Ford B, Winfield L, Pullman S L, Frucht S J, Du Y, Greene P, Cheringal J H, Yu Q, Cote L J, Fahn S, McKhann G M, Goodman R R
Center for Movement Disorders Surgery, Columbia-Presbyterian Medical Center, Columbia University, New York, NY 10032, USA.
J Neurol Neurosurg Psychiatry. 2004 Sep;75(9):1255-9. doi: 10.1136/jnnp.2003.027557.
To measure the effect of deep brain stimulation (DBS) of the subthalamic nucleus in patients with advanced Parkinson's disease.
Open label follow up using blinded ratings of videotaped neurological examinations.
30 patients with advanced Parkinson's disease (19 male, 11 female; mean age 58.8 years; mean disease duration 12.8 years), complicated by intractable wearing off motor fluctuations and dopaminergic dyskinesias.
Unified Parkinson's disease rating scale (UPDRS), part III (motor), score at one year, from blinded reviews of videotaped neurological examinations. Secondary outcomes included the other UPDRS subscales, Hoehn and Yahr scale, activities of daily living (ADL) scale, mini-mental state examination (MMSE), estimates of motor fluctuations and dyskinesia severity, drug intake, and patient satisfaction questionnaire.
Subthalamic nucleus stimulation was associated with a 29.5% reduction in motor scores at one year (p<0.0001). The only important predictors of improvement in UPDRS part III motor scores were the baseline response to dopaminergic drugs (p = 0.015) and the presence of tremor (p = 0.027). Hoehn and Yahr scores and ADL scores in the "on" and "off" states did not change, nor did the mean MMSE score. Weight gain occurred in the year after surgery, from (mean) 75.8 kg to 78.5 kg (p = 0.028). Duration of daily wearing off episodes was reduced by 69%. Dyskinesia severity was reduced by 60%. Drug requirements (in levodopa equivalents) declined by 30%.
The 30% improvement in UPDRS motor scores was a more modest result than previously reported. DBS did not improve functional capacity independent of drug use. Its chief benefits were reduction in wearing off duration and dyskinesia severity.
测量丘脑底核深部脑刺激（DBS）对晚期帕金森病患者的影响。
采用录像神经学检查的盲法评分进行开放标签随访。
30例晚期帕金森病患者（男性19例，女性11例；平均年龄58.8岁；平均病程12.8年），伴有难治性运动波动和多巴胺能异动症。
统一帕金森病评定量表（UPDRS）第三部分（运动），通过对录像神经学检查的盲法评估得出的一年时评分。次要结局包括其他UPDRS分量表、霍恩和雅尔分级量表、日常生活活动（ADL）量表、简易精神状态检查表（MMSE）、运动波动和异动症严重程度评估、药物摄入量以及患者满意度问卷。
丘脑底核刺激与一年时运动评分降低29.5%相关（p<0.0001）。UPDRS第三部分运动评分改善的唯一重要预测因素是对多巴胺能药物的基线反应（p = 0.015）和震颤的存在（p = 0.027）。“开”和“关”状态下的霍恩和雅尔评分以及ADL评分未改变，平均MMSE评分也未改变。术后一年体重增加，从（平均）75.8千克增至78.5千克（p = 0.028）。每日运动波动发作时长减少69%。异动症严重程度降低60%。药物需求（以左旋多巴等效剂量计）下降30%。
UPDRS运动评分提高30%，这一结果比先前报告的更为有限。DBS并不能独立于药物使用改善功能能力。其主要益处是减少运动波动时长和异动症严重程度。
