BACKGROUND Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects. OBJECTIVE To compare nonmotor effects of STN-DBS and GPi-DBS. METHODS In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. RESULTS In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. CONCLUSIONS To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.

中文翻译：

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丘脑底和苍白球神经刺激对帕金森病的有益非运动作用

背景 丘脑底 (STN) 和苍白球 (GPi) 深部脑刺激 (DBS) 可改善晚期帕金森病 (PD) 的生活质量、运动和非运动症状 (NMS)。然而，很少有研究比较它们的非运动效应。目的比较 STN-DBS 和 GPi-DBS 的非运动效应。方法在这项前瞻性、观察性、多中心研究中，包括 60 名接受双侧 STN-DBS（n = 40）或 GPi-DBS（n = 20）的 PD 患者，我们检查了 PDQuestionnaire (PDQ)、NMSScale (NMSS)、统一 PD 评定量表 -术前和 6 个月随访时的日常生活活动、运动障碍、并发症（UPDRS-II、-III、-IV）、Hoehn&Yahr、Schwab&England 量表和左旋多巴等效日剂量 (LEDD)。如果参数检验适用，则使用 Wilcoxon 符号秩或配对 t 检验分析随访时的组内变化，并进行多重比较校正。使用 Mann-Whitney-U/未配对 t 检验探索组间差异。在平衡人口统计学和术前临床特征的倾向评分匹配之前和之后进行分析。临床变化的强度用效应大小进行评估。结果 两组的 PDQ、UPDRS-II、-IV、Schwab&England 量表和 NMSS 在随访中均有显着改善。STN-DBS 在 LEDD 减少方面明显更好，GPi-DBS 在 UPDRS-IV 方面表现更好。虽然 NMSS 总分结果相似，但探索性 NMSS 领域分析揭示了不同的特征：两个目标都改善了睡眠/疲劳和情绪/认知，但只有 STN-DBS 杂项（疼痛/嗅觉）和注意力/记忆，只有 GPi-DBS 心血管和性功能域。结论 据我们所知，这是第一项报告 STN-DBS 和 GPi-DBS 在 PD 中有益的非运动效应的不同模式的研究。这项研究强调了 NMS 评估对根据患者的个人运动和非运动特征定制 DBS 目标选择的重要性。