Association of clinical outcomes and connectivity in awake versus asleep deep brain stimulation for Parkinson disease.
Association of clinical outcomes and connectivity in awake versus asleep deep brain stimulation for Parkinson disease.
复制标题
DOI：
10.3171/2022.6.jns212904
复制
发表时间：
2023-04-01
影响因子：
4.1
通讯作者：
Sheth, Sameer A.
中科院分区：
文献类型：
--
作者：
Gadot, Ron;Arroyave, Nora Vanegas;Dang, Huy;Anand, Adrish;Najera, Ricardo A.;Taneff, Lisa Yutong;Bellows, Steven;Tarakad, Arjun;Jankovic, Joseph;Horn, Andreas;Shofty, Ben;Viswanathan, Ashwin;Sheth, Sameer A.
关键词：
帕金森病（PD）的脑深部电刺激（DBS）传统上采用清醒术中测试和/或微电极记录进行。然而，最近，该手术越来越多地在全身麻醉下进行，并进行基于图像的验证。我们试图比较丘脑底核（PD-DBS）清醒和睡眠时参与的结构和功能网络，并将其与临床结局相关联。在植入双侧DBS电极导线的PD患者中，对6个月时的左旋多巴等效日剂量（LEDD）、MDS统一帕金森病评定量表（MDS-UMRS）的术前和术后运动评分以及输送的总电能（TEED）进行了回顾性评估。在子集分析中，使用电极导线-DBS工具箱重建植入电极。将组织激活（VTA）的阈值用作组体积和连接分析中的种子点。回顾了122例患者（n = 52例睡眠，70例清醒）的临床病程。睡眠患者的手术室和手术时间明显缩短。在6个月随访时，两组之间的LEDD减少、MDS-MRS III改善和TEED没有差异。在子集分析（n = 40）中，主动接触的接近度、VTA重叠和期望的网络纤维计数与运动神经功能缺损相关，DBS能量需求较低，运动评分改善。涉及辅助运动区、丘脑和脑干的鉴别性结构纤维束与最佳临床改善相关。与腹侧被盖区的最高结构和功能连接区域在两组之间没有显著差异。与清醒的DBS相比，睡眠过程可以在更有效的过程和更短的手术室时间内基于临床结果、电极放置和连接估计实现类似的最佳靶向。
Deep brain stimulation (DBS) for Parkinson’s disease (PD) is traditionally performed with awake intraoperative testing and/or microelectrode recording. Recently, however, the procedure has been increasingly performed under general anesthesia with image-based verification. We sought to compare structural and functional networks engaged by awake and asleep PD-DBS of the subthalamic nucleus (STN) and correlate them with clinical outcomes. Levodopa equivalent daily dose (LEDD), pre- and post-operative motor scores on MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), and total electrical energy delivered (TEED) at 6 months were retroactively assessed in patients with PD who were implanted with bilateral DBS leads. In subset analysis, implanted electrodes were reconstructed using the Lead-DBS toolbox. Volumes of tissue activated (VTAs) were used as seed points in group volumetric and connectivity analysis. The clinical courses of 122 patients (n = 52 asleep, 70 awake) were reviewed. Operating room and procedure times were significantly shorter in asleep cases. LEDD reduction, MDS-UPDRSIII improvement, and TEED at 6 months follow-up did not differ between groups. In subset analysis (n = 40), proximity of active contact, VTA overlap, and desired network fiber-counts with motor STN correlated with lower DBS energy requirement and improved motor scores. Discriminative structural fiber tracts involving supplementary motor area, thalamus, and brainstem were associated with optimal clinical improvement. Areas of highest structural and functional connectivity with VTAs did not significantly differ between the two groups. Compared to awake STN DBS, asleep procedures can achieve similarly optimal targeting based on clinical outcomes, electrode placement, and connectivity estimates in more efficient procedures and shorter operating room times.