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Master Thesis

Évolution et facteurs prédictifs à court terme des dyskinésies après stimulation cérébrale profonde du noyau sous-thalamique dans la maladie de Parkinson

Abstract : Introduction: deep brain stimulation of the subthalamic nucleus (STN-DBS) improves motor state in advanced Parkinson's disease (PD). Dyskinesia is among the symptoms that reduce the most the quality of life at the stage of motor fluctuations. The aims of our study were to i) assess the evolution of dyskinesia at one year after STN-DBS, ii) identify predictors of the outcome and iii) identify an optimal location of active contacts to obtain improvement of dyskinesia. Materials and methods: we included 269 patients from the Predi-Stim multicenter prospective cohort, who underwent STN-DBS and had had evaluation at one year post-surgery. The primary endpoint was the UPDRS IV dyskinesia sub-scores 4.1 + 4.2 + 4.6 (UPDRS DSK) scored at baseline and at one year follow-up. Motor and neuropsychiatric clinical data were collected pre-operatively and at one year. Pre-surgery cerebral MRI and post-surgery CT-scan were collected and treated to locate active contacts. Logistic regression analysis was performed to identify independent predictors of outcome. An analysis by ROC curve was made in order to establish a threshold of UPDRS IV DSK at inclusion allowing to determine outcome. Results: dyskinesia was improved at one-year follow-up in 82,4% of patients: the UPDRS DSK mean score decreased from 3.26 +-2.31 to 1.3 +-1.73 (p <0.001 ). This improvement concerned all subtypes of dyskinesia. Only the severity of the dyskinesia was predictive of the outcome at one year: the UPDRS DSK score at baseline was positively correlated with its decrease at one year post-surgery (r = -0.5654, p < 0.0001). A UPDRS DSK score of less than 3 at baseline allowed to identify with a specificity of 77.0% and a sensitivity of 81.4% the patients with an pejorative evolution of dyskinesia at one year. A more favorable evolution of dyskinesia was associated with a dorsal position of the active contacts (r = 0.2238, p= 0.0350) and the location of at least one active contact in the sensorimotor territory (p = 0.0303) in 89 patients for whom the location of active contacts was available. Conclusion: in a homogeneous cohort of patients with advanced PD, we showed that i) STNDBS improved dyskinesia, ii) initial severity of dyskinesia was predictive of improvement and iii) improvement correlated with a posterior location of active contacts.
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Master Thesis
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Submitted on : Monday, May 3, 2021 - 4:38:31 PM
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  • HAL Id : dumas-03216015, version 1


Agathe Vrillon. Évolution et facteurs prédictifs à court terme des dyskinésies après stimulation cérébrale profonde du noyau sous-thalamique dans la maladie de Parkinson. Médecine humaine et pathologie. 2019. ⟨dumas-03216015⟩



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