Barichella Michela, Marczewska Agnieszka M, Mariani Claudio, Landi Andrea, Vairo Antonella, Pezzoli Gianni
Centro per la Malattia di Parkinson ed i Disturbi del Movimento, Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
Mov Disord. 2003 Nov;18(11):1337-40. doi: 10.1002/mds.10543.
We evaluated body weight changes in patients with Parkinson's disease (PD) after electrode implantation for deep brain stimulation (DBS) in the subthalamic nucleus (STN) in relation to clinical improvement. Thirty PD patients who received STN DBS were included (22 men, 8 women; mean age, 60.0 +/- 7.1 years; mean PD duration, 13.5 +/- 3.7 years; mean body mass index [BMI], 21.6 +/- 3.0 kg/m2). Body weight, physical activity, and Unified Parkinson's Disease Rating Scale (UPDRS) scores were noted before and 3 and 12 months after the procedure. Significant weight gain occurred in 29 patients; the mean increase was 14.8 +/- 9.8% of initial body weight in 1 year. Of the patients, 46.5% reported weight gain in the first 3 months, 21.4% gradual weight gain in the first 6 months, and 32.1% a slow increase for 1 year. Mean BMI increased up to 24.7 +/- 3.7 kg/m2. After 1 year, mean UPDRS motor score improved significantly in off and in on; and therapy complications improved by 91.0 +/- 17.0%. BMI changes at 3 and 12 months were significantly correlated to dyskinesia score changes, and levodopa dosage was not. In PD, STN DBS produces not only symptom control, but also weight gain. DBS candidates should be given nutritional counseling before the intervention to prevent rapid and/or excessive weight gain.
我们评估了帕金森病（PD）患者在丘脑底核（STN）植入电极进行脑深部电刺激（DBS）后的体重变化及其与临床改善情况的关系。纳入了30例接受STN-DBS治疗的PD患者（22例男性，8例女性；平均年龄60.0±7.1岁；平均PD病程13.5±3.7年；平均体重指数[BMI]21.6±3.0kg/m²）。记录了手术前、术后3个月和12个月时的体重、身体活动及统一帕金森病评定量表（UPDRS）评分。29例患者体重显著增加；1年内平均增加量为初始体重的14.8±9.8%。其中，46.5%的患者在最初3个月体重增加，21.4%的患者在最初6个月体重逐渐增加，32.1%的患者在1年内缓慢增加。平均BMI增至24.7±3.7kg/m²。1年后，平均UPDRS运动评分在关期和开期均显著改善；治疗并发症改善了91.0±17.0%。3个月和12个月时的BMI变化与异动症评分变化显著相关，而与左旋多巴剂量无关。在PD患者中，STN-DBS不仅能控制症状，还会导致体重增加。在进行干预前，应为拟接受DBS治疗的患者提供营养咨询，以防止体重快速和/或过度增加。
