Università Cattolica del Sacro Cuore, Milan, Italy.
J Neurol. 2010 Nov;257(Suppl 2):S298-304. doi: 10.1007/s00415-010-5720-3.
The long-term efficacy and safety of deep brain stimulation (DBS) implant for Parkinson's disease (PD) is described in several recent papers. This procedure has been reported to permit a stable reduction of dopaminergic therapy requirements for up to 5 years, although some expectation of deterioration in non-dopaminergic signs has been recently stated. Our aim is to perform a literature-based review of papers available describing long-term post-operative follow-up after a bilateral implant for subthalamic DBS (STN-DBS). Only peer-reviewed published papers with a post-operative follow-up of at least 5 years were considered. Clinical outcome, disease progression and side effects were assessed at baseline and 2 (or 3 years) and 5 years after surgery. Seven papers were included in the review. A total of 238 patients were analyzed. STN-DBS was confirmed to be an effective treatment for selected patients with PD. In all studies, off-related motor symptoms improved dramatically, compared with pre-implant, at 2 (or 3, according to the study) years and this result persisted at 5-year evaluations. Antiparkinsonian drug reductions, improvements in motor fluctuations and dyskinesias, functional measures and the progression of underlying PD were also reported in all series. Some axial scores, in particular postural stability and speech, improved transiently. Persisting adverse effects included eyelid opening apraxia, weight gain, psychiatric disorders, depression, dysarthria, dyskinesias, and apathy. The present review of the 5-year observations confirms that STN-DBS is a powerful method in the management of PD, but its long-term effects must be thoroughly assessed.
几项近期的研究报告描述了深部脑刺激（DBS）植入术治疗帕金森病（PD）的长期疗效和安全性。该手术已被报道可稳定减少多巴胺能治疗药物的需求长达 5 年，尽管最近有研究表明非多巴胺能症状会出现恶化。我们的目的是对描述立体定向丘脑底核（STN）DBS（STN-DBS）双侧植入术后长期随访的文献进行综述。仅考虑经过同行评审且术后随访至少 5 年的已发表论文。在基线、术后 2（或 3 年）和 5 年时评估临床结果、疾病进展和副作用。共有 7 篇论文被纳入综述。共分析了 238 例患者。STN-DBS 被证实是治疗特定 PD 患者的有效方法。在所有研究中，与术前相比，术后 2（或 3 年，具体取决于研究）年时患者的与运动相关的非运动症状显著改善，这一结果在 5 年评估时仍然存在。所有系列均报告了抗帕金森病药物减少、运动波动和运动障碍改善、功能测量和潜在 PD 进展情况。一些轴性评分，特别是姿势稳定性和言语，暂时有所改善。持续存在的不良反应包括眼睑张开失用症、体重增加、精神障碍、抑郁、构音障碍、运动障碍和冷漠。对 5 年观察结果的本次综述证实，STN-DBS 是治疗 PD 的有力方法，但必须彻底评估其长期效果。
