Deep brain stimulation of globus pallidus internus and subthalamic nucleus in Parkinson’s disease: a multicenter, retrospective study of efficacy and safety

Abstract

Background Deep brain stimulation (DBS) is an established therapeutic option in advanced Parkinson’s disease (PD). Literature data and recent guidelines remain inconclusive about the best choice as a target between the subthalamic nucleus (STN) and the globus pallidus internus (GPi). Materials and methods We retrospectively reviewed the clinical efficacy outcomes of 48 DBS-implanted patients (33 STN-DBS and 15 GPi-DBS) at a short- (<1 year from the surgery) and long-term (2–5 years) follow-up. Also, clinical safety outcomes, including postoperative surgical complications and severe side effects, were collected. Results We found no difference between STN-DBS and GPi-DBS in improving motor symptoms at short-term evaluation. However, STN-DBS achieved a more prominent reduction in oral therapy (l-dopa equivalent daily dose, P = .02). By contrast, GPi-DBS was superior in ameliorating motor fluctuations and dyskinesia (MDS-UPDRS IV, P < .001) as well as motor experiences of daily living (MDS-UPDRS II, P = .03). The greater efficacy of GPi-DBS on motor fluctuations and experiences of daily living was also present at the long-term follow-up. We observed five serious adverse events, including two suicides, all among STN-DBS patients. Conclusion Both STN-DBS and GPi-DBS are effective in improving motor symptoms severity and complications, but GPi-DBS has a greater impact on motor fluctuations and motor experiences of daily living. These results suggest that the two targets should be considered equivalent in motor efficacy, with GPi-DBS as a valuable option in patients with prominent motor complications. The occurrence of suicides in STN-treated patients claims further attention in target selection.

Utility of diffusion tensor imaging and generalized q-sampling imaging for predicting short-term clinical effect of deep brain stimulation in Parkinson’s disease

“…The prominence of the Gpi in the study was not surprising. It is highly associated with motor symptoms and therefore with UPDRS-3 score [ 25 ]. Deep brain stimulation of Gpi has also been shown to be effective in improving motor symptoms.…”

“…Deep brain stimulation of Gpi has also been shown to be effective in improving motor symptoms. Moreover, it has been demonstrated that Gpi has a greater impact on motor fluctuations and motor experiences of daily living [ 25 ]. The Gpi results may be associated with the correlated role of both Gpi and STN in motor excitatory and inhibitory processes.…”

Architecture of the subthalamic nucleus

“…A comparison of adverse impact between brain regions indicated that targeting the STN relatively worsened the condition of apathy compared to GPi-DBS 29 . Retrospective studies comparing DBS in STN and GPi in PD show improvement on short-term motor symptoms, yet among STN-DBS treated patients there were incidence of suicide and impact on mood and quality of life 30,31 .…”