From the Center for Neurological Restoration (C.S.K.), Neuroethics Program (P.J.F.), Center for Pediatric Behavioral Health (T.F.), and Center for Neurological Restoration (A.M.), Cleveland Clinic, OH; and Department of Neurology (S.E.C., J.V.), University of Minnesota, Minneapolis.
Neurology. 2018 Jul 31;91(5):e472-e478. doi: 10.1212/WNL.0000000000005917. Epub 2018 Jun 29.
To determine using a repeated-measures, prospective design whether deep brain stimulation (DBS) results in changes in the importance of symptom and behavioral goals individually identified by patients with Parkinson disease (PD) before DBS surgery.
Fifty-two participants recruited from a consecutive series completed a semistructured interview soliciting their rank-ordered symptom and behavioral goals and corresponding visual analog scales measuring perceived symptom severity and limits to goal attainment. Rank orders were reassessed at 2 times after DBS. Changes in rank order over time were examined with χ analyses. The relationships between change in symptom severity/limits to behavioral goal attainment and change in rank order were examined with mixed-effects linear regression models.
Most participants changed the rank order of their symptom (81%) and behavioral (77%) goals 3 months after DBS surgery. Change in rank order of symptom goals was significantly related to change in severity ratings such that improvements in self-reported symptom severity were associated with reductions in rank. In contrast, no such relationship was evident for the behavioral goals.
These data illustrate how patients' primary goals for DBS shift early in stimulation and highlight the important differences between symptom and behavioral goals. Changes in the rank order of symptom goals were related to changes in symptom severity, whereas subtler shifts in behavioral goals were unrelated to improvements after DBS. This observation suggests that DBS does not affect goals that may be more reflective of core personal values. The findings provide empiric data that can help improve the informed consent process.
采用重复测量、前瞻性设计，确定是否深部脑刺激（DBS）会改变帕金森病（PD）患者术前单独确定的症状和行为目标的重要性。
从连续系列中招募的 52 名参与者完成了半结构化访谈，征求他们的症状和行为目标的排序，并使用视觉模拟量表测量感知症状严重程度和实现目标的限制。在 DBS 后 2 次重新评估排名。使用 χ 分析检查随时间变化的排名变化。使用混合效应线性回归模型检查症状严重程度/实现行为目标限制变化与排名变化之间的关系。
大多数参与者在 DBS 手术后 3 个月改变了他们的症状（81%）和行为（77%）目标的排名。症状目标的排名变化与严重程度评分的变化显著相关，即自我报告的症状严重程度的改善与排名的降低有关。相比之下，行为目标没有这种关系。
这些数据说明了患者对 DBS 的主要目标如何在早期刺激中发生变化，并强调了症状和行为目标之间的重要差异。症状目标排名的变化与症状严重程度的变化有关，而行为目标的细微变化与 DBS 后的改善无关。这一观察结果表明，DBS 不会影响可能更能反映核心个人价值观的目标。研究结果提供了有助于改善知情同意过程的经验数据。
