The Effects Of White Matter Hyperintensity On The Outcome Of Deep Brain Stimulation In Parkinson's Disease

Objietive:To evaluate the effects of white matter hyperintensity(WMH)on the outcome of patients with Parkinson's disease treated with subthalamic nucleus deep brain stimulation(STN-DBS)therapy.Methods:Thirty STN-DBS candidates with PD were enrolled and were followed-up for 6 months.WMH was evaluated with Fezakas scale according to the magnetic resonance imaging(MRI)image before surgery.Among them,14 were classified as none to mild WMH group,and 16 as moderate-severe MWH group.Assessments included an off medication unified Parkinson's disease rating scale ?(UPDRS ?),Parkinson's disease questionnaire-39(PDQ-39),Mini-mental state examination(MMSE),the mean levodopa equivalent daily dose(LEDD)and Schwab&England on the baseline and after 6 months of the operation.A11 patients were classified into 2 groups based on the activities of daily living at 6 months after DBS.The good prognostic group(15 cases)showed a S&E scale score of more than 70 during the off-period,and the poor prognostic group(15 cases)showed a score of no more than 70 during the off-period.Results:1)The symptoms were improved significantly after 6 months of the operation(P<0.05).The improvement rate of UPDRS ?total motor score were 43.94%,the improvement rate of PDQ-39 score and LEDD were 41.72%and 27.14%,6 months after surgery in the on stimulation off medication condition.2)The improvement rate of tremor,rigidity,bradykinesia and axial motor were 5932%,39.21%,39.53%and 27.89%respectively In each sub-phase,tremor improved more significant(P<0.05).axial motor improved the worst(P<0.05).3)There were significant differenees in PD age at surgery,preoperative UPDRS ?,bradykinesia>Fezakas,MMSE and S&E scores between the good prognostic group and the poor prognostic group.Multiple logistic regression analysis showed that the independent factors of daily activities after STN-DBS included the Fezakas score(OR=0.348,95%CI:0.126?0.962,P<0.05),S&E score(OR=1.275,95%CI:1.015?1.603,P<0.05).4)The improvement rate of UPDRS ? total motor in the none-mild WMH group and in the moderate-severe MWH group were 50.30%?38.37%(P<0.05),bradykinesia were 45.22%?34.54%(P<0.05)and axial motor were 38.81%?18.33%(P<0.05).The descent rate of LEDD after 6 month of the operation in the none-mild WMH group and in the moderate-severe MWH group were 41.81%and 14.30%(P<0.05).Conclusions:1)The STN-DBS can obviously improve motor symptom in patients with PD and improve patients' quality of life,effectively reduce drug dosage.2)In each sub-phase,tremor improved the most,axial motor improved the worst.3)The degree of WMH and preoperative S&E scale scores during the off-period appear to be the independent factors of prognosis.4)The UPDRS ? total motor,bradykinesia,axial motor and LED in the none-mild WMH group improve more significant than in the moderate-severe MWH group.