对帕金森病患者进行丘脑底核脑深部电刺激的低频刺激可减少吞咽困难和步态冻结。
Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD.
作者信息
Xie Tao, Vigil Julie, MacCracken Ellen, Gasparaitis Arunas, Young Joan, Kang Wenjun, Bernard Jacqueline, Warnke Peter, Kang Un J
机构信息
From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY.
出版信息
Neurology. 2015 Jan 27;84(4):415-20. doi: 10.1212/WNL.0000000000001184. Epub 2014 Dec 24.
OBJECTIVES
To study whether 60-Hz stimulation, compared with routine 130 Hz, improves swallowing function and freezing of gait (FOG) in patients with Parkinson disease (PD) who undergo bilateral subthalamic nucleus (STN) deep brain stimulation (DBS).
METHODS
We studied 7 patients with PD who experienced FOG that persisted despite routine 130-Hz stimulation and dopaminergic medication. Each patient received 3 modified barium swallow (MBS) studies in a single day under 3 DBS conditions in the medication-on state: 130 Hz, 60 Hz, or DBS off, in a randomized double-blind manner. The laryngeal penetration and aspiration events were cautiously assessed, and a swallowing questionnaire was completed. The Unified Parkinson's Disease Rating Scale, Part III motor score, axial subscore, tremor subscore, and FOG by a questionnaire and stand-walk-sit test were also assessed. The best DBS condition (60 Hz here) producing the least FOG was maintained for 3 to 8 weeks, and patients were assessed again. Changes in measurements between the 60 Hz and 130 Hz were analyzed using paired t test, with swallowing function as primary and the remainder as secondary outcomes. Changes between other DBS conditions were further explored with Bonferroni correction.
RESULTS
Compared with the routine 130 Hz, 60-Hz stimulation significantly reduced aspiration frequency by 57% on MBS study and perceived swallowing difficulty by 80% on questionnaire. It also significantly reduced FOG, and axial and parkinsonian symptoms. The benefits at 60-Hz stimulation persisted over the average 6-week assessment.
CONCLUSIONS
Compared with the routine 130 Hz, the 60-Hz stimulation significantly improved swallowing function, FOG, and axial and parkinsonian symptoms in patients with PD treated with bilateral STN-DBS, which persisted over the 6-week study period.
CLASSIFICATION OF EVIDENCE
This study provides Class IV evidence that for patients with PD who experience FOG, STN-DBS at 60 Hz decreases aspiration events observed during MBS compared with DBS at 130 Hz.
目的
研究与常规130赫兹刺激相比，60赫兹刺激是否能改善接受双侧丘脑底核（STN）深部脑刺激（DBS）的帕金森病（PD）患者的吞咽功能和冻结步态（FOG）。
方法
我们研究了7例尽管接受常规130赫兹刺激和多巴胺能药物治疗仍存在FOG的PD患者。每位患者在服药状态下，于同一天在3种DBS条件下接受3次改良钡餐吞咽（MBS）研究：130赫兹、60赫兹或DBS关闭，采用随机双盲方式。仔细评估喉部穿透和误吸事件，并完成一份吞咽问卷。还评估了统一帕金森病评定量表第三部分运动评分、轴向亚评分、震颤亚评分以及通过问卷和站立-行走-坐下测试得出的FOG。维持产生最少FOG的最佳DBS条件（此处为60赫兹）3至8周，然后再次对患者进行评估。使用配对t检验分析60赫兹和130赫兹之间测量值的变化，以吞咽功能作为主要结果，其余作为次要结果。使用Bonferroni校正进一步探讨其他DBS条件之间的变化。
结果
与常规130赫兹相比，60赫兹刺激在MBS研究中使误吸频率显著降低57%，在问卷中使吞咽困难感知显著降低80%。它还显著降低了FOG以及轴向和帕金森症状。60赫兹刺激的益处持续到平均6周的评估期。
结论
与常规130赫兹相比，60赫兹刺激显著改善了接受双侧STN-DBS治疗的PD患者的吞咽功能、FOG以及轴向和帕金森症状，这些改善在6周的研究期内持续存在。
证据分类
本研究提供了IV类证据，即对于经历FOG的PD患者，与130赫兹DBS相比，60赫兹STN-DBS减少了MBS期间观察到的误吸事件。
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