Kim Minkyeong, Cho Kyung Rae, Park Ji-Hyung, Ahn Jong Hyeon, Cho Jin Whan, Park Suyeon, Lee Jung-Il, Youn Jinyoung
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
Clin Neurol Neurosurg. 2018 Oct;173:182-186. doi: 10.1016/j.clineuro.2018.08.025. Epub 2018 Aug 14.
We aimed to provide evidence that subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective and safe treatment option for older patients with Parkinson's disease (PD).
Bilateral STN DBS was performed in 55 patients with PD from 2012 to 2016 at Samsung Medical Center. We divided them into two groups based on the age at DBS: younger group (<65 years, n = 38) and older group (≥65 years, n = 17). For evaluating effectiveness, we compared pre- and post-DBS Unified Parkinson's Disease Rating Scale (UPDRS) part 3 and 4 scores and levodopa equivalent daily dose (LEDD) between the two groups. Additionally, surgery-related complications in each group were assessed.
The mean age of the younger group was 56.7 ± 5.7 and that of the older group was 68.5 ± 2.9. More female patients underwent STN DBS in the younger group, but there were no differences in baseline characteristics. In terms of effectiveness, UPDRS part 3 and 4 scores and LEDD significantly improved 6 months after DBS in both groups. In terms of safety, 1 complication was observed in the younger group (2.6%), while 2 complications, including 1 subject with intracerebral hemorrhage, were observed in the older group (11.8%, p = 0.225).
Based on our results, STN DBS can be applied in well-selected older patients with PD as well as in younger patients. However, despite the lack of statistical significance, more attention should be paid on surgical complications in the older group.
我们旨在提供证据，证明丘脑底核（STN）深部脑刺激（DBS）是老年帕金森病（PD）患者一种有效且安全的治疗选择。
2012年至2016年期间，三星医疗中心对55例PD患者进行了双侧STN DBS治疗。我们根据DBS时的年龄将他们分为两组：较年轻组（<65岁，n = 38）和较年长组（≥65岁，n = 17）。为评估疗效，我们比较了两组DBS前后的帕金森病统一评分量表（UPDRS）第3和第4部分评分以及左旋多巴等效日剂量（LEDD）。此外，还评估了每组与手术相关的并发症。
较年轻组的平均年龄为56.7±5.7岁，较年长组为68.5±2.9岁。较年轻组接受STN DBS的女性患者更多，但两组的基线特征无差异。在疗效方面，两组在DBS后6个月时UPDRS第3和第4部分评分以及LEDD均显著改善。在安全性方面，较年轻组观察到1例并发症（2.6%），而较年长组观察到2例并发症，包括1例脑出血患者（11.8%，p = 0.225）。
根据我们的结果，STN DBS可应用于精心挑选的老年PD患者以及年轻患者。然而，尽管缺乏统计学意义，但较年长组的手术并发症应得到更多关注。
