Observation on the efficacy of deep brain stimulation of the caudal zona incerta and subthalamic nucleus in the treatment of tremor-dominant Parkinson's disease
Objective To compare and analyze the differences in efficacy,stimulation parameters and adverse reactions between caudal zone incerta(cZI)and subthalamic nucleus(STN)deep brain stimulation(DBS)in the treatment of patients with tremor-dominant Parkinson's disease(PD).Methods A total of 26 tremor-dominant PD patients who were treated with DBS at the Department of Neurosurgery,Zhongnan Hospital of Wuhan University from September 2018 to November 2021 were included for retrospective analysis.Among them,10 cases(19 sides)used cZI as the stimulation target(cZI-DBS group),and 16 cases(30 sides)used STN as the stimulation target(STN-DBS).We evaluated the improvement rate of the Unified Parkinson's Disease Rating Scale Part Ⅲ(UPDRS-Ⅲ)scores and its sub-scores(including tremor,rigidity,gait disorder and bradykinesia scores)as well as the reduction rate of levodopa equivalent daily dose(LEDD),stimulation parameters and stimulation-related adverse reactions after surgery compared with preoperative conditions in the two groups.Results At 1,3,9,and 12 months after surgery,compared with the time before the DBS device was turned on,the average or median improvement rate of UPDRS-Ⅲ,tremor,rigidity,gait disorder,and bradykinesia scores of the two groups of patients after the device was turned on was ≥50％.Comparing the two groups,there was no statistically significant difference in the improvement rates of rigidity,bradykinesia,or gait scores at each time point after surgery(all P＞0.05).In the cZI-DBS group,the improvement rates of tremor scores at 1,3,6,and 12 months were(92.15±6.36)％,(90.20± 6.37)％,(85.38±9.72)％,and(89.62±7.18)％respectively;in the STN-DBS group,the improvement rates of tremor scores at 1,3,6 and 12 months were(63.22±17.17)％and(63.38±12.55)％,(61.91± 13.17)％,(68.29±16.23)％respectively.The differences between the two groups at each time point were statistically significant(all P＜0.05).There was no statistically significant difference in the rate of less LEDD between the two groups(P=0.576).the stimulation frequency,pulse width,electrode impedance,and stimulation power of the cZI-DBS group were lower than those of the STN-DBS group(all P＜0.05).The incidences of adverse reactions related to stimulation were 3/10 in the cZI-DBS group and 11/16 in the STN-DBS group.There was a lower trend in the incidence of adverse reactions related to stimulation in the cZI-DBS group(P=0.063).Conclusion Both cZI and STN are effective targets for DBS in the treatment of tremor-dominant PD,while cZI-DBS controls tremor symptoms better than STN-DBS.
Parkinson diseaseTremorDeep brain stimulationTreatment outcomeCaudal zona incertaSubthalamic nucleus
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