Krause Martin, Fogel Wolfgang, Mayer Petra, Kloss Manja, Tronnier Volker
Department of Neurology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
J Neurol Sci. 2004 Apr 15;219(1-2):119-24. doi: 10.1016/j.jns.2004.01.004.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a popular treatment option for patients suffering from severe Parkinson's disease (PD). Yet the long-term outcome of subthalamic DBS is unknown. A total of 27 patients suffering from severe PD underwent bilateral stereotactic implantation of high-frequency stimulators in the STN. Before surgery and at least annually after surgery they were examined with the Unified Parkinson's Disease Rating Scale (UPDRS). This study presents the results of a mean 30 months (range 23 to 55) follow-up of these patients. We found stable and significant off medication improvement of motor function by DBS (between 40% and 44% in the UPDRS part III). While on medication there was no significant change in the motor function by DBS. UPDRS part III worsened gradually during the follow-up period, suggesting disease progression. Thirty months postsurgery the UPDRS part II (ADL) was still improved by 17%. There was a lasting decrease in fluctuations by more than 50%, and dyskinesias were reduced by about 70%. Freezing was reduced significantly from 2.2 in the UPDRS part II to 1.2 at the endpoint. The daily levodopa-equivalent dose was reduced by 39% at 12 months and by 30% at 30 months after STN stimulator implantation. Subthalamic DBS improves sustainable motor function in patients with severe Parkinson's disease and leads to a lasting reduction of medication. Limitations of this procedure were found for disturbances of speech and swallowing.
丘脑底核（STN）的深部脑刺激（DBS）已成为重度帕金森病（PD）患者一种常用的治疗选择。然而，丘脑底核DBS的长期疗效尚不清楚。共有27例重度PD患者接受了双侧立体定向丘脑底核高频刺激器植入术。术前以及术后至少每年，使用统一帕金森病评定量表（UPDRS）对他们进行检查。本研究呈现了对这些患者平均30个月（范围23至55个月）随访的结果。我们发现DBS使运动功能在未用药状态下得到稳定且显著的改善（UPDRS第三部分改善了40%至44%）。在用药状态下，DBS对运动功能无显著改变。在随访期间，UPDRS第三部分逐渐恶化，提示疾病进展。术后30个月，UPDRS第二部分（日常生活活动能力）仍改善了17%。波动持续减少超过50%，异动症减少约70%。冻结现象从UPDRS第二部分的2.2显著降至终点时的1.2。丘脑底核刺激器植入后12个月，左旋多巴等效日剂量减少39%，30个月时减少30%。丘脑底核DBS可改善重度帕金森病患者的持续运动功能，并导致药物用量持续减少。该手术存在言语和吞咽障碍等局限性。
