University of Torino, 'Rita Levi Montalcini' Department of Neuroscience, Via Cherasco, 15, 10126 Torino, Italy.
University "Cattolica del Sacro Cuore", Department of Neurology, 00168 Roma, Italy.
Parkinsonism Relat Disord. 2014 Apr;20(4):376-81. doi: 10.1016/j.parkreldis.2014.01.012. Epub 2014 Jan 23.
Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome.
To report the results of a long-term follow-up (mean 11 years, range 10-13) on 26 patients bilaterally implanted in two centres.
Patients were assessed preoperatively and 1, 5 and 11 years after the implant by the Unified Parkinson's Disease Rating Scale (UPDRS) and a battery of neuropsychological tests. Stimulation parameters, drugs dosages, non-motor symptoms and adverse events were also recorded.
At 11 years, stimulation significantly improved the motor symptoms by 35.8%, as compared to the preoperative off-state. Motor complications were well controlled, with a 84.6% improvement of dyskinesias and a 65.8% improvement of motor fluctuations. Despite this, the UPDRS-II-on score worsened by 88.5%, mainly for the worsening of poorly levodopa-responsive symptoms. More than 70% of the patients performed in the normal range in most of the neuropsychological tests, despite the development of dementia in 22.7%. Age at disease onset, axial subscore in off-condition and presence of REM behaviour disorder at baseline were found to be associated with a higher risk of developing disability over time.
Our study confirms the long-term safety and efficacy of STN-DBS in PD. Nevertheless, the functionality of patients worsens over time, mainly for the onset and progression of levodopa-resistant and non-motor symptoms. The role of PD-subtype seems to be relevant in the long-term outcome.
丘脑底核深部脑刺激术（STN-DBS）是治疗帕金森病（PD）的有效方法，但仅有少数研究调查了其长期疗效。此外，关于 PD 亚型对 STN-DBS 长期结果的影响知之甚少。
报告在两个中心接受双侧植入的 26 例患者的长期随访（平均 11 年，范围 10-13 年）结果。
患者在植入前和植入后 1、5 和 11 年，采用统一帕金森病评定量表（UPDRS）和一系列神经心理学测试进行评估。还记录了刺激参数、药物剂量、非运动症状和不良事件。
与术前关药状态相比，11 年后，刺激使运动症状显著改善了 35.8%。运动并发症得到了很好的控制，异动症改善了 84.6%，运动波动改善了 65.8%。尽管如此，UPDRS-II-on 评分仍恶化了 88.5%，主要是由于对左旋多巴反应不良症状的恶化。尽管有 22.7%的患者发展为痴呆，但仍有超过 70%的患者在大多数神经心理学测试中表现正常。发病年龄、关药时的轴性评分和基线时的 REM 行为障碍与随时间推移出现残疾的风险增加相关。
我们的研究证实了 STN-DBS 在 PD 中的长期安全性和有效性。然而，患者的功能随着时间的推移而恶化，主要是由于左旋多巴抵抗和非运动症状的出现和进展。PD 亚型的作用在长期结果中似乎是相关的。
