Witjas Tatiana, Kaphan Elsa, Régis Jean, Jouve Elisabeth, Chérif André Ali, Péragut Jean-Claude, Azulay Jean Philippe
Department of Clinical Neurosciences, University Hospital Timone, Marseille, France.
Mov Disord. 2007 Sep 15;22(12):1729-34. doi: 10.1002/mds.21602.
The aim of this study was to assess the outcome of nonmotor fluctuations (NMF) after chronic Subthalamic nucleus (STN) Deep Brain Stimulation (DBS) in Parkinson's disease(PD). Chronic stimulation of the STN has proved to be an effective treatment for advanced PD with motor complications. The outcome of NMF, which are also disabling, remains unknown. Forty-patients underwent bilateral STN stimulation. Each patient was interviewed before and after 1 yr of STN DBS with a structured questionnaire about their NMF. After 1 yr of chronic stimulation, the improvement in the motor score (UPDRS III) and dyskinesia amounted respectively to 67.4 and 76.3%. The decrease in motor fluctuations (MF) was 59% and 13 patients reported that their MF had disappeared. Comparatively, a reduction of the total number of NMF was also observed (mean number preoperatively: 15.6 per patient, postoperatively: 6.6). Most of the nonmotor fluctuating symptoms occurred in the "off" state preoperatively and no longer depended on the patient's motor state after surgery. The improvement in NMF was not identical for the different categories: pain/sensory fluctuations showed the best response to STN DBS (84.2%). Dysautonomic and cognitive fluctuations were also markedly improved (>60%) while psychic fluctuations remained the most frequent postoperative NMF observed. Some incapacitating manifestations such as drenching sweats and akathisia showed a remarkably good response to STN stimulation. In conclusion STN DBS alleviates NMF. It has strikingly successful effects on sensory, dysautonomic and cognitive fluctuations. However, psychic fluctuations respond less consistently to this treatment.
本研究旨在评估帕金森病（PD）患者慢性丘脑底核（STN）深部脑刺激（DBS）后非运动波动（NMF）的结果。事实证明，慢性刺激STN是治疗伴有运动并发症的晚期PD的有效方法。同样会导致残疾的NMF的结果仍不明确。40例患者接受了双侧STN刺激。每位患者在STN DBS治疗1年前后均接受了关于其NMF的结构化问卷调查。慢性刺激1年后，运动评分（UPDRS III）和异动症的改善率分别为67.4%和76.3%。运动波动（MF）减少了59%，13例患者报告其MF消失。相比之下，NMF的总数也有所减少（术前平均每位患者15.6次，术后6.6次）。大多数非运动波动症状术前出现在“关”期，术后不再依赖于患者的运动状态。不同类别NMF的改善情况并不相同：疼痛/感觉波动对STN DBS的反应最佳（84.2%）。自主神经功能障碍和认知波动也有明显改善（>60%），而精神波动仍是术后最常见的NMF。一些致残表现，如多汗和静坐不能，对STN刺激反应良好。总之，STN DBS可减轻NMF。它对感觉、自主神经功能障碍和认知波动有显著的成功效果。然而，这种治疗对精神波动的反应不太一致。
