帕金森病药物治疗的“脆性反应”：特征及对深部脑刺激的反应
The "brittle response" to Parkinson's disease medications: characterization and response to deep brain stimulation.
作者信息
Martinez-Ramirez Daniel, Giugni Juan, Vedam-Mai Vinata, Wagle Shukla Aparna, Malaty Irene A, McFarland Nikolaus R, Rodriguez Ramon L, Foote Kelly D, Okun Michael S
机构信息
Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America.
Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America.
出版信息
PLoS One. 2014 Apr 14;9(4):e94856. doi: 10.1371/journal.pone.0094856. eCollection 2014.
OBJECTIVE
Formulate a definition and describe the clinical characteristics of PD patients with a "brittle response" (BR) to medications versus a "non-brittle response" (NBR), and characterize the use of DBS for this population.
METHODS
An UF IRB approved protocol used a retrospective chart review of 400 consecutive PD patients presenting to the UF Center for Movement Disorders and Neurorestoration. Patient records were anonymized and de-identified prior to analysis. SPSS statistics were used to analyze data.
RESULTS
Of 345 included patients, 19 (5.5%) met criteria for BR PD. The BR group was comprised of 58% females, compared to 29% in the NBR group (P = .008). The former had a mean age of 63.4 compared to 68.1 in the latter. BR patients had lower mean weight (63.5 vs. 79.6, P = <.001), longer mean disease duration (12.6 vs. 8.9 years, P = .003), and had been on LD for more years compared to NBR patients (9.8 vs. 5.9, P = .001). UPDRS motor scores were higher (40.4 vs. 30.0, P = .001) in BR patients. No differences were observed regarding the Schwab and England scale, PDQ-39, and BDI-II. Sixty-three percent of the BR group had undergone DBS surgery compared to 18% (P = .001). Dyskinesias were more common, severe, and more often painful (P = <.001) in the BR group. There was an overall positive benefit from DBS.
CONCLUSION
BR PD occurred more commonly in female patients with a low body weight. Patients with longer disease duration and longer duration of LD therapy were also at risk. The BR group responded well to DBS.
目的
制定“脆性反应”（BR）与“非脆性反应”（NBR）的帕金森病（PD）患者的定义并描述其临床特征，以及明确该人群深部脑刺激（DBS）的使用情况。
方法
佛罗里达大学（UF）机构审查委员会批准的一项方案对连续400例到UF运动障碍与神经修复中心就诊的PD患者进行了回顾性病历审查。在分析之前，患者记录已进行匿名化和去识别处理。使用SPSS统计软件分析数据。
结果
在纳入的345例患者中，19例（5.5%）符合BR-PD标准。BR组女性占58%，而NBR组为29%（P = 0.008）。前者的平均年龄为63.4岁，后者为68.1岁。BR患者的平均体重较低（63.5 vs. 79.6，P < 0.001），平均病程较长（12.6 vs. 8.9年，P = 0.003），与NBR患者相比接受左旋多巴（LD）治疗的时间更长（9.8 vs. 5.9年，P = 0.001）。BR患者的统一帕金森病评定量表（UPDRS）运动评分更高（40.4 vs. 30.0，P = 0.001）。在施瓦布和英格兰量表、帕金森病问卷-39（PDQ-39）和贝克抑郁量表第二版（BDI-II）方面未观察到差异。BR组63%的患者接受了DBS手术，而NBR组为18%（P = 0.001）。异动症在BR组更常见、更严重，且更常伴有疼痛（P < 0.001）。DBS总体上有积极益处。
结论
BR-PD在体重低的女性患者中更常见。病程较长和接受LD治疗时间较长的患者也有风险。BR组对DBS反应良好。
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