Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts |
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| Authors: | Haidar Salimi Dafsari Jan Niklas Petry-Schmelzer K Ray-Chaudhuri Keyoumars Ashkan Luca Weis Till A Dembek Michael Samuel Alexandra Rizos Monty Silverdale Michael T Barbe Gereon R Fink Julian Evans Pablo Martinez-Martin Angelo Antonini Veerle Visser-Vandewalle Lars Timmermann |
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| Institution: | 1. Department of Neurology, University Hospital Cologne, Cologne, Germany;2. National Parkinson Foundation International Centre of Excellence, King''s College Hospital, London, United Kingdom;3. The Maurice Wohl Clinical Neuroscience Institute, King''s College London, London, United Kingdom;4. Department of Neurology, IRCCS, San Camillo, Venice, Italy;5. Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom;6. Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany;7. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain;8. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany;9. Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany |
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| Abstract: | BackgroundSubthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS.ObjectiveTo investigate the impact of active contact location on NMS in STN-DBS in PD.MethodsIn this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Changes were analyzed with Wilcoxon signed-rank/t-test and Bonferroni-correction for multiple comparisons. Although the STN was targeted visually, we employed an atlas-based approach to explore the relationship between active contact locations and DBS outcomes. Based on fused MRI/CT-images, we identified Cartesian coordinates of active contacts with patient-specific Mai-atlas standardization. We computed linear mixed-effects models with x-/y-/z-coordinates as independent, hemispheres as within-subject, and test change scores as dependent variables.ResultsNMSS, NMSQ, PDQ-8, motor examination, complications, and LEDD significantly improved at follow-up. Linear mixed-effect models showed that NMS and QoL improvement significantly depended on more medial (HADS-D, NMSS), anterior (HADS-D, NMSQ, PDQ-8), and ventral (HADS-A/-D, NMSS, PDQ-8) neurostimulation. ADL improved more in posterior, LEDD in lateral neurostimulation locations. No relationship was observed for motor examination and complications scores.ConclusionsOur study provides evidence that more anterior, medial, and ventral STN-DBS is significantly related to more beneficial non-motor outcomes. |
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| Keywords: | Deep brain stimulation Subthalamic nucleus Non-motor symptoms Non motor symptoms Quality of life |
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