Objective: We aimed to investigate the correlation between the small vessel disease (SVD) burden and the 1-year outcome after the globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson’s disease(PD).

Background: SVD presents as white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), or lacunes on brain magnetic resonance imaging(MRI). Both WMH and EPVS play critical roles in brain homeostasis via the glymphatic system and contribute to neurodegenerative diseases such as cognitive impairment. Recent studies have shown that EPVS is associated with motor progression and cognition in PD. However, the clinical implication of SVD burden on the motor outcomes after DBS surgery has not been investigated.

Method: We investigated 53 patients with PD who underwent bilateral GPi DBS surgery. Using preoperative brain MRI, we counted the number of EPVS in the basal ganglia on axial T2-weighted images according to the Standards for Reporting Vascular Changes on Neuroimaging criteria, and we rated WMH using Fazekas scale. The motor severity in PD patients was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) part 3 score both before and 1 year after DBS surgery. The correlation between EPVS or Fazekas scale and UPDRS part 3 score was evaluated using Pearson correlation.

Results: The median age of study population was 61.5 (95% confidence interval 55.0-66.0), and 28 of 53 patients (52.8%) were female. The preoperative UPDRS part 3 score at medication on state showed a significant positive correlation with Fazekas scale (r=0.36, P=0.008) and EPVS (r=0.46, P=0.001), respectively. However, the preoperative UPDRS part 3 score at medication off state was not correlated with both Fazekas scale and EPVS (P>0.05). The postoperative UPDRS part 3 score at both medication and stimulation on state showed a positive correlation with EPVS (r=0.32, P=0.02) and a correlation trend with Fazekas scale (r=0.25, P=0.07). The changes in UPDRS part 3 score between before and after DBS surgery did not show the association with Fazekas scale and EPVS at medication-off/stimulation-on state (P>0.05).

Conclusion: In this study, we found that the therapeutic effect of DBS, in contrast to the levodopa responsiveness, in PD patients was not affected by the degree of the SVD burden, implicating the outcome prediction of the motor symptoms in PD patients after DBS surgery.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-implication-of-small-vessel-disease-burden-on-deep-brain-stimulation-outcome-in-parkinsons-disease/