Chopra Amit, Abulseoud Osama A, Sampson Shirlene, Lee Kendall H, Klassen Bryan T, Fields Julie A, Matsumoto Joseph Y, Adams Andrea C, Stoppel Cynthia J, Geske Jennifer R, Frye Mark A
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Department of Neurosurgery, Mayo Clinic, Rochester, MN.
Psychosomatics. 2014 Sep-Oct;55(5):478-84. doi: 10.1016/j.psym.2013.09.003. Epub 2013 Dec 21.
Deep brain stimulation for Parkinson disease has been associated with psychiatric adverse effects including anxiety, depression, mania, psychosis, and suicide.
The purpose of this study was to evaluate the safety of deep brain stimulation in a large Parkinson disease clinical practice.
Patients approved for surgery by the Mayo Clinic deep brain stimulation clinical committee participated in a 6-month prospective naturalistic follow-up study. In addition to the Unified Parkinson's Disease Rating Scale, stability and psychiatric safety were measured using the Beck Depression Inventory, Hamilton Depression Rating Scale, and Young Mania Rating scale. Outcomes were compared in patients with Parkinson disease who had a psychiatric history to those with no co-morbid psychiatric history.
The study was completed by 49 of 54 patients. Statistically significant 6-month baseline to end-point improvement was found in motor and mood scales. No significant differences were found in psychiatric outcomes based on the presence or absence of psychiatric comorbidity.
Our study suggests that patients with Parkinson disease who have a history of psychiatric co-morbidity can safely respond to deep brain stimulation with no greater risk of psychiatric adverse effect occurrence. A multidisciplinary team approach, including careful psychiatric screening ensuring mood stabilization and psychiatric follow-up, should be viewed as standard of care to optimize the psychiatric outcome in the course of deep brain stimulation treatment.
帕金森病的脑深部电刺激治疗与包括焦虑、抑郁、躁狂、精神病和自杀在内的精神不良反应有关。
本研究的目的是评估在大型帕金森病临床实践中脑深部电刺激的安全性。
被梅奥诊所脑深部电刺激临床委员会批准手术的患者参与了一项为期6个月的前瞻性自然随访研究。除统一帕金森病评定量表外，还使用贝克抑郁量表、汉密尔顿抑郁评定量表和杨氏躁狂评定量表来衡量稳定性和精神安全性。对有精神病史的帕金森病患者和无共病精神病史的患者的结果进行了比较。
54名患者中有49名完成了研究。在运动和情绪量表中发现从6个月基线到终点有统计学显著的改善。基于有无精神共病，精神结果未发现显著差异。
我们的研究表明，有精神共病史的帕金森病患者可以安全地接受脑深部电刺激治疗，且发生精神不良反应的风险不会更高。多学科团队方法，包括仔细的精神筛查以确保情绪稳定和精神随访，应被视为在脑深部电刺激治疗过程中优化精神结果的护理标准。
