Fabbri Margherita, Coelho Miguel, Guedes Leonor Correia, Rosa Mario M, Abreu Daisy, Gonçalves Nilza, Antonini Angelo, Ferreira Joaquim J
Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal.
Parkinsonism Relat Disord. 2017 Aug;41:113-117. doi: 10.1016/j.parkreldis.2017.05.003. Epub 2017 May 8.
Subthalamic deep brain stimulation (STN-DBS) is an established treatment for the motor complications of Parkinson's disease (PD) and may have beneficial effects on non-motor symptoms (NMS). However, the acute effect of STN stimulation on NMS has only been explored in small PD cohorts with short post-surgical follow-up.
To study NMS response to an acute stimulation challenge in an STN-DBS PD population with a medium/long-term post-surgical follow-up.
32 STN-DBS PD patients were tested twice (MED OFF/STIM OFF and MED OFF/STIM ON). MDS-UPDRS-III, blood pressure (BP) assessment, a visual analogue scale for pain and fatigue and State Trait Anxiety Scale score were evaluated during both stimulation conditions. NMS were assessed with MDS-UPDRS-I, Non-Motor Symptoms Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory scale.
Mean (SD) age was 62.5 (±13.3) years, mean disease duration 18.7 (±5.1) years, mean post-surgical follow-up 4.6 (±1.3) years, and the mean reduction of levodopa equivalent daily dose after surgery was 58.9% (±25.4%). Mean (SD) motor response to stimulation was 40% (15%). STN stimulation significantly improved anxiety (mean 18% ± 19%, P < 0.005) and fatigue (mean 25% ± 51%; P < 0.05), while pain, although improved did not reach statistical significance. With stimulation ON, BP significantly decreased during orthostatism (P < 0.05) and there was a significant increase in asymptomatic orthostatic hypotension (P < 0.05).
Acute STN stimulation improves anxiety and fatigue but decreases orthostatic BP in PD, several years after surgery. These effects should be considered when assessing long-term effect of DBS.
丘脑底核深部脑刺激术（STN-DBS）是治疗帕金森病（PD）运动并发症的一种既定疗法，可能对非运动症状（NMS）有有益影响。然而，STN刺激对NMS的急性影响仅在术后随访时间较短的小样本PD队列中进行过研究。
研究在术后有中长期随访的STN-DBS治疗的PD患者中，NMS对急性刺激挑战的反应。
对32例接受STN-DBS治疗的PD患者进行两次测试（药物关/刺激关和药物关/刺激开）。在两种刺激条件下，评估统一帕金森病评定量表第三部分（MDS-UPDRS-III）、血压（BP）、疼痛和疲劳视觉模拟量表以及状态特质焦虑量表评分。使用MDS-UPDRS第一部分、非运动症状量表、老年抑郁量表和神经精神科问卷量表评估NMS。
平均（标准差）年龄为62.5（±13.3）岁，平均病程18.7（±5.1）年，平均术后随访4.6（±1.3）年，术后左旋多巴等效日剂量平均减少58.9%（±25.4%）。刺激的平均（标准差）运动反应为40%（15%）。STN刺激显著改善了焦虑（平均改善18%±19%，P<0.005）和疲劳（平均改善25%±51%；P<0.05），疼痛虽有改善但未达到统计学显著性。刺激开启时，直立位时BP显著下降（P<0.05），无症状性直立性低血压显著增加（P<0.05）。
术后数年，急性STN刺激可改善PD患者的焦虑和疲劳，但会降低直立位血压。在评估DBS的长期效果时应考虑这些影响。
