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. 2022 Aug:164:e245-e255.
doi: 10.1016/j.wneu.2022.04.084. Epub 2022 Apr 27.

Differential Effects of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation on Motor Subtypes in Parkinson's Disease

Shiying Fan  1 , Defeng Liu  1 , Lin Shi  1 , Fangang Meng  2 , Huaying Fang  3 , Huanguang Liu  1 , Hua Zhang  1 , Anchao Yang  1 , Jianguo Zhang  4
Affiliations

Differential Effects of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation on Motor Subtypes in Parkinson's Disease

Shiying Fan et al. World Neurosurg. 2022 Aug.

Abstract

Objective: We investigated the differences in motor symptom change outcomes after bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in well-defined motor subtypes of Parkinson's disease (PD) to improve clinical decision making.

Methods: We included 114 patients who had undergone STN-DBS and 65 patients who had undergone GPi-DBS. The patients were classified as having akinetic-rigid type (ART), tremor-dominant type (TDT), and mixed type (MT) using the preoperative Movement Disorder Society Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) scores in the no-medication state. The outcome measures included the no-medication MDS-UPDRS-III scores and subscore changes at the last follow-up after surgery. The outcomes were compared among the different motor subtypes and between STN-DBS and GPi-DBS.

Results: At the last follow-up (14.92 ± 8.35 months), the TDT patients had had a greater median overall motor improvement in the no-medication MDS-UPDRS-III scores compared with the ART patients (62.90% vs. 46.67%; P < 0.001), regardless of the stimulation target. The ART patients showed greater improvement after STN-DBS than after GPi-DBS (54.44% vs. 37.21%; P < 0.001), with improvements in rigidity, akinesia, and posture and gait disorders accounting for the difference.

Conclusions: Our results suggest that the different PD motor subtypes will have differential responses to STN-DBS and GPi-DBS, that TDT patients will experience greater improvement than ART patients, and that STN-DBS provides better effects for ART patients than does GPi-DBS. In addition, different motor symptoms among the different motor subtypes might respond differently to STN-DBS than to GPi-DBS. All these factors could reflect the heterogeneity of PD. Longer-term outcomes across the different motor subtypes and stimulation targets should be studied further.

Keywords: GPi-DBS; Motor subtypes; No-medication MDS-UPDRS-III score; Parkinson's disease; STN-DBS.

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