| Objective:We collected the clinical data of patients with Parkinson's disease admitted to Neurosurgery Department at a top-level hospital in Shanxi Province for 3 years,and conducted statistical analysis of the data of patients who chose DBS surgery.The efficacy of improving symptoms after surgery in patients with Parkinson's disease was explored in order to select optimal surgical targets for future treatment and appropriate stimulation programming parameters,which could help improve the surgical effect of such patients and provide reference for long-term treatment.Methods:A retrospective analysis was conducted on all patients with Parkinson's disease who were treated at a top-level hospital in Shanxi Province from January 2016 to January2019.A total of 30 patients with DBS surgery were randomly selected.Of those,21 cases were in STN group and 9 were in GPi group.Those operations were performed by a team of neurosurgery specialists in Shanxi Province.We collected the general clinical data of those 30 patients,diagnosis and treatment process,analyzed the patients' imaging data,constantly adjusted the parameters,including the electrical current,voltage,frequency and active contacts of implanted intracranial electrodes according to the patient's feedback and electrophysiological monitoring information,and finally achieved the optimal control of symptoms.Patients were regularly assessed for non-motor symptoms,daily activities,motor function,and motor complications using the Hoehn-Yahr(H-Y)scale and the MDS-UPDRS score.All motor scores were evaluated by a certified neurologist.Regular follow-up of one year with patients was conducted,which included postoperative patient stimulation parameter adjustment and data collection.We collected all clinical data and evaluated the patients before and after surgery,and analyzed the efficacy comprehensively.Participants completed all assessments in one day in the same order.Electrode stimulation settings were also recorded during this period,and there was no significant difference in the stimulation settings in patients.Results:The study included 30 patients(13 males).The average age was 68.6±7.6 years old,and the average duration of the disease was 9.20±4.6 years.Studies of STN and GPi-DBS showed no statistical difference in baseline data such as sex,age,duration of illness,severity of motor impairment,cognitive impairment,etc.in the two groups.DBS therapy effectively controlled motor symptoms in PD patients with resting tremor and muscle rigidity at both targets.STN-DBS significantly reduced the dopamine dosage after surgery,and GPi-DBS improved patients' cognitive and mental state significantly better than STN-DBS.STN-DBS had more verbal side effects and GPi-DBS improved language fluency.There was no statistical difference in the symptoms before surgery and improved quality of life,and there was no significant difference in the incidence of complications between the two treatment options(i.e.intracranial hemorrhage,intracranial infection)or hospital stay.In addition,patients in the GPi group were more likely to have a second operation,and STN-DBS would yield more satisfactory clinical benefits.Conclusion:Parkinson's disease was a common neurological disease,for which the main treatment is still medication.DBS is currently an effective and feasible method to treat PD.Therefore,preoperative correct disease evaluation,accurate electrode implantation,reasonable postoperative programming and drug adjustment for patients with DBS surgery are particularly important.The choice of different surgical targets has varying effects on the improvement of clinical symptoms in patients.Different patients should choose individualized optimal stimulation target to achieve the best efficacy.DBS treatment requires the coordination of the entire neurosurgery team and the auxiliary examination departments.Both GPi and STN-DBS have similarly improved motor function.However,STN-DBS is associated with a significant reduction in dopamine drugs,and GPi-DBS provides greater cognitive and psychiatric symptom relief.Therefore,in clinical practice,more STN targets are chosen for surgical treatment,and for patients with certain cognitive and mental defects,the choice of GPi targets is more likely. |
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