Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 4:S76-80. doi: 10.1016/S1353-8020(09)70840-5.
This article reports the detailed analysis of antiparkinsonian drug therapy in 78 consecutive Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN).
The amount and type of antiparkinsonian drugs--including L-dopa, dopamine receptor agonists, associated drugs such as catechol-O-methyl transferase and monoamine oxidase inhibitors, amantadine and anticholinergics--were quantified before surgery and at two control visits 1 and 3 years following chronic STN stimulation.
The L-dopa mean daily dose was reduced by approximately 60% after 1 year and remained stable after 3 years. Apomorphine, bromocriptine, tolcapone and selegiline were withdrawn after STN-DBS. Three years postoperatively, 9 patients (11.5%) no longer required L-dopa and 6 patients (7.7%) completely stopped all dopaminergic medications. More patients were on monotherapy with either L-dopa or dopamine receptor agonist, and fewer patients required combined treatment of dopamine receptor agonist and L-dopa compared with the pre-surgical condition.
Dopaminergic drug treatment is persistently reduced and simplified following chronic STN-DBS for up to 3 years.
本文详细分析了 78 例连续帕金森病（PD）患者在接受丘脑底核（STN）深部脑刺激（DBS）后的抗帕金森病药物治疗。
在手术前以及慢性 STN 刺激后 1 年和 3 年的 2 次对照访视中，量化了抗帕金森病药物的用量和类型，包括左旋多巴、多巴胺受体激动剂、儿茶酚-O-甲基转移酶和单胺氧化酶抑制剂、金刚烷胺和抗胆碱能药物。
1 年后，左旋多巴的平均日剂量减少了约 60%，3 年后保持稳定。阿扑吗啡、溴隐亭、托卡朋和司来吉兰在 STN-DBS 后停用。术后 3 年，9 名患者（11.5%）不再需要左旋多巴，6 名患者（7.7%）完全停止所有多巴胺能药物治疗。与术前相比，更多的患者接受单一左旋多巴或多巴胺受体激动剂治疗，接受多巴胺受体激动剂和左旋多巴联合治疗的患者更少。
在接受慢性 STN-DBS 治疗长达 3 年后，多巴胺能药物治疗持续减少和简化。
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