Moro Elena, Schüpbach Michael, Wächter Tobias, Allert Niels, Eleopra Roberto, Honey Christopher R, Rueda Mauricio, Schiess Mya C, Shimo Yasushi, Valkovic Peter, Whone Alan, Stoevelaar Herman
Division of Neurology, CHU of Grenoble, Joseph Fourier University, INSERM U836, Grenoble, France.
Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern, Switzerland.
J Neurol. 2016 Jan;263(1):112-9. doi: 10.1007/s00415-015-7942-x. Epub 2015 Nov 3.
In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson's disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on-off fluctuations, dyskinesias and refractory tremor (positive association, p < 0.001), and cognitive impairment (negative association, p < 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable 'non-motor side effects of anti-PD medication' was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.
2005年，一个欧洲专家小组开发并验证了一种电子工具，以支持对帕金森病（PD）患者进行适当转诊，以便考虑进行脑深部电刺激（DBS）。由于在过去十年中出现了新的证据，因此有必要对该工具进行更新。一个全球专家小组（71名神经科医生和11名神经外科医生）使用兰德/加州大学洛杉矶分校适当性方法，对1296种情况（9分制）的转诊适当性进行了评估。这些情况是与转诊决策相关的8个临床变量的排列组合。转诊适当性是根据中位数得分和一致程度计算得出的。与2005年相比，开-关波动的严重程度、异动症和难治性震颤（正相关，p<0.001）以及认知障碍（负相关，p<0.001）对转诊适当性的临床变量影响相似。左旋多巴无反应性步态和平衡障碍以及年龄较大的负面影响相对更强，后者很可能是由于较高的临界值（先前研究中为70岁，此次为75岁）。PD病程对转诊适当性的影响不如2005年明显。新纳入的变量“抗PD药物的非运动副作用”的贡献非常小。基于这些结果，该小组就PD患者DBS评估的转诊适当性提出了新的建议。与先前研究的差异反映了新的临床证据，特别是与在PD早期使用DBS有关的证据。更新建议的验证工作正在进行中。
