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双侧丘脑底核深部脑刺激对帕金森病非运动和运动症状的初始影响:一项开放性前瞻性单机构研究。

Bilateral subthalamic deep brain stimulation initial impact on nonmotor and motor symptoms in Parkinson's disease: An open prospective single institution study.

作者信息

Kurcova Sandra, Bardon Jan, Vastik Miroslav, Vecerkova Marketa, Frolova Monika, Hvizdosova Lenka, Nevrly Martin, Mensikova Katerina, Otruba Pavel, Krahulik David, Kurca Egon, Sivak Stefan, Zapletalova Jana, Kanovsky Petr

机构信息

Department of Neurology Department of Neurosurgery, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Slovak Republic Department of Biostatistics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.

出版信息

Medicine (Baltimore). 2018 Feb;97(5):e9750. doi: 10.1097/MD.0000000000009750.

Abstract

Numerous studies document significant improvement in motor symptoms in patients with Parkinson's disease (PD) after deep brain stimulation of the subthalamic nucleus (STN-DBS). However, little is known about the initial effects of STN-DBS on nonmotor domains.Our objective was to elucidate the initial effects of STN-DBS on non-motor and motor symptoms in PD patients in a 4-month follow-up.This open prospective study followed 24 patients with PD who underwent STN-DBS. The patients were examined using dedicated rating scales preoperatively and at 1 and 4 months following STN-DBS to determine initial changes in motor and nonmotor symptoms. Patients at month 1 after STN-DBS had significantly reduced the Parkinson's disease Questionnaire scores (P = .018) and Scales for Outcomes in Parkinson's disease - Autonomic scores (P = .002); these scores had increased at Month 4 after DBS-STN. Nonmotor Symptoms Scale for Parkinson's Disease had improved significantly at Month 1 (P < .001); at Month 4, it remained significantly lower than before stimulation (P = .036). There was no significant difference in The Parkinson's Disease Sleep Scaleat Month 1 and significant improvement at Month 4 (P = .026). There were no significant changes in The Female Sexual Function Index or International Index of Erectile Function. Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III scores show significant improvements at Month 1 (P < .001) and at Month 4 (P < .001).STN-DBS in patients with advanced PD clearly improves not only motor symptoms, but also several domains of nonmotor functions, namely sleep, autonomic functions and quality of life quickly following the start of stimulation.

摘要

大量研究表明,帕金森病(PD)患者在接受丘脑底核深部脑刺激(STN-DBS)后运动症状有显著改善。然而,关于STN-DBS对非运动领域的初始影响知之甚少。我们的目标是在4个月的随访中阐明STN-DBS对PD患者非运动和运动症状的初始影响。这项开放性前瞻性研究跟踪了24例接受STN-DBS的PD患者。术前以及STN-DBS后1个月和4个月使用专门的评定量表对患者进行检查,以确定运动和非运动症状的初始变化。STN-DBS后1个月的患者帕金森病问卷评分(P = 0.018)和帕金森病自主神经功能结局量表评分(P = 0.002)显著降低;STN-DBS后4个月这些评分有所增加。帕金森病非运动症状量表在1个月时显著改善(P < 0.001);在4个月时,仍显著低于刺激前水平(P = 0.036)。帕金森病睡眠量表在1个月时无显著差异,在4个月时有显著改善(P = 0.026)。女性性功能指数或国际勃起功能指数无显著变化。运动障碍协会统一帕金森病评定量表第三部分评分在1个月时(P < 0.001)和4个月时(P < 0.001)均显示出显著改善。晚期PD患者的STN-DBS不仅能明显改善运动症状,还能在刺激开始后迅速改善非运动功能的多个领域,即睡眠、自主神经功能和生活质量。

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