From the Departments of Neurology (C.B., L.M., J.H., C.G., W.H.Z.), Medical Biometry and Epidemiology (E.V.), Neurophysiology and Pathophysiology (C.K.E.M., A.K.E.), and Neurosurgery (W.H.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neurology. 2014 Jan 7;82(1):32-40. doi: 10.1212/01.wnl.0000438223.17976.fb. Epub 2013 Dec 18.
To examine the influence of subthalamic nucleus (STN) deep brain stimulation (DBS) on driving in patients with Parkinson disease (PD).
Using a driving simulator setup proven to reflect on-road driving, 2 main analyses were performed: 1) comparison of driving performance among 23 patients with deep brain surgery (DBS patients), 21 patients without surgery (no-DBS patients), and 21 controls; and 2) analysis of the effect of stimulation vs levodopa on driving performance. To this end, 3 tests were run in the medicated DBS patient cohort, with 3 different conditions: "stimulation on" (STIM) (equated to daily treatment), "stimulation off" (OFF), and "stimulation off/levodopa" (LD) (dosage aimed at maintaining motor status). Differences in driving times and errors among conditions were analyzed.
Age and cognitive deficits influenced driving performance negatively. The no-DBS patient group performed worse in driving time and driving errors than controls. DBS patients drove slower than controls and no-DBS patients. Driving safety was comparable to controls but higher than in no-DBS patients. Within the DBS patient group, driving was more accurate with STIM than with LD, although motor effects did not differ. Driving with STIM, but not with LD, was superior to driving in the OFF condition.
DBS of the STN seems to have a beneficial effect on driving ability in patients with PD, potentially because of nonmotor driving-relevant aspects. Our data suggest that driving permission for DBS-treated patients with PD should not be handled more restrictively than permissions for patients with PD in general.
This study provides Class IV evidence that STN-DBS in patients with PD is associated with a reduction in driving errors and improvements in driving accuracy in driving simulations.
研究丘脑底核（STN）深部脑刺激（DBS）对帕金森病（PD）患者驾驶能力的影响。
采用经证实可反映道路驾驶的驾驶模拟器设置，进行了 2 项主要分析：1）比较 23 例深部脑手术（DBS 患者）、21 例未手术（无 DBS 患者）和 21 例对照组患者的驾驶表现；2）分析刺激与左旋多巴对驾驶表现的影响。为此，对接受药物治疗的 DBS 患者队列进行了 3 项测试，采用 3 种不同条件：“刺激开启”（STIM）（等同于日常治疗）、“刺激关闭”（OFF）和“刺激关闭/左旋多巴”（LD）（旨在维持运动状态的剂量）。分析条件间的驾驶时间和错误差异。
年龄和认知缺陷对驾驶表现有负面影响。无 DBS 患者组的驾驶时间和驾驶错误比对照组差。DBS 患者的驾驶速度比对照组和无 DBS 患者慢。驾驶安全性与对照组相当，但高于无 DBS 患者。在 DBS 患者组中，STIM 条件下的驾驶比 LD 条件下更准确，尽管运动效果没有差异。与 OFF 条件相比，STIM 条件下的驾驶优于 LD 条件下的驾驶。
STN-DBS 似乎对 PD 患者的驾驶能力有有益影响，这可能是由于与运动无关的驾驶相关方面。我们的数据表明，对于接受 DBS 治疗的 PD 患者，不应比一般 PD 患者更严格地限制驾驶许可。
本研究提供了 IV 级证据，表明 PD 患者的 STN-DBS 与驾驶模拟中的驾驶错误减少和驾驶准确性提高相关。
