Movement Disorders Centre, Toronto Western Hospital, University of Toronto, UHN, Toronto, Canada.
J Neurol. 2013 Sep;260(9):2306-11. doi: 10.1007/s00415-013-6983-2. Epub 2013 Jun 9.
Axial symptoms such as freezing of gait and falls are common manifestations of advanced Parkinson's disease (PD) and are partially responsive to medical treatment. High-frequency (≥130 Hz) deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly efficacious in ameliorating appendicular symptoms in PD. However, it is typically less effective in improving axial symptomatology, especially in the long term. We have studied the effects of low-frequency stimulation (LFS) (≤80 Hz) for improving speech, gait and balance dysfunction in the largest patient population to date. PD patients with bilateral STN-DBS and resistant axial symptoms were switched from chronic 130 Hz stimulation to LFS and followed up to 4 years. Primary outcome measures were total motor UPDRS scores, and axial and gait subscores before and after LFS. Bivariate analyses and correlation coefficients were calculated for the different conditions. Potential predictors of therapeutic response were also investigated. Forty-five advanced PD patients who had high frequency stimulation (HFS) for 39.5 ± 27.8 consecutive months were switched to LFS. LFS was kept on for a median period of 111.5 days before the assessment. There was no significant improvement in any of the primary outcomes between HFS and LFS, although a minority of patients preferred to be maintained on LFS for longer periods of time. No predictive factors of response could be identified. There was overall no improvement from LFS in axial symptoms. This could be partly due to some study limitations. Larger prospective trials are warranted to better clarify the impact of stimulation frequency on axial signs.
轴向症状，如冻结步态和跌倒，是帕金森病（PD）晚期的常见表现，部分对药物治疗有反应。高频（≥130 Hz）丘脑底核（STN）深部脑刺激（DBS）对改善 PD 的肢体症状非常有效。然而，它通常对改善轴向症状的效果较差，尤其是在长期治疗中。我们研究了低频刺激（LFS）（≤80 Hz）在改善最大患者群体中言语、步态和平衡功能障碍的效果。将双侧 STN-DBS 且有抵抗性轴向症状的 PD 患者从慢性 130 Hz 刺激切换为 LFS，并进行了长达 4 年的随访。主要观察指标为总运动 UPDRS 评分，以及 LFS 前后的轴向和步态亚评分。对不同情况进行了双变量分析和相关系数计算。还研究了治疗反应的潜在预测因素。45 名接受高频刺激（HFS）治疗的晚期 PD 患者，连续治疗了 39.5±27.8 个月后，切换为 LFS。在评估前，LFS 持续了 111.5 天的中位数时间。HFS 和 LFS 之间，任何主要结果均无显著改善，尽管少数患者更愿意长时间维持 LFS。未确定反应的预测因素。从 LFS 总体上看，轴向症状没有改善。这可能部分归因于一些研究限制。需要更大规模的前瞻性试验来更好地阐明刺激频率对轴向体征的影响。
