Su Xin-Ling, Luo Xiao-Guang, Lv Hong, Wang Jun, Ren Yan, He Zhi-Yi
Department of Neurology, First Affiliated Hospital, China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 China.
Department of Neurosurgery, First Affiliated Hospital, China Medical University, China Medical University, Shenyang, China.
Transl Neurodegener. 2017 May 26;6:14. doi: 10.1186/s40035-017-0084-6. eCollection 2017.
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson's disease (PD), the predictive effect of levodopa responsiveness on surgical outcomes was confirmed by some studies, however there were different conclusions about that through long- and short-term follow-ups. We aimed to investigate the factors which influence the predictive value of levodopa responsiveness, and discover more predictive factors of surgical outcomes.
Twenty-three PD patients underwent bilateral STN-DBS and completed our follow-up. Clinical evaluations were performed 1 week before and 3 months after surgery.
STN-DBS significantly improved motor function of PD patients after 3 months; preoperative levodopa responsiveness and disease subtype predicted the effect of DBS on motor function; gender, disease duration and duration of motor fluctuations modified the predictive effect of levodopa responsiveness on motor improvement; the duration of motor fluctuations and severity of preoperative motor symptoms modified the predictive effect of disease subtype on motor improvement.
The intensity of levodopa responsiveness served as a predictor of motor improvement more accurately in female patients, patients with shorter disease duration or shorter motor fluctuations; PD patients with dominant axial symptoms benefit less from STN-DBS compared to those with limb-predominant symptoms, especially in their later disease stage.
丘脑底核脑深部电刺激术（STN-DBS）是治疗帕金森病（PD）的一种有效方法，一些研究证实左旋多巴反应性对手术效果具有预测作用，但长期和短期随访对此存在不同结论。我们旨在研究影响左旋多巴反应性预测价值的因素，并发现更多手术效果的预测因素。
23例PD患者接受双侧STN-DBS并完成随访。分别在术前1周和术后3个月进行临床评估。
STN-DBS术后3个月显著改善了PD患者的运动功能；术前左旋多巴反应性和疾病亚型可预测DBS对运动功能的影响；性别、病程和运动波动持续时间可改变左旋多巴反应性对运动改善的预测作用；运动波动持续时间和术前运动症状严重程度可改变疾病亚型对运动改善的预测作用。
在女性患者、病程较短或运动波动时间较短的患者中，左旋多巴反应强度作为运动改善的预测指标更为准确；与以肢体症状为主的患者相比，以轴性症状为主的PD患者从STN-DBS中获益较少，尤其是在疾病晚期。
