Nunta-Aree Sarun, Sitthinamsuwan Bunpot, Boonyapisit Kanokwan, Pisarnpong Apichart
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2010 May;93(5):529-40.
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the recent surgical treatment of choice for patients with idiopathic Parkinson's disease (PD) complicated by motor fluctuation and disabling dyskinesia.
To study 2 years clinical outcomes, changes of medication and complications following STN-DBS in patients with advanced PD.
Twenty-seven patients with 2-year follow-up and complete data were enrolled for retrospective evaluation of Unified Parkinson's Disease Rating Scale (UPDRS) and levodopa equivalent dose (LED). Postoperative UPDRS at 6-month, 1-year and 2-years were compared with the preoperative corresponding UPDRS. Postoperative LED at 2 years was compared with the preoperative baseline. Statistical analysis was performed with paired t-test. Additionally, 62 patients with STN-DBS were enrolled for evaluation of treatment complications.
Of 27 patients with complete 2-years follow-up, preoperative dopamine challenge test showed 50.6% improvement of motor score (UPDRS axis III). Mentation, behavior and mood (UPDRS axis I) were not significantly improved in each subscore, but significantly improved in the total score. Marked improvement of activities of daily living (UPDRS axis II) and complications of therapy (UPDRS IV) was found. Two-year postoperative motor score (UPDRS axis III) during "off medication-on stimulator" showed progressive and dramatic improvement by mean of 59.83%. The present study also revealed significant improvement of motor score (UPDRS axis III) during "on medication-on stimulator" in some items. A significant 33.4% reduction of LED was noted. Of 62 patients with bilateral STN-DBS, there was 1 asymptomatic intracerebral hemorrhage (0.8% per side), 2 speech difficulty (3.2%), 1 transient confusion (1.6%), 2 transient hypomania (3.2%), 1 stimulation induced hemiballism (1.6%), 1 wound infection (1.6%) and 1 lead malposition (0.8% per side).
STN-DBS is a safe and effective treatment for PD complicated by motor fluctuation or dyskinesia. The operative outcomes show long-term improvement of activities of daily living, motor function and reduction of medication and drug-related complications.
丘脑底核深部脑刺激术（STN-DBS）是治疗伴有运动波动和致残性异动症的特发性帕金森病（PD）患者的最新手术选择。
研究晚期PD患者接受STN-DBS治疗2年的临床疗效、药物变化及并发症情况。
纳入27例有2年随访且数据完整的患者，对统一帕金森病评定量表（UPDRS）和左旋多巴等效剂量（LED）进行回顾性评估。将术后6个月、1年和2年的UPDRS与术前相应的UPDRS进行比较。将术后2年的LED与术前基线进行比较。采用配对t检验进行统计学分析。此外，纳入62例行STN-DBS治疗的患者评估治疗并发症。
在27例有完整2年随访的患者中，术前多巴胺激发试验显示运动评分（UPDRS第三部分）改善了50.6%。精神、行为和情绪（UPDRS第一部分）各亚评分无显著改善，但总分显著改善。发现日常生活活动能力（UPDRS第二部分）和治疗并发症（UPDRS第四部分）有明显改善。术后2年“关药-开刺激器”状态下的运动评分（UPDRS第三部分）平均有59.83%的渐进性显著改善。本研究还显示，在某些项目中，“开药-开刺激器”状态下的运动评分（UPDRS第三部分）有显著改善。LED显著降低了33.4%。在62例双侧STN-DBS患者中，有1例无症状性脑出血（每侧0.8%），2例言语困难（3.2%），1例短暂性意识模糊（1.6%），2例短暂性轻躁狂（3.2%），1例刺激诱发的偏身投掷症（1.6%），1例伤口感染（1.6%）和1例电极位置不当（每侧0.8%）。
STN-DBS是治疗伴有运动波动或异动症的PD的一种安全有效的方法。手术结果显示日常生活活动能力、运动功能长期改善，药物及药物相关并发症减少。
