Effect Assessment Of STN DBS On Motor Symptoms In Parkinson’s Disease And Analysis Of Intraoperative And Postoperative CT Imaging

Primary Parkinson’s disease(Parkinson’s disease,PD)is the second common chronic progressive central nervous system degenerative disease that afflicts humans,which is more common in people over 60 years of age.The pathogenesis is usually considered to be degenerative lesions of dopaminergic neurons in substantia nigra,caused a decrease of dopaminergic neurotransmission in striatum and an imbalance of dopamine/acetylcholine transmitters,therefore impairing the function of cortical-basal ganglia-thalamus-cortical neural circuit.In the early stages of Parkinson’s disease,dopaminergic drugs can significantly alleviate patient’s motor symptoms,leaving their quality of life almost unaffected.However,as disease gradually progresses to middle and advanced stages,it is increasingly difficult for drugs to control symptoms,leading to a significant decrease of life quality to patients.Drug-related side effects will also deeply afflict patients.At this point,patients often need help of surgical treatment.Deep brain stimulation(DBS)is one of the functional neurosurgical stereotactic surgery.It controls motor symptoms of Parkinson’s disease by reversibly regulating central neural circuit.It is particularly effective for most patients with advanced Parkinson’s disease.Common target nuclei for DBS in Parkinson’s disease includes Subthalamic nucleus(STN)and Globus Pallidus internus(GPi),and the former is most widely used.For deep brain stimulation of Parkinson’s disease,the main purpose is to obtain satisfactory clinical efficacy while avoid irritating side effects.From screening selection and preoperative assessment,to the verification of intraoperative electrode implantation sites,as well as postoperative stimulation programming,each detail may have an impact on the clinical efficacy.Precise and safe implantation of electrodes is important to ensure the clinical effect.Mobile CT scan has advantages of safety,rapidity and convenience.It can help recognize the position of electrodes and eliminate risk of bleeding,which creating favorable conditions for intraoperative imaging verification of DBS in Parkinson’s disease.This study firstly summarized Parkinson’s disease and deep brain stimulation.The second part compares the preoperative assessment and postoperative clinical efficacy of STN DBS to patients with Parkinson’s disease and assesses its efficacy.The third part aims to summarize features of electrode position deviation between intraoperative and postoperative CT imaging for STN DBS in Parkinson’s disease.It hopes to be favorable for development of DBS in Parkinson’s disease.Section1 Review of Parkinson’s Disease and Deep Brain StimulationObjective To summarize Parkinson’s disease and deep brain stimulation.Methods Review of Parkinson’s disease and deep brain stimulation was provided through literature surveys.Results The literature review was mainly discussed in the following aspects,including the clinical symptoms,diagnostic criteria and treatment of Parkinson’s disease;besides,the treatment process,clinical efficacy,and programming of deep brain stimulation.Conclusion Deep brain stimulation is an effective surgical treatment for Parkinson’s disease.It can reversibly regulate the central neural circuit through neuromodulation,significantly improve symptoms of Parkinson’s disease and will have a broad prospect development in the future.Section 2 Effect assessment of STN DBS on motor symptoms in Parkinson’s diseaseObjective To assess the clinical effect of STN DBS on motor symptoms in Parkinson’s disease.Methods preoperative UPDRS III scoring results and postoperative clinical efficacy scores of 35 patients with Parkinson’s disease who underwent bilateral subthalamic nucleus deep brain stimulation were retrospectively reviewed.UPDRS III scores were classified into tremor,rigidity,and limb mobility,and other items.Comparatively analyze the preoperative and postoperative score results and improvement rates of each item and overall.Results The postoperative on-medication and on-stimulation state scores of rigidity were further improved compared with the preoperative on-medication state,and scores of other items were basically approximate.For postoperative off-medication and on-stimulation state,improvement rate of tremor,rigidity and limb mobility is more than 50%,of which posture balance function close to 50%,while improvement rate of speech function and facial expression is less than 25%,and of significant fluctuations.As for Postoperative on-medication and on-stimulation state,improvement rate of rigidity,limb mobility,gait and posture balance function is the same as preoperative on-medication state,while improvement rate of speech and facial expression is lower than preoperative on-medication state.Conclusions Deep brain stimulation can significantly improve tremor,rigidity,limb mobility,gait and posture balance of Parkinson’s disease,and the corresponding preoperative improvement rate can simulate and predict postoperative efficacy.Efficacy of deep brain stimulation for speech function and facial expression is inaccurate,and therefore,assessing their postoperative effect with the score results is more reasonable.Section 3 Analysis of intraoperative and postoperative CT imaging for STN DBS in Parkinson’s diseaseObjective To investigate displacement features between intraoperative and postoperative position of electrode on CT imaging for STN DBS in Parkinson’s disease.Methods Retrospectively analyze the preoperative MRI images,intraoperative and postoperative CT images of 35 patients with Parkinson’s disease treated for STN DBS.A three-dimensional coordinate system was established based on preoperative MRI.MRI/CT fusion technique was used to fuse intraoperative and postoperative CT images with preoperative MRI.Locate position of intraoperative and postoperative electrode.The displacement features of intraoperative and postoperative electrode were analyzed.Results Spatial distance between intraoperative and postoperative position of bilateral electrodes is about 1mm,and the depth displacement is minimal.The postoperative position of first side electrode on lateral axis is shifted outwardly from intraoperative position,and the second side electrode is shifted internally with a small degree;on AC-PC axis,the first side electrode shifts backward obviously,while the second side electrode shifts backward mildly.Conclusions The displacement of electrode between intraoperative and postoperative position has obvious rules after STN DBS in Parkinson’s disease,which can guide the adjustment of intraoperative electrode position and predict the postoperative position.