May Suggest Cognitive Worsening After Deep Brain Stimulation Therapy in Patients With Parkinson's Disease
Low Pulvinar Intensity in Susceptibility-Weighted Imaging May Suggest Cognitive Worsening After Deep Brain Stimulation Therapy in Patients With Parkinson's Disease
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DOI：
10.3389/fneur.2019.01158
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发表时间：
2019-10-31
影响因子：
3.4
通讯作者：
Tomimoto, Hidekazu
中科院分区：
文献类型：
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作者：
Matsuura, Keita;Maeda, Masayuki;Tomimoto, Hidekazu
目的：脑深部电刺激(DBS)是治疗帕金森病(PD)的有效方法。然而，DBS后认知功能的恶化对受影响的患者来说是一个相当大的问题。这项研究是为了评估在磁化率加权成像(SWI)中枕骨的发现是否可以提示认知恶化。方法：对21例PD患者行DBS、SWI和神经黑素敏感磁共振成像(NMI)检查。我们根据SWI的发现和NMI中黑质致密部的面积，进一步评估了枕骨低信号。然后，我们研究了认知变化、枕骨低信号和SN区之间的联系。比较患者术前即刻和术后1年的认知功能。结果：21例帕金森病患者中有11例在SWI上发现枕骨低信号。术后一年，21名患者中有6名患者的简易精神状态检查分数比基线分数低3分。我们观察了这6名患者中的5名患者在DBS手术前的枕部低信号(p=0.072)。在术后第一年，21名患者中有6名出现一过性或永久性幻觉；我们观察到这6名患者有枕部低信号，而10名没有枕部低信号的患者没有出现幻觉。结论：帕金森病患者SWI的枕区低信号可能为提示DBS治疗后认知功能减退提供有用的信息。
Purpose: Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD). However, deteriorating cognitive function after DBS is a considerable problem for affected patients. This study was undertaken to assess whether pulvinar findings in susceptibility-weighted imaging (SWI) can suggest cognitive worsening. Methods: We examined 21 patients with PD who underwent DBS along with SWI and neuromelanin-sensitive MR imaging (NMI). We further assessed pulvinar hypointensity based on the SWI findings and also the area of the substantia nigra (SN) pars compacta in NMI. We then examined associations among cognitive changes, pulvinar hypointensity, and SN area. The cognitive function of the patient immediately before surgery was compared with function at 1 year postoperatively. Results: Pulvinar hypointensity in SWI was found in 11 of 21 patients with PD at baseline. One year postoperatively, six of the 21 patients demonstrated a Mini-Mental State Examination score that was >= 3 points lower than the baseline score. We observed pulvinar hypointensity in SWI before DBS surgery in five of these six patients (p = 0.072). During the first postoperative year, six of 21 patients reported both transient or permanent hallucinations; we observed pulvinar hypointensity in these six patients, while 10 patients without pulvinar hypointensity had no hallucinations. Conclusion: Pulvinar hypointensity in SWI in patients with PD may provide information that is useful for suggesting cognitive deterioration after DBS treatment.