Sobstyl Michał, Ząbek Mirosław, Górecki Wojciech, Mossakowski Zbigniew
Neurosurgical Department of Postgraduate Medical Center, Marymoncka 99/103 Street, Warsaw 01-813, Poland.
Neurosurgical Department of Postgraduate Medical Center, Marymoncka 99/103 Street, Warsaw 01-813, Poland.
Clin Neurol Neurosurg. 2014 Sep;124:161-5. doi: 10.1016/j.clineuro.2014.06.019. Epub 2014 Jun 23.
The aims of this study were to assess the quality of life (QoL) using Parkinson's Disease Questionnaire PDQ-39 after bilateral subthalamic deep brain stimulation (STN DBS), and to identify correlations between changes in UPDRS score and separate PDQ-39 QoL dimensions and PDQ summary index (SI) score at long-term follow-up.
We evaluated 16 patients with advanced PD after bilateral STN DBS. All 16 patients were assessed 1 year after surgery and 14 were studied 2 years after surgery. The patients were assessed using Unified Parkinson's Disease Rating Scale (UPDRS) in medication-on and medication-off conditions, both preoperatively and postoperatively. All UPDRS evaluations were performed postoperatively during stimulation-on condition. QoL levels were determined by applying PDQ-39 questionnaire.
The UPDRS scores after 1 and 2 years in medication-off and -on conditions when bilateral STN DBS was switched on showed a significant difference between baseline scores and follow-up scores (both in -off and -on conditions) in every UPDRS measurement except for mentation after 2 years. Most of P-values indicated that the differences were highly significant (P<0.01) based on Wilcoxon signed-rank test. All dimensions of PDQ-39 as well PDQ-39 SI score were highly significantly improved after 1 year. The same improvements were visible in 2 years follow-up with the exception of social support and communication. We found a positive correlation between ADL UPDRS, motor off UPDRS scores and PDQ-39 ADL and PDQ-39 SI scores. A further analysis of separate motor PD features revealed that tremor, bradykinesia and axial features were correlated with improvements mostly seen in PDQ-39 ADL and PDQ-39 SI scores. Moreover, in medication-on condition, we found a strong correlation between dyskinesia UPDRS score and PDQ-39 mobility, ADL, and PDQ-39 SI score. We observed a negative correlation between improved fluctuation UPDRS score and PDQ-39 mobility. We identified no correlation between the duration of the off period and levodopa dose and changes in PDQ-39.
STN DBS significantly improved important aspects of QoL as measured by PDQ-39. The improvements were maintained at 2 years follow-up except for social support and communication. We demonstrated a positive correlation between changes in the off condition of motor UPDRS scores and dyskinesia UPDRS scores in several PDQ-39 dimensions, whereas fluctuation UPDRS scores were negatively correlated with PDQ-39 mobility scores.
本研究旨在评估双侧丘脑底核深部脑刺激（STN DBS）术后使用帕金森病问卷PDQ - 39的生活质量（QoL），并确定长期随访时UPDRS评分变化与PDQ - 39生活质量各维度及PDQ总结指数（SI）评分之间的相关性。
我们评估了16例接受双侧STN DBS的晚期帕金森病患者。所有16例患者在术后1年进行评估，14例患者在术后2年进行研究。患者在术前和术后分别在服药和未服药状态下使用统一帕金森病评定量表（UPDRS）进行评估。所有UPDRS评估均在术后刺激开启状态下进行。生活质量水平通过应用PDQ - 39问卷来确定。
在双侧STN DBS开启后，1年和2年时未服药和服药状态下的UPDRS评分显示，除2年后的精神状态外，每个UPDRS测量中基线评分与随访评分之间（未服药和服药状态下）均存在显著差异。大多数P值表明，基于Wilcoxon符号秩检验，差异具有高度显著性（P<0.01）。PDQ - 39的所有维度以及PDQ - 39 SI评分在1年后均有高度显著改善。在2年随访中，除社会支持和交流外，同样可见改善。我们发现ADL的UPDRS评分、运动未服药状态下的UPDRS评分与PDQ - 39的ADL评分和PDQ - 39 SI评分之间呈正相关。对单独的运动性帕金森病特征进行进一步分析发现，震颤、运动迟缓及轴性特征与主要在PDQ - 39的ADL评分和PDQ - 39 SI评分中观察到的改善相关。此外，在服药状态下，我们发现异动症的UPDRS评分与PDQ - 39的活动能力、ADL以及PDQ - 39 SI评分之间存在强相关性。我们观察到改善后的症状波动UPDRS评分与PDQ - 39的活动能力之间呈负相关。我们未发现关期时长、左旋多巴剂量与PDQ - 39变化之间存在相关性。
STN DBS显著改善了以PDQ - 39衡量的生活质量的重要方面。除社会支持和交流外，这些改善在2年随访中得以维持。我们证明了运动性UPDRS评分的未服药状态变化和异动症UPDRS评分在几个PDQ - 39维度中呈正相关，而症状波动UPDRS评分与PDQ - 39的活动能力评分呈负相关。
