Objective

To evaluate the effects of bilateral caudal zona incerta (cZi) deep brain stimulation (DBS) for Parkinson's disease (PD) one year after surgery and to create anatomical improvement maps based on patient-specific simulation of the electric field.

Materials and Methods

We report the one-year results of bilateral cZi-DBS in 15 patients with PD. Patients were evaluated on/off medication and stimulation using the Unified Parkinson's Disease Rating Scale (UPDRS). Main outcomes were changes in motor symptoms (UPDRS-III) and quality of life according to Parkinson's Disease Questionnaire-39 (PDQ-39). Secondary outcomes included efficacy profile according to sub-items of UPDRS-III and simulation of the electric field distribution around the DBS lead using the finite element method. Simulations from all patients were transformed to one common magnetic resonance imaging template space for the creation of improvement maps and anatomical evaluation.

Results

Median UPDRS-III score off medication improved from 40 at baseline to 21 on stimulation at one-year follow-up (48%, p < 0.0005). PDQ-39 summary index did not change, but the subdomain activities of daily living (ADL) and stigma improved (25%, p < 0.03 and 75%, p < 0.01), whereas communication worsened (p < 0.03). For UPDRS-III sub-items, stimulation alone reduced median tremor score by 9 points, akinesia by 3, and rigidity by 2 points at one-year follow-up in comparison to baseline (90%, 25%, and 29%, respectively, p < 0.01). Visual analysis of the anatomical improvement maps based on simulated electrical fields showed no evident relation with the degree of symptom improvement and neither did statistical analysis show any significant correlation.

Conclusions

Bilateral cZi-DBS alleviates motor symptoms, especially tremor, and improves ADL and stigma in PD patients one year after surgery. Improvement maps may be a useful tool for visualizing the spread of the electric field. However, there was no clear-cut relation between anatomical location of the electric field and the degree of symptom relief.

中文翻译：

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对帕金森氏病的尾部不定带的深部脑刺激：一年的随访和电场模拟

客观的

评估双侧尾部不定带 (cZi) 深部脑刺激 (DBS) 对帕金森病 (PD) 手术一年后的效果，并根据患者特定的电场模拟创建解剖学改善图。

材料和方法

我们报告了 15 名 PD 患者双侧 cZi-DBS 的一年结果。使用统一帕金森病评定量表 (UPDRS) 对患者的用药和刺激进行评估。根据帕金森病问卷 39 (PDQ-39)，主要结果是运动症状 (UPDRS-III) 和生活质量的变化。次要结果包括根据 UPDRS-III 子项的功效概况和使用有限元方法模拟 DBS 引线周围的电场分布。所有患者的模拟都被转换为一个通用的磁共振成像模板空间，用于创建改进图和解剖评估。

结果

一年随访时，UPDRS-III 中位药物评分从基线时的 40 提高到刺激时的 21（48%，p  < 0.0005）。PDQ-39 总结指数没有变化，但日常生活（ADL）和污名的子域活动有所改善（25%，p < 0.03 和 75%，p < 0.01），而沟通恶化（p < 0.03）。对于 UPDRS-III 子项，与基线相比，在一年的随访中，单独刺激使中位震颤评分降低 9 分，运动不能降低 3 分，僵直降低 2 分（分别为 90%、25% 和 29% , p< 0.01)。基于模拟电场的解剖改善图的可视化分析显示与症状改善程度没有明显关系，统计分析也没有显示任何显着相关性。

结论

双侧 cZi-DBS 可减轻 PD 患者术后一年的运动症状，尤其是震颤，并改善 ADL 和耻辱感。改进图可能是可视化电场扩散的有用工具。然而，电场的解剖位置与症状缓解程度之间没有明确的关系。