DiMarzio Marisa, Pilitsis Julie G, Gee Lucy, Peng Sophia, Prusik Julia, Durphy Jennifer, Ramirez-Zamora Adolfo, Hanspal Era, Molho Eric, McCallum Sarah E
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Neuromodulation. 2018 Aug;21(6):617-622. doi: 10.1111/ner.12778. Epub 2018 Apr 2.
Pain is a prevalent and debilitating nonmotor symptom of Parkinson's disease (PD) that is often inadequately managed. Deep brain stimulation (DBS) has been shown to relieve pain in PD but an effective method of identifying which types of PD pain respond to DBS has not been established. We examine the effects of DBS on different types of PD pain using the King's Parkinson's disease pain scale (KPDPS), the only validated scale of PD pain.
We prospectively followed 18 PD patients undergoing subthalamic nucleus (STN) or Globus pallidus interna (GPi) DBS. Subjects completed the KPDPS, low back disability index (LBDI), and McGill pain questionnaire (MPQ), preoperatively and at six months postoperatively. Subjects underwent the unified Parkinson's disease rating scale-III (UPDRS-III) with preoperative scores ON medication and postoperative scores ON medication/DBS stimulation.
Of the 18 patients, a total of 12 subjects had STN DBS and 6 had GPi DBS. As a group, subjects showed improvement in total KPDPS score at six-month postoperative follow-up (p = 0.004). Fluctuation and nocturnal pain were most significantly improved (p = 0.006, 0.01, respectively). Significant improvements were found in fluctuation-related pain domain following GPi DBS.
In this pilot study, we are the first group to employ KPDPS to monitor pain relief following DBS in PD patients. We demonstrate that fluctuation-related pain and nocturnal pain significantly improve with DBS. Use of the KPDPS in the future will allow better understanding of how STN and GPi DBS treat PD pain over time.
疼痛是帕金森病（PD）常见且使人衰弱的非运动症状，其治疗往往不充分。深部脑刺激（DBS）已被证明可缓解PD患者的疼痛，但尚未建立一种有效的方法来确定哪些类型的PD疼痛对DBS有反应。我们使用金氏帕金森病疼痛量表（KPDPS，唯一经过验证的PD疼痛量表）来研究DBS对不同类型PD疼痛的影响。
我们前瞻性地跟踪了18例接受丘脑底核（STN）或苍白球内侧部（GPi）DBS的PD患者。受试者在术前和术后6个月完成KPDPS、下背部残疾指数（LBDI）和麦吉尔疼痛问卷（MPQ）。受试者接受统一帕金森病评定量表-III（UPDRS-III）评估，术前评分基于服药状态，术后评分基于服药状态/DBS刺激状态。
18例患者中，共有12例接受STN DBS，6例接受GPi DBS。作为一个整体，受试者在术后6个月随访时KPDPS总分有所改善（p = 0.004）。波动痛和夜间痛改善最为显著（分别为p = 0.006、0.01）。在接受GPi DBS后，与波动相关的疼痛领域有显著改善。
在这项初步研究中，我们是第一组使用KPDPS来监测PD患者DBS后疼痛缓解情况的研究团队。我们证明，DBS可显著改善与波动相关的疼痛和夜间痛。未来使用KPDPS将有助于更好地理解STN和GPi DBS如何长期治疗PD疼痛。
