From the Université Pierre et Marie Curie-Paris 6 (M.-L.W., M.S., V.C., C.K., S.F.-V., J.-L.G., A.H., V.M., F.P., Y.W., D. Grabli, D. Galanaud, D.D., M.V., L.M., E.B., J.Y., Y.A.), Centre de Recherche de l'Institut du Cerveau et de, la Moelle épinière, UMR-S975, Paris; Inserm (M.-L.W., M.S., V.C., C.K., S.F.-V., A.H., V.M., F.P., Y.W., D. Grabli, D. Galanaud, D.D., M.V., L.M., E.B., J.Y., Y.A.), U975, Paris; CNRS (M.-L.W., M.S., C.K., S.F.-V., A.H., V.M., F.P., Y.W., D. Grabli, D. Galanaud, D.D., M.V., L.M., E.B., J.Y., Y.A.), UMR 7225, Paris; Centre d'Investigation Clinique (M.-L.W., M.S., C.K., G.S., A.H., V.M., F.P., Y.W., P.Z., D. Grabli, A.-M.B., M.V., Y.A.), Département de Neurologie (M.-L.W., V.C., A.W., A.H., V.M., D. Grabli, A.-M.B., M.V., Y.A.), IM2A (V.C., F.P.), Service de Neurochirurgie (C.K., S.N., P.C., H.B.), Department of Clinical Neurophysiology (B.P.), and Service de Neuroradiologie Diagnostique et Fonctionnelle (D. Galanaud, D.D.), Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (M.S.), University Hospital, Bern, Switzerland; Centre de Neuroimagerie de Recherche (S.F.-V., D. Galanaud, D.D.), Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France; Département de Biostatistiques et Information Médicale (J.-L.G.), Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Assistance Publique-Hôpitaux de Paris, ER4 (ex EA3974) Modélisation en Recherche Clinique, Paris, France; Department of Neurology (P.Z.), 251 Hellenic Air Force General Hospital, Athens, Greece; and Department of Neurology (J.-L.H.), CHU Poitiers, France.
Neurology. 2014 Apr 15;82(15):1352-61. doi: 10.1212/WNL.0000000000000315. Epub 2014 Mar 19.
To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD).
Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts.
Pre- and postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms.
In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.
进一步确定帕金森病（PD）患者丘脑底核深部脑刺激（DBS-STN）结果多变的原因。
我们从 1996 年至 2009 年间接受 DBS-STN 的 309 例 PD 患者的队列中获取数据。我们检查了 1 年的运动、认知和精神结局与（1）术前 PD 临床特征、（2）MRI 测量、（3）手术程序和（4）治疗接触部位之间的关系。
我们获得了 262 例 PD 患者的术前和术后结果。与间脑核（64%比 49%改善）相比，刺激接触位于 STN 内时获得最佳运动结局。18%的患者出现术后认知下降，这主要与手术程序有关。其他预测认知结局不佳的因素是围手术期意识混乱和精神病。19 例患者出现刺激诱导的轻躁狂，这与疾病的形式（年龄较小、病程较短、左旋多巴反应性较高）和腹侧接触部位有关。已经存在术前抑郁和/或残留轴性运动症状的患者术后抑郁更为常见。
在这组同质的 PD 患者中，我们表明（1）STN 是改善运动症状的最佳靶点，（2）术后认知缺陷主要与手术本身有关，（3）刺激诱导的轻躁狂与疾病特征和更腹侧 STN 位置的组合有关。
Zotero 插件