Accolla Ettore, Caputo Elena, Cogiamanian Filippo, Tamma Filippo, Mrakic-Sposta Simona, Marceglia Sara, Egidi Marcello, Rampini Paolo, Locatelli Marco, Priori Alberto
Dipartimento di Scienze Neurologiche, Università di Milano, Fondazione IRCCS Ospedale, Policlinico, Milano, Italy.
Mov Disord. 2007 Jun 15;22(8):1150-6. doi: 10.1002/mds.21520.
We investigated gender-differences in clinical phenomenology and response to deep brain stimulation (DBS) of the subthalamic nucleus (STN) in a group of patients with advanced Parkinson's disease (PD). Thirty-eight consecutive patients with PD (22 men and 16 women), bilaterally implanted for DBS of the STN, were evaluated 1 month before and 11 to 14 months after surgery. Gender differences in severity of the disease (HY and UPDRS), ability in the activities of daily living (ADL, UPDRS II), tremor and rigidity (UPDRS III), bradykinesia (UPDRS III and hand tapping test), levodopa-induced dyskinesias (LIDs, UPDRS IV), and levodopa equivalent daily dosage (LEDD) were analyzed before and after intervention. We found a predominantly male population, with no gender-related differences in age at onset, disease progression rate, or severity of disease. Nevertheless, women had more severe LIDs than men, only before the intervention. Bradykinesia was significantly less responsive to any kind of treatment (pharmacologic and neurosurgical) in women than in men. Finally, although STN-DBS induced similar total benefits in both genders, postoperative assessment suggested that the ADL improved more in women than in men. Women and men with advanced PD appear to differ in some clinical features and in response to dopaminergic and STN-DBS treatment.
我们研究了一组晚期帕金森病（PD）患者在临床现象学以及丘脑底核（STN）深部脑刺激（DBS）反应方面的性别差异。连续38例接受双侧STN-DBS植入的PD患者（22例男性和16例女性）在手术前1个月以及术后11至14个月接受评估。分析了干预前后疾病严重程度（Hoehn-Yahr分级和统一帕金森病评定量表（UPDRS））、日常生活活动能力（ADL，UPDRS第二部分）、震颤和强直（UPDRS第三部分）、运动迟缓（UPDRS第三部分和手部敲击试验）、左旋多巴诱导的异动症（LIDs，UPDRS第四部分）以及左旋多巴等效日剂量（LEDD）方面的性别差异。我们发现该人群以男性为主，在发病年龄、疾病进展速度或疾病严重程度方面不存在与性别相关的差异。然而，仅在干预前，女性的LIDs比男性更严重。女性的运动迟缓对任何类型的治疗（药物和神经外科）的反应都明显低于男性。最后，尽管STN-DBS在两性中产生的总体益处相似，但术后评估表明女性的ADL改善程度高于男性。晚期PD的女性和男性在一些临床特征以及对多巴胺能和STN-DBS治疗的反应方面似乎存在差异。
