药物治疗和 STN-DBS 对帕金森病患者姿势控制的影响。
Effect of medication and STN-DBS on postural control in subjects with Parkinson's disease.
机构信息
Department of Neurology and Neurological Sciences, Rm A343, 300 Pasteur Drive, Stanford University School of Medicine, Stanford, CA 94303, USA.
出版信息
Parkinsonism Relat Disord. 2012 Mar;18(3):285-9. doi: 10.1016/j.parkreldis.2011.11.005. Epub 2011 Nov 29.
AIMS AND OBJECTIVES
To assess the effect of disease severity, dopaminergic medication (med) and STN-DBS on postural stability in Parkinson's disease (PD).
METHODS
Postural sway in quiet stance, and the Unified Parkinson's Disease Rating Scale (motor) (UPDRS III) were evaluated in 129 subjects in the off-med state. A subgroup of 28 subjects was studied on-med and after STN-DBS. Postural sway was measured using center of pressure (CoP) root mean square displacement (RMS(CoP)) and mean velocity (V(CoP)) in the anterior-posterior (AP) and medial-lateral (ML) directions.
RESULTS
All CoP parameters were larger in moderate/advanced subjects vs controls (P < 0.001) and early subjects. Only RMS(CoP)ML was larger in early subjects vs controls (P < 0.05). Med, DBS and DBS + med decreased UPDRS III compared to off-med (P < 0.001). RMS(CoP)ML and V(CoP)ML were larger on-med vs off-med and vs DBS (P < 0.001). Compared to controls and PD subjects with normal CoP sway off-med, med increased all CoP parameters (P < 0.01) but DBS returned V(CoP)ML to normal values. For 'abnormal' PD subjects, STN-DBS improved the excessive V(CoP) in ML compared to off and on-med pre-DBS (P < 0.05).
CONCLUSIONS
Postural sway in quiet stance increased with disease severity. Only ML CoP displacement was abnormal in early stage PD, and this may be a compensatory mechanism. Medication increased ML postural sway. In 'normal' PD subjects, STN-DBS reversed medication induced postural instability. Subjects with abnormal balance in quiet stance did not benefit from medication or DBS, except for improvement in ML CoP velocity from DBS. This may serve to reduce postural instability and falling.
目的和目标
评估疾病严重程度、多巴胺能药物（med）和 STN-DBS 对帕金森病（PD）患者姿势稳定性的影响。
方法
在 129 名处于停服药物状态的受试者中，评估其在安静站立时的姿势摆动和统一帕金森病评定量表（运动）（UPDRS III）。对 28 名受试者进行了停服药物、服药物和 STN-DBS 后的研究。使用中心压力（CoP）均方根位移（RMS（CoP））和平均速度（V（CoP））在前后（AP）和内侧-外侧（ML）方向测量姿势摆动。
结果
所有 CoP 参数在中度/晚期患者中均大于对照组（P < 0.001）和早期患者。仅早期患者的 CoP 侧向 RMS（CoP）大于对照组（P < 0.05）。与停服药物相比，med、DBS 和 DBS + med 降低了 UPDRS III（P < 0.001）。与停服药物和 DBS 相比，RMS（CoP）ML 和 V（CoP）ML 在服药物时更大（P < 0.001）。与对照组和停服药物时 CoP 摆动正常的 PD 患者相比，med 增加了所有 CoP 参数（P < 0.01），但 DBS 使 V（CoP）ML 恢复到正常水平。对于“异常”PD 患者，与停服和服药物前的 DBS 相比，STN-DBS 改善了 ML 中过度的 V（CoP）（P < 0.05）。
结论
在安静站立时的姿势摆动随着疾病的严重程度而增加。在早期 PD 中，只有 ML CoP 位移异常，这可能是一种代偿机制。药物增加了 ML 姿势摆动。在“正常”PD 患者中，STN-DBS 逆转了药物引起的姿势不稳定。在安静站立时平衡异常的患者，除了 DBS 可改善 ML CoP 速度外，不能从药物或 DBS 中获益。这可能有助于降低姿势不稳定和跌倒的风险。
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