Title Page
요약
Contents
Ⅰ. Introduction 10
1. Deep brain stimulation for advanced Parkinson's disease 10
2. Freezing of gait 10
3. Stimulation-induced dyskinesia 11
Ⅱ. Materials and methods 12
1. Participants 12
2. Surgical procedures 12
3. Perioperative procedures 13
4. Measurements of outcomes after GPi DBS 13
5. Clinical assessment of freezing of gait 14
6. Identification of stimulation-induced dyskinesia 14
7. Dopamine transporter imaging acquisition and quantification 15
8. Electrode localization and modelling of the volume of tissue activated 15
9. Statistical analysis 16
Ⅲ. Results 17
1. Predictive values of preoperative factors for outcomes after GPi DBS 17
2. Factors associated with therapeutic effects of GPi DBS on FOG 25
3. Comparison of PD patients with and without SID 37
Ⅳ. Discussion 42
Ⅴ. References 46
Abstract 50
Table 1. Clinical characteristics, striatal dopamine transporter availability and outcomes after GPi DBS in 31 patients with advanced Parkinson's disease 19
Table 2. Univariable and multivariate regression analysis of preoperative factors associated with the motor responsiveness of GPi DBS in patients with advanced Parkinson's disease 21
Table 3. Univariable and multivariate regression analysis of preoperative factors associated with the UPDRS III scores in the medication on stimulation on state after GPi DBS in patients with advanced... 23
Table 4. Univariable and multivariate regression analysis of the factors associated with the change in UPDRS IV score 12 months after GPi DBS in patients with advanced Parkinson's disease 26
Table 5. Univariable and multivariate regression analysis of the factors associated with postoperative changes in dyskinesia scores 12 months after GPi DBS in patients with advanced Parkinson's disease 28
Table 6. Univariable and multivariate regression analysis of the factors associated with postoperative changes in motor fluctuation scores 12 months after GPi DBS in patients with advanced Parkinson's disease 29
Table 7. Clinical characteristics, cognitive status, and dopamine transporter availability of 20 patients with freezing of gait who underwent GPi DBS in advanced Parkinson's disease 30
Table 8. Analysis of the active contact location and the volume of tissue activated in patients with freezing of gait who underwent globus pallidus deep brain stimulation in Parkinson's disease 31
Table 9. Univariable logistic regression analysis of the factors associated with the therapeutic effects of GPi DBS on freezing of gait in Parkinson's disease 34
Table 10. The response to treatment and clinical courses of freezing of gait before and after GPi DBS in 20 patients with advanced Parkinson's disease 36
Table 11. Clinical presentations and DBS programming parameters during stimulation-induced dyskinesia in patients with advanced Parkinson's disease who underwent GPi DBS 38
Table 12. Clinical characteristics and outcomes after GPi DBS of Parkinson's disease patients with or without stimulation-induced dyskinesia 39
Table 13. DBS programming parameters and the distance between electrode contact and GPi motor region in patients with advanced Parkinson's disease who underwent GPi DBS 40
Figure 1. The study flow chart for the association between preoperative factors and outcomes after GPi DBS in PD. PD, Parkinson's disease; GPi, globus pallidus interna; DBS, deep brain stimulation; DAT,... 18
Figure 2. Scatter plots of preoperative factors and motor outcomes 12 months after GPi DBS in patients with advanced Parkinson's disease. (A) There is a negative linear relationship between age at onset of PD... 22
Figure 3. Scatter plots of preoperative levodopa responsiveness and postoperative UPDRS III score in the medication on stimulation on state 12 months after GPi DBS in patients with advanced Parkinson's... 24
Figure 4. Scatter plots of age at onset of Parkinson's disease and postoperative changes in UPDRS IV scores 12 months after GPi DBS. There was a negative linear relationship between the age at onset of PD and... 27
Figure 5. Visualization of the location of the active contacts in 20 Parkinson's disease patients with freezing of gait who underwent GPi DBS. The frontal view of the bilateral active contacts projected on the GPi... 32
Figure 6. Anatomical locations of GPi DBS electrodes in Parkinson's disease patients with stimulation-induced dyskinesia (A) and without stimulation-induced dyskinesia (B). Of the eight PD patients who developed... 41