Objective

During the surgical procedure of deep brain stimulation (DBS), insertion of an electrode in the subthalamic nucleus (STN) frequently causes a temporary improvement of motor symptoms, known as the microlesion effect (MLE). The objective of this study was to determine the correlation between the intraoperative MLE and the clinical effect of DBS.

Materials and Methods

Thirty Parkinson's disease (PD) patients with Movement Disorder Society (MDS) Unified Parkinson's Disease Rating Scale (UPDRS) part III (MDS-UPDRS III) scores during bilateral STN-DBS implantation were included in this retrospective study. MDS-UPDRS III subscores (resting tremor, rigidity, and bradykinesia) of the contralateral upper extremity were used. During surgery, these subscores were assessed directly before and after insertion of the electrode. Also, these subscores were determined in the outpatient clinic after 11 weeks on average (on-stimulation). All assessments were performed in an off-medication state (at least 12 hours of medication washout).

Results

Postinsertion MDS-UPDRS motor scores decreased significantly compared to preinsertion scores (p < 0.001 for both hemispheres). The MLE showed a positive correlation with the clinical effect of DBS in both hemispheres (rho = 0.68 for the primarily treated hemisphere, p < 0.001, and rho = 0.59 for the secondarily treated hemisphere, p < 0.01).

Conclusion

The MLE has a clinically relevant correlation with the effect of DBS in PD patients. These results suggest that the MLE can be relied upon as evidence of a clinically effective DBS electrode placement.

中文翻译：

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术中微创效应与帕金森病脑深部电刺激的短期临床疗效呈正相关

客观的

在深部脑刺激 (DBS) 的外科手术过程中，将电极插入底丘脑核 (STN) 经常导致运动症状的暂时改善，称为微损伤效应 (MLE)。本研究的目的是确定术中 MLE 与 DBS 临床效果之间的相关性。

材料和方法

本回顾性研究纳入了 30 名在双侧 STN-DBS 植入期间具有运动障碍协会 (MDS) 统一帕金森病评定量表 (UPDRS) 第三部分 (MDS-UPDRS III) 评分的帕金森病 (PD) 患者。使用对侧上肢的 MDS-UPDRS III 子评分（静息震颤、强直和运动迟缓）。在手术过程中，这些分项评分是在电极插入前后直接评估的。此外，这些分项分数是在平均 11 周（刺激时）后在门诊确定的。所有评估均在停药状态下进行（至少 12 小时的药物清除）。

结果

与插入前分数相比，插入后 MDS-UPDRS 运动分数显着下降（两个半球的p  < 0.001）。MLE 与两个半球的 DBS 临床效果呈正相关（主要治疗半球的 rho = 0.68，p  < 0.001，二次治疗半球的 rho = 0.59，p  < 0.01）。

结论

MLE 与 DBS 在 PD 患者中的作用具有临床相关性。这些结果表明 MLE 可以作为临床有效 DBS 电极放置的证据。