Category: Surgical Therapy: Parkinson's Disease
Objective: To investigate the effect of deep brain stimulation (DBS) in the treatment of camptocormia in patients with Parkinson’s disease (PD).
Background: Camptocormia is a common type of postural deformity in PD which is often debilitating. Currently, few treatments are available for camptocormia in PD. Deep brain stimulation in subthalamic nucleus (STN) and globus pallidus internus (GPi) shows promising potential in treating camptocormia, while few studies investigated the comparative effectiveness of these two targets and evidence of GPi-DBS on camptocormia limited to case reports.
Method: Patients’ video recordings were retrospectively reviewed. The Unified Parkinson’s Disease Motion Assessment Scale Part III (UPDRS-III) was used to assess the patients’ motor symptoms. The total and upper camptocormia angle (TCC and UCC, respectively), which were measured using NeuroPostureApp© (http://www.neuroimaging.uni-kiel.de/NeuroPostureApp/), were used to compare camptocormia alterations. The improvements after surgery was calculated as the percent changes in TCC/UCC angles at post-surgical medication off and DBS on state compared to pre-surgical medication off states.
Results: Seventy-five advanced PD patients (39 for STN-DBS and 36 for GPi-DBS) were included. Using an objective criteria of camptocormia angles, thirteen patients were identified as having camptocormia: 8 in STN-DBS group and 8 in GPi-DBS group with TCC>30° (TCC-CC); 2 in STN-DBS group and 4 in GPi-DBS group with UCC>45° (UCC-CC). The mean follow-up times in STN- and GPi-DBS group were 6.2±2.3 months and 7.3±3.3 months, respectively. In patients with TCC-CC, STN-DBS resulted in an improvement of 49.6 % (from 50.2±11.7° to 25.3±8.3°, p=0.001) and GPi-DBS resulted in an improvement of 40.4% (from 39.1±10.1° to 23.3±8.1°, p=0.017) in TCC camptocormia. In patients with UCC-CC, the corresponding improvement in UCC camptocormia in STN- and GPi- DBS group were 27.9% (from 56.3±6.6° to 40.6±10.1°) and 22.8% (from 50.5±2.6° to 39.0±6.7°, p=0.012). Significant correlation was found between pre-operative medication response and post-operative improvement in TCC/UCC.
Conclusion: Our study demonstrates the potential of DBS in the treatment of camptocormia in PD patients. Studies with larger number of camptocormia patients are warranted for firm conclusion.
To cite this abstract in AMA style:Y. Lai, Y. Song, D. Su, L. Wang, C. Zhang, B. Sun, D. Li. Deep brain stimulation in the treatment of camptocormia in Parkinson’s disease [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-the-treatment-of-camptocormia-in-parkinsons-disease/. Accessed December 7, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-the-treatment-of-camptocormia-in-parkinsons-disease/