Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Parkinsonism Relat Disord. 2014 Apr;20(4):400-4. doi: 10.1016/j.parkreldis.2014.01.008. Epub 2014 Jan 20.
Evidence suggests that both motor improvement and decline in verbal fluency in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) may be attributed to a lead implantation effect.
We investigated whether the number of microelectrode recording (MER) passes influenced either motor UPDRS scores just prior to stimulation initiation at 4 weeks or decline in verbal fluency 6-24 months after surgery.
We retrospectively analyzed 50 PD patients who underwent bilateral STN DBS. Off medication UPDRS III motor scores were obtained before surgery and before stimulation was initiated. Neuropsychological testing was completed pre- and post-operatively in 28 patients at a mean of 377 days. Coordinates of lead tip and active stimulation site were calculated.
There was no improvement in off-medication UPDRS III motor scores at a mean 33.9 days following surgery, with mean change of 0.04 ± 10.48 (p = 0.98). There was no correlation between the number of MER passes and change in individual UPDRS motor score (r = -0.0001, p = 1.0). We observed significant decline in phonemic verbal fluency by 16% (p = 0.003) but it was not correlated with number of left hemisphere (r = -0.15, p = 0.46), or total number of passes (r = -0.02, p = 0.94) or coordinates of the lead tip or active stimulation site. There was a trend toward correlation with age (r = 0.38, p = 0.07).
Significant decline in phonemic verbal fluency did not correlate with surgical passes nor with location of the lead tip or active stimulation site. These data suggest that age may influence verbal fluency decline more than surgical technique.
有证据表明，接受深部脑刺激（DBS）的帕金森病（PD）患者的运动改善和言语流畅性下降可能归因于导丝植入的影响。
我们研究了微电极记录（MER）次数是否会影响刺激开始前 4 周的运动 UPDRS 评分，或手术后 6-24 个月言语流畅性的下降。
我们回顾性分析了 50 例接受双侧 STN-DBS 的 PD 患者。在手术前和刺激开始前，患者停用药物后的 UPDRS III 运动评分。28 例患者在平均 377 天进行了术前和术后的神经心理学测试。计算了导丝尖端和活性刺激部位的坐标。
术后平均 33.9 天，患者停用药物后的 UPDRS III 运动评分无改善，平均变化为 0.04±10.48（p=0.98）。MER 次数与个体 UPDRS 运动评分的变化之间无相关性（r=0.0001，p=1.0）。我们观察到语音流畅性显著下降 16%（p=0.003），但与左侧大脑半球的 MER 次数（r=-0.15，p=0.46）或总 MER 次数（r=-0.02，p=0.94）或导丝尖端或活性刺激部位的坐标均无相关性。与年龄呈相关性趋势（r=0.38，p=0.07）。
语音流畅性的显著下降与手术次数、导丝尖端或活性刺激部位的位置均无相关性。这些数据表明，年龄对言语流畅性下降的影响可能大于手术技术。
