Objective Previous studies showed that deep brain stimulation (DBS) relieves pain symptoms in Parkinson disease (PD) patients when programmed for motor-symptom relief. One factor involved in pain processing is sensory perception of stimuli. With the advent of directional leads, we explore whether directional DBS affects quantitative sensory testing (QST) metrics acutely. Methods PD patients with subthalamic (STN) DBS and directional leads were tested in 5 settings (DBS-OFF, DBS-ON with omnidirectional stimulation, and DBS-ON) for each of three directional segments of contact used for clinical programming. The Unified Parkinson’s Disease Rating Scale (UPDRS-III) assessed patient’s motor skills at time of study visit at clinical contact and at contact which produced optimal sensory threshold (defined by the greatest tolerance to mechanical stimuli). Correlation analyses were performed between stimulation parameters [amplitude, frequency, pulse width (PW), total electrical energy delivered (TEED)] and outcome metrics. Results Sensory thresholds were obtained in nine patients. Directional stimulation did not significantly alter patient perceptions of sensory stimulus [cold pain (p = 0.69), warm pain (p = 0.99), Von frey fibers (p = 0.09), pin-prick (p = 0.88), vibration (p = 0.40), pressure (p = 0.98)]. With correlation analysis, increasing PW at the posterior contact increased pin prick and vibration sensitivity (p < 0.001). Additionally, an increase in TEED caused a decrease in sensitivity to warm detection when using the anterior (p = 0.04), lateral (p = 0.02), and medial contacts (p = 0.03), and also caused a decrease in sensitivity to cold detection when using the medial contact (p = 0.03). UPDRS-III remained stable during testing. Conclusion Motor benefit can be acutely maintained at directional contacts, whereas directional stimulation can modulate thermal and mechanical sensitivity. Further investigation will determine whether these changes are maintained chronically or can be improved with optimized programming.

中文翻译：

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定向深部脑刺激对帕金森病感觉阈值的影响

目的 先前的研究表明，当针对运动症状缓解进行编程时，深部脑刺激 (DBS) 可缓解帕金森病 (PD) 患者的疼痛症状。与疼痛处理有关的一个因素是对刺激的感官知觉。随着定向线索的出现，我们探讨定向 DBS 是否会严重影响定量感官测试 (QST) 指标。方法 具有丘脑底 (STN) DBS 和定向导联的 PD 患者在 5 种设置（DBS-OFF、带全向刺激的 DBS-ON 和 DBS-ON）中针对用于临床编程的三个定向接触段中的每一个进行测试。统一帕金森病评定量表 (UPDRS-III) 在临床接触和接触产生最佳感觉阈值（由对机械刺激的最大耐受性定义）时评估患者的运动技能。在刺激参数 [幅度、频率、脉冲宽度 (PW)、总电能输送 (TEED)] 和结果指标之间进行相关分析。结果 9 名患者获得了感觉阈值。定向刺激没有显着改变患者对感觉刺激的感知 [冷痛 (p = 0.69)、热痛 (p = 0.99)、冯弗雷纤维 (p = 0.09)、针刺 (p = 0.88)、振动 (p = 0.40)，压力 (p = 0.98)]。通过相关性分析，增加后接触处的 PW 会增加针刺和振动敏感性 (p < 0.001)。此外，TEED 的增加导致使用前接触 (p = 0.04)、外侧 (p = 0.02) 和内侧接触 (p = 0.03) 时对热检测的灵敏度降低，并且还导致对冷检测的灵敏度降低当使用内侧接触时 (p = 0. 03)。UPDRS-III 在测试期间保持稳定。结论 定向接触可以敏锐地维持运动益处，而定向刺激可以调节热敏感性和机械敏感性。进一步的调查将确定这些变化是长期保持还是可以通过优化编程来改进。