Kaiser Iris, Kryspin-Exner Ilse, Brücke Thomas, Volc Dieter, Alesch François
Department of Neurosurgery, Medical University of Vienna, Austria.
BMC Neurol. 2008 Nov 11;8:43. doi: 10.1186/1471-2377-8-43.
Deep brain stimulation of the subthalamic nucleus significantly improves motor function in patients with severe Parkinson's disease. However, the effects on nonmotor aspects remain uncertain. The present study investigated the effects of subthalamic nucleus deep brain stimulation on mood and psychosocial functions in 33 patients with advanced Parkinson's disease in a three year follow-up.
Self-rating questionnaires were administered to 33 patients prior to surgery as well as three, six, twelve and 36 months after surgery.
In the long run, motor function significantly improved after surgery. Mood and psychosocial functions transiently improved at one year but returned to baseline at 36 months after surgery. In addition, we performed cluster and discriminant function analyses and revealed four distinct psychosocial profiles, which remained relatively stable in the course of time. Two profiles featured impaired psychosocial functioning while the other two of them were characterized by greater psychosocial stability.
Compared to baseline no worsening in mood and psychosocial functions was found three years after electrode implantation. Moreover, patients can be assigned to four distinct psychosocial profiles that are relatively stable in the time course. Since these subtypes already exist preoperatively the extent of psychosocial support can be anticipatory adjusted to the patients' needs in order to enhance coping strategies and compliance. This would allow early detection and even prevention of potential psychiatric adverse events after surgery. Given adequate psychosocial support, these findings imply that patients with mild psychiatric disturbances should not be excluded from surgery.
对丘脑底核进行深部脑刺激可显著改善重度帕金森病患者的运动功能。然而，其对非运动方面的影响仍不确定。本研究对33例晚期帕金森病患者进行了为期三年的随访，调查丘脑底核深部脑刺激对情绪和社会心理功能的影响。
在手术前以及手术后3个月、6个月、12个月和36个月，对33例患者进行自评问卷调查。
从长远来看，手术后运动功能显著改善。情绪和社会心理功能在术后1年短暂改善，但在术后36个月恢复至基线水平。此外，我们进行了聚类和判别函数分析，发现了四种不同的社会心理特征，这些特征在一段时间内保持相对稳定。其中两种特征表现为社会心理功能受损，而另外两种特征则表现为更高的社会心理稳定性。
与基线相比，电极植入三年后情绪和社会心理功能并未恶化。此外，患者可被分为四种不同的社会心理特征，这些特征在时间进程中相对稳定。由于这些亚型在术前就已存在，因此可以根据患者的需求预先调整社会心理支持的程度，以增强应对策略和依从性。这将有助于早期发现甚至预防术后潜在的精神不良事件。在给予充分的社会心理支持的情况下，这些发现意味着轻度精神障碍患者不应被排除在手术之外。
