Department of Neurology and Movement Disorder Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea.
J Clin Neurosci. 2013 Jul;20(7):964-9. doi: 10.1016/j.jocn.2012.07.020. Epub 2013 May 24.
The effect of subthalamic nucleus deep brain stimulation (STN DBS) on impulse control and related behaviors (ICRB) in patients with Parkinson's disease (PD) is conflicting. We evaluated ICRB before and after bilateral STN DBS in patients with PD. A total of 89 patients with PD treated with bilateral DBS of STN underwent retrospective assessment of ICRB before and after DBS. Of the 89 patients studied, 20 patients (22.5%) had ICRB in the preoperative period. In 13 of those 20 patients (65%), preoperative ICRB improved, including resolution in six patients. Nine patients developed de novo ICRB after DBS, thus 23 patients (25.8%) had ICRB in the postoperative period. There was no demographic difference between the patients with or without ICRB in the preoperative state. In the postoperative state, the patients with ICRB had higher levodopa equivalent daily dose (LEDD) levels and lower Mini-Mental State Examination (MMSE) scores than the patients without ICRB. However, postoperative worsening or de novo ICRB did not correlate with LEDD levels or MMSE scores. Severity of ICRB worsened more after DBS in older patients. Patients with worsened or de novo ICRB after surgery had a greater decrease in Beck Depression Index scores after surgery compared with patients whose ICRB improved. In conclusion, ICRB may resolve or improve, or new ICRB may appear, after bilateral STN DBS. The difference in risk factors for preoperative vs. postoperative ICRB suggests that the pathogenesis of those conditions is different, at least in part.
丘脑底核深部脑刺激（STN DBS）对帕金森病（PD）患者冲动控制和相关行为（ICRB）的影响存在争议。我们评估了双侧 STN DBS 前后 PD 患者的 ICRB。共 89 例接受双侧 STN DBS 治疗的 PD 患者回顾性评估 DBS 前后的 ICRB。在研究的 89 例患者中，20 例（22.5%）在术前存在 ICRB。在这 20 例患者中，有 13 例（65%）术前 ICRB 改善，包括 6 例患者的 ICRB 得到解决。9 例患者在 DBS 后出现新的 ICRB，因此有 23 例（25.8%）在术后存在 ICRB。术前状态时，有或无 ICRB 的患者在人口统计学上无差异。在术后状态下，有 ICRB 的患者的左旋多巴等效日剂量（LEDD）水平更高，简易精神状态检查（MMSE）评分更低。然而，术后 ICRB 恶化或新发与 LEDD 水平或 MMSE 评分无关。年龄较大的患者 DBS 后 ICRB 恶化更严重。与 ICRB 改善的患者相比，术后 ICRB 恶化或新发的患者的贝克抑郁指数评分术后下降更大。总之，双侧 STN DBS 后 ICRB 可能会缓解或改善，也可能会出现新的 ICRB。术前与术后 ICRB 的危险因素不同表明，这些情况的发病机制至少部分不同。
