Table_2_STN Versus GPi Ddeep Brain Stimulation for Action and Rest Tremor in Parkinson’s Disease.docx

ObjectiveTo investigate the effects of subthalamic nucleus (STN) and globus pallidus internus (GPi), deep brain stimulation (DBS) on individual action tremor/postural tremor (AT) and rest tremor (RT) in Parkinson’s disease (PD). Randomized DBS studies have reported marked benefit in tremor with both GPi and STN and DBS, however, there is a paucity of information available on AT vs RT when separated by the surgical target.
MethodsWe retrospectively reviewed the 1-year clinical outcome of PD patients treated with STN and GPi DBS at the University of Florida. We specifically selected patients with moderate to severe AT. Eighty-eight patients (57 STN and 31 GPi) were evaluated at 6 and 12 months for changes in AT and RT in the OFF-medication/ON stimulation state. A comparison of “response” was performed and defined as greater than or equal to a 2-point decrease in tremor score.
ResultsSTN and GPi DBS both improved AT at 6- and 12-months post-implantation (p < 0.001 and p < 0.001). The STN DBS group experienced a greater improvement in AT at 6 months compared to the GPi group (p = 0.005) but not at the 12 months follow-up (p = 0.301). Both STN and GPi DBS also improved RT at 6- and 12-months post-implantation (p < 0.001 and p < 0.001). There was no difference in RT scores between the two groups at 6 months (p = 0.23) or 12 months (p = 0.74). The STN group had a larger proportion of patients who achieved a “response” in AT at 6 months (p < 0.01), however, this finding was not present at 12 months (p = 0.23). A sub-analysis revealed that in RT, the STN group had a larger percentage of “responders” when followed through 12 months (p < 0.01).
ConclusionBoth STN and GPi DBS reduced PD associated AT and RT at 12 months follow-up. There was no advantage of either brain target in the management of RT or AT. One nuance of the study was that STN DBS was more effective in suppressing AT in the early postoperative period, however, this effect diminished over time. Clinicians should be aware that it may take longer to achieve a similar tremor outcome when utilizing the GPi target.

### 研究目的
本研究旨在探讨丘脑底核（subthalamic nucleus, STN）与内侧苍白球（globus pallidus internus, GPi）的脑深部电刺激（deep brain stimulation, DBS）对帕金森病（Parkinson’s disease, PD）患者个体动作性震颤/姿势性震颤（action tremor/postural tremor, AT）及静止性震颤（rest tremor, RT）的影响。既往随机对照DBS研究均报道GPi与STN-DBS均可显著改善震颤症状，但针对不同手术靶点下动作性震颤与静止性震颤的对比研究仍较为匮乏。

### 研究方法
本研究回顾性分析了佛罗里达大学收治的接受STN与GPi-DBS治疗的帕金森病患者1年临床结局。我们特意筛选了存在中重度动作性震颤的患者。共纳入88例患者（57例接受STN-DBS，31例接受GPi-DBS），分别于术后6个月与12个月评估停药-刺激状态下动作性震颤与静止性震颤的变化情况。以震颤评分较基线下降≥2分定义为“有效应答”，并对两组应答情况进行对比分析。

### 研究结果
STN与GPi-DBS均能在术后6个月及12个月改善动作性震颤（均p<0.001）。术后6个月时，STN-DBS组患者的动作性震颤改善程度优于GPi-DBS组（p=0.005），但该差异在12个月随访时不复存在（p=0.301）。两类手术方式同样可在术后6个月及12个月改善静止性震颤（均p<0.001）。两组患者的静止性震颤评分在术后6个月（p=0.23）及12个月（p=0.74）时均无显著差异。术后6个月时，STN-DBS组达到动作性震颤有效应答的患者比例更高（p<0.01），但该优势在12个月随访时消失（p=0.23）。亚组分析显示，对于静止性震颤，STN-DBS组在12个月随访时的有效应答患者占比更高（p<0.01）。

### 研究结论
术后12个月随访时，STN与GPi-DBS均可减轻帕金森病相关的动作性震颤与静止性震颤。两种手术靶点在改善动作性震颤或静止性震颤方面并无显著优劣之分。本研究的一项关键细节为：STN-DBS在术后早期对动作性震颤的抑制效果更优，但该效应随时间推移逐渐减弱。临床医师应注意，采用GPi靶点时，达到同等震颤改善效果可能需要更长时间。