Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea; Aerospace Medical Group, Air Force Education and Training Command, Jinju, Republic of Korea.
Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea.
Parkinsonism Relat Disord. 2017 Nov;44:133-136. doi: 10.1016/j.parkreldis.2017.08.016. Epub 2017 Aug 10.
To assess the influence of preoperative depression on the change in freezing of gait (FOG) following subthalamic nucleus stimulation (STN-DBS) in patients with Parkinson's disease (PD).
One hundred and twelve PD patients were included who received bilateral STN-DBS. Of these, 33 had no preoperative depression (PD-ND) and the other 79 had preoperative depression (PD-D). Each PD-ND patient was matched with one PD-D patient by the propensity score for which sex, age at PD onset, disease duration, UPDRS-III score during off-medication state, levodopa-equivalent daily dose, and mini mental state examination were the independent variables. We compared both a FOG-questionnaire (FOG-Q) and the axial score from UPDRS-III between the two groups over 12-month follow-up.
During the off-medication state, FOG-Q at 12-month was decreased with STN-DBS in both PD-ND (-52.9%, p < 0.001) and PD-D (-24.2%, p < 0.001) with a significant difference in the change of FOG in favor of PD-ND (p = 0.001). Similarly, there was an improvement in the axial score for both PD-ND (-66.1%, p < 0.001) and PD-D (-45.3%, p < 0.001) at 12-month with a significant difference between the groups. (p = 0.005). During the on-medication state, both the FOG-Q and axial score at 12-month were not improved with STN-DBS in the PD-ND and PD-D with no difference between the groups.
Our findings suggest that preoperative depression negatively affects the outcome of FOG following STN-DBS in the off-medication state but not in the on-medication state.
评估术前抑郁对帕金森病（PD）患者接受丘脑底核刺激（STN-DBS）后冻结步态（FOG）变化的影响。
纳入 112 例接受双侧 STN-DBS 的 PD 患者，其中 33 例患者术前无抑郁（PD-ND），79 例患者术前有抑郁（PD-D）。每个 PD-ND 患者通过倾向评分与 1 例 PD-D 患者相匹配，匹配变量为性别、PD 发病年龄、病程、停服药物状态下 UPDRS-III 评分、左旋多巴等效日剂量和简易精神状态检查。我们比较了两组患者在 12 个月随访期间的 FOG 问卷（FOG-Q）和 UPDRS-III 轴评分。
在停服药物状态下，STN-DBS 可降低 PD-ND（-52.9%，p<0.001）和 PD-D（-24.2%，p<0.001）患者的 FOG-Q，且 PD-ND 组的 FOG 改善程度明显优于 PD-D 组（p=0.001）。同样，在停服药物状态下，PD-ND（-66.1%，p<0.001）和 PD-D（-45.3%，p<0.001）患者的 UPDRS-III 轴评分在 12 个月时均有所改善，且两组之间存在显著差异（p=0.005）。在服用药物状态下，PD-ND 和 PD-D 患者的 FOG-Q 和 UPDRS-III 轴评分在 12 个月时均未改善，两组之间无差异。
我们的研究结果表明，术前抑郁会影响 STN-DBS 治疗后患者在停服药物状态下的 FOG 结局，但不会影响在服用药物状态下的 FOG 结局。
