| Objective: Parkinson's disease (PD) is a common neurodegenerative disease in the centralnervous system in middle-aged and elderly people. Relief of motor symptoms had been theprimary target of the treatment for PD over a long period. Nonmotor symptoms (NMS)were ignored by both patients and clinicians, though they greatly influenced the quanlity oflife in PD patients. Subthalamic neucleus deep brain stimulation (STN-DBS) might be aneffective cure to NMS besides its improvement for motor symptoms, which has beenuniversally accepted for treating advanced PD due to its efficacy and safety. However, itmight have nagetive effect to cognition and depresion too. Until now, no scientificconsensus about the relationship of STN-DBS and NMS was concluded and no standardersof surgical indication and efficacy accessment were established. Recently, functionalneuroimaging has been acknowledged as an objective and quantificational tool fordiagnosing and evaluating PD by the neurologists. However, it has not been widely used inthe accessment of STN-DBS for PD. This study aims to observe the changes of NMS andfunctional neuroimaging after6-month chronical stimulation in STN, and to find theinfluence factors and possible mechanism of STN-DBS.Methods: Twenty-nine idiopathic PD patients who underwent STN-DBS in the departmentof neurosurgery in Changhai Hospital were involved in between2011.02and2011.08.Preoperatively, multiple scales including UPDRS, NMSquest, PDQ-39, MMSE, MoCA,HAMD, PSQI and scale of constipation were used to accessing the motor symptoms andNMS when medication on and off.18patients were also evaluated by18-F-FDG and11C-β-CFT PET/CT. The postoperative improvement was calculated by the total pointsand some single items compared with preopertive ones. Paired student-t test or Wilcoxonsinged ranks test were used to analyse the difference between pre-and postoperative scores.Multiple linear regression and Logesticanalysis were uesed to find out the influencingfactors of postoperative NMS scores. The differenceS of functianal neuroimaging werechecked by visual images, radiology index of ROI, semiquantitational ratio of ROI andSPM. Scatter plots, trend lines and multiple linear regression analysis were used to find outthe relationship between clinical improvement and functional neuroimaging change. Allstatistic analysis were calculated by the software SPSS15.0. All P-values were two-sidedand P<0.05was considered to be significant.Results: Twenty-seven patients completed the follow up with multiple NMS questionares.1. Postoperative UPDRS II improved by44.8%. PDQ-39SI improved by30.4%. UPDRS III improved by55.6%. LED decreased by36.8%. UPDRS IV decreased58.8%. On andoffD phenomenon disappeared in55.6%patients. All the differences above are statisticalsignificant.2. The number of NMS decreased2.6by mean. Difficulty in falling in sleep,pains and uncomfortable of legs were significantly improved. Cognition anduncomfortableness parts were significantly improved in PDQ-39SI by21.4%(P=0.001)and63.0%(P<0.001) respectively. MMSE score increased0.8(P=0.045) and MoCAincreased1.0(P=0.013) postoperatively. HAMD socre decreased only0.3point and it'sinsignificant. Sleep quanlity improved20%by means accessed with PSQI. The meansleeping time increasd1.16hour (P<0.001). Constipation of6patiets were better and thescore of constipation decreased by14.8%.3. The postoperative decreasing score ofPDQ-39SI was significant positive correlation with UPDRS III improvement. Thepostoperative cognitive level was significant positive correlation with the preoperativecognitive level and the improvement of UPDRS II and III. The postoperative PSQI scorewas positive correlation with the preoperative PSQI score, and negative correlation withthe improvement of UPDRS III. The increasing time of sleep was significant positivecorrelation with preoperative sleep time. The decreasing score of HAMD was significantpositive correlation with both improvement of UPDRS III and preoperative HAMD score.The preoperative HAMD score had better not to be over27. The decreasing score ofconstipation was significant positive correlation with squared decrease of LED andnegative correlation with preoperative LED. The level of perioperative sleep disorder wassignificant negative correlation with preoperative MoCA and significant positivecorrelation with age and preoperative NMS number. The duration of perioperative sleepdisorder was significant negative correlation with preoperative MMSE and PD duration,and significant positive correlation with UPDRS IV.4. The preopertive DAT in corpusstriatum significantly decreased in all the patients and got worse after surgery. The UPDRSIII score under optimal treatment, no matter medication or DBS, were both significantpositive correlation with the DAT level in caudatum. The preopertive FDG radiologyimages and the SPM were in accordance with PDRP. The abnormal metabolism regions ofPDRP were normalised gradually after surgery.Conclusions:The remarkable improvement after STN-DBS could be observed in someNMS as well as motor symptoms and quality of life. Some NMS improvement wasattributed to motor symptoms relief. Preopertive NMS accessments are important for theindication of STN-DBS and they could predict the perioperative NMS level. DAT in corpus striatum significantly decreased pre-and postoperatively. The DAT level incaudatum are correlation with improvement of both medical and DBS therapy. Theabnormal metabolism of PDRP could be normalised after surgery, which might be themechanism for STN-DBS treatment of PD. |
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