Department of Neurology, Faculty of Medicine, University of Porto, Hospital de São João, São João Hospital, Alameda Hernani Monteiro, 4202-451 Porto, Portugal.
J Neurol. 2009 Dec;256(12):2072-8. doi: 10.1007/s00415-009-5252-x.
Chronic bilateral subthalamic stimulation (DBS-STN) provides considerable clinical benefits in Parkinson disease patients, with improvement in primary symptoms and resolution of side effects of chronic pharmacological treatment. Apart from its therapeutic effects on PD symptoms, DBS-STN also appears to induce weight gain, which may itself induce critical metabolic disorders and limit the benefits of surgery. No data are available in literature showing the efficacy of a nutritional intervention to prevent rapid and/or excessive weight gain after DBSSTN. Fifty-seven PD patients were included in this study and were divided into two groups: Group 1 comprised 16 patients with a nutritional intervention immediately after surgery (1 week after); Group 2 comprised 41 patients with a nutritional intervention in a later period after surgery (mean time of 2.5 ± 1.6 years). Weight, body mass index (BMI), percentage of fat mass, levodopa daily dose (LDD) and part III of the Unified Parkinson's disease rating scale (UPDRS) were studied before and after an individualized and structured nutritional intervention. Three months after nutritional intervention, Group 1 had a mean BMI (24.1 ± 2.99), that was not significantly different (p = 0.114) from BMI before intervention, with stability of the weight and in percentage of fat mass. In Group 2 all the patients gained weight, reaching to 13.17 ± 10%; a total of 63% of patients became overweight (BMI 25 kg/m(2)). Three months after nutritional intervention, Group 2 had a mean BMI (24.80 ± 2.45) that was significantly (p = 0.03) different from BMI before intervention (26.75 ± 2.99), although percentage of fat mass was higher in women. With this study, we have conclude that nutritional intervention adequate to patient-age, disease characteristics, medical therapy with L-dopa and physical activity, is effective incontrolling weight after DBS-STN surgery.
慢性双侧丘脑底核刺激（DBS-STN）为帕金森病患者提供了显著的临床益处，改善了主要症状并解决了慢性药物治疗的副作用。除了对 PD 症状的治疗作用外，DBS-STN 似乎还会导致体重增加，这本身可能会引发严重的代谢紊乱并限制手术的益处。目前尚无文献显示营养干预对预防 DBS-STN 手术后快速和/或过度体重增加的疗效。这项研究纳入了 57 例 PD 患者，将其分为两组：第 1 组 16 例患者术后立即进行营养干预（术后 1 周）；第 2 组 41 例患者在术后较晚进行营养干预（平均时间为 2.5 ± 1.6 年）。在个体化和结构化营养干预前后，研究了体重、体重指数（BMI）、体脂百分比、左旋多巴日剂量（LDD）和帕金森病评定量表第三部分（UPDRS）评分。营养干预 3 个月后，第 1 组的 BMI（24.1 ± 2.99）平均无显著变化（p = 0.114），体重和体脂百分比稳定。第 2 组所有患者体重均增加，达到 13.17 ± 10%；共有 63%的患者超重（BMI 25 kg/m²）。营养干预 3 个月后，第 2 组的 BMI（24.80 ± 2.45）平均显著高于干预前（26.75 ± 2.99）（p = 0.03），尽管女性的体脂百分比更高。通过这项研究，我们得出结论，对于年龄、疾病特征、左旋多巴药物治疗和体力活动与患者相匹配的营养干预，对 DBS-STN 手术后的体重控制是有效的。
