降低丘脑底核深部脑刺激频率可逆转帕金森病步态启动时的认知干扰。
Decreasing subthalamic deep brain stimulation frequency reverses cognitive interference during gait initiation in Parkinson's disease.
机构信息
Sorbonne Université, Université Pierre et Marie Curie (UPMC), Université Paris VI, UMR S 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Epinière (ICM), Paris, France; Department of Motor Sciences and Wellness, University of Naples Parthenope, Naples, Italy; Plateforme de physiologie et d'analyse du mouvement (PANAM), Institut du Cerveau et de la Moelle Epinière, ICM, Paris, France.
Sorbonne Université, Université Pierre et Marie Curie (UPMC), Université Paris VI, UMR S 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Epinière (ICM), Paris, France.
出版信息
Clin Neurophysiol. 2018 Nov;129(11):2482-2491. doi: 10.1016/j.clinph.2018.07.013. Epub 2018 Aug 2.
OBJECTIVE
Freezing of gait (FOG) represents a major burden for Parkinson's disease (PD) patients. High-frequency (130-Hz) subthalamic deep-brain-stimulation (STN-DBS) has been reported to aggravate FOG whereas lowering the frequency to 60-80 Hz improves FOG. To further understand the effects of STN-DBS on FOG, we assessed the effects of 80-Hz and 130-Hz STN-DBS on gait initiation performance, in relation to motor and executive function processing.
METHODS
Gait initiation was recorded in 19 PD patients and 20 controls, combined or not with a cognitive interference task with a modified Stroop paradigm. PD patients were recorded before surgery with and without dopaminergic treatment, and after surgery with 80-Hz and 130-Hz STN-DBS in a randomised double-blind crossover study.
RESULTS
In the absence of cognitive interference, PD patients exhibited significant gait initiation improvement with dopaminergic treatment, 80-Hz and 130-Hz STN-DBS. Nine patients performed the cognitive interference task. With 130-Hz STN-DBS, all gait initiation parameters were significantly degraded, whereas the cognitive interference task induced no major changes before surgery and with 80-Hz STN-DBS, as in controls.
CONCLUSIONS
High-frequency STN-DBS leads to an inability to simultaneously process motor and cognitive information while this ability seems preserved with low-frequency STN-DBS.
SIGNIFICANCE
This study supports the potential benefit of 80-Hz STN-DBS on FOG.
目的
冻结步态（FOG）是帕金森病（PD）患者的主要负担。高频（130Hz）丘脑底核深部脑刺激（STN-DBS）已被报道加重 FOG，而将频率降低至 60-80Hz 可改善 FOG。为了进一步了解 STN-DBS 对 FOG 的影响，我们评估了 80Hz 和 130Hz STN-DBS 对步态启动性能的影响，与运动和执行功能处理有关。
方法
在 19 名 PD 患者和 20 名对照者中记录步态启动，结合或不结合使用修改后的 Stroop 范式的认知干扰任务。PD 患者在手术前用和不用多巴胺治疗记录，在手术后用 80Hz 和 130Hz STN-DBS 在随机双盲交叉研究中记录。
结果
在没有认知干扰的情况下，PD 患者在多巴胺治疗、80Hz 和 130Hz STN-DBS 下表现出明显的步态启动改善。9 名患者进行了认知干扰任务。在 130Hz STN-DBS 下，所有步态启动参数均显著恶化，而在手术前和 80Hz STN-DBS 下，认知干扰任务没有引起重大变化，如同对照者一样。
结论
高频 STN-DBS 导致同时处理运动和认知信息的能力丧失，而这种能力似乎在低频 STN-DBS 下得到保留。
意义
这项研究支持 80Hz STN-DBS 对 FOG 的潜在益处。
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