Zahodne Laura B, Okun Michael S, Foote Kelly D, Fernandez Hubert H, Rodriguez Ramon L, Wu Samuel S, Kirsch-Darrow Lindsey, Jacobson Charles E, Rosado Christian, Bowers Dawn
Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA.
J Neurol. 2009 Aug;256(8):1321-9. doi: 10.1007/s00415-009-5121-7. Epub 2009 Apr 12.
While deep brain stimulation (DBS) surgery is a well-accepted treatment for Parkinson disease (PD) that improves overall quality of life (QoL), its effects across different domains of QoL are unclear. The study reported here directly compared the effects of unilateral DBS in subthalamic nucleus (STN) or globus pallidus (GPi) on QoL in 42 non-demented patients with medication-refractory PD. Patients were enrolled in the COMPARE trial, a randomized clinical trial of cognitive and mood effects of STN versus GPi DBS conducted at the University of Florida Movement Disorders Center. Patients underwent motor, mood, verbal fluency and QoL (Parkinson disease questionnaire: PDQ-39) measures before and 6 months following surgery. Groups experienced motor and mood improvements that did not differ by target. Patients with STN DBS evidenced a slight decrement on letter fluency. On average, all patients endorsed better overall QoL after surgery. However, despite similar motor and mood improvements, GPi patients improved more than STN patients (38 vs. 14%, respectively; P = 0.03). Patients reported better QoL on subscales of mobility, activities of daily living (ADLs), emotional well-being, stigma, cognition and discomfort, but not on those of social support and communication. Improvements on the mobility, ADLs, stigma and social support subscales were greater amongst GPi patients. In regression analyses, only depression changes independently predicted changes in overall QoL as well as emotional well-being and social support changes. Within the STN group only, declining category fluency scores correlated with poorer QoL on the communication subscale. Unilateral DBS in both STN and GPi improved QoL overall and in disparate domains 6 months after surgery. Patients receiving GPi DBS reported greater improvements that cannot be explained by differential mood or motor effects; however, verbal fluency changes may have partially contributed to lesser QoL improvements amongst STN patients.
虽然深部脑刺激（DBS）手术是治疗帕金森病（PD）的一种广泛接受的方法，可改善整体生活质量（QoL），但其对QoL不同领域的影响尚不清楚。本文报道的研究直接比较了42例药物难治性非痴呆PD患者接受丘脑底核（STN）或苍白球内侧部（GPi）单侧DBS对QoL的影响。患者参加了COMPARE试验，这是一项在佛罗里达大学运动障碍中心进行的关于STN与GPi DBS认知和情绪影响的随机临床试验。患者在手术前和手术后6个月接受运动、情绪、语言流畅性和QoL（帕金森病问卷：PDQ - 39）测量。两组患者的运动和情绪均有改善，且改善情况在不同靶点间无差异。接受STN DBS的患者在字母流畅性方面有轻微下降。平均而言，所有患者术后的整体QoL均有所改善。然而，尽管运动和情绪改善程度相似，但GPi组患者的改善程度超过STN组患者（分别为38%和14%；P = 0.03）。患者在活动能力、日常生活活动（ADL）、情绪健康、耻辱感、认知和不适等分量表上的QoL有所改善，但在社会支持和沟通分量表上则不然。GPi组患者在活动能力、ADL、耻辱感和社会支持分量表上的改善更大。在回归分析中，只有抑郁变化独立预测了整体QoL以及情绪健康和社会支持的变化。仅在STN组内，类别流畅性得分下降与沟通分量表上较差的QoL相关。STN和GPi的单侧DBS在术后6个月总体上以及在不同领域均改善了QoL。接受GPi DBS的患者报告的改善更大，这无法用不同的情绪或运动效应来解释；然而，语言流畅性变化可能部分导致了STN组患者QoL改善程度较小。
