Departments of1Neurosurgery and.
2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana.
J Neurosurg. 2018 Sep 28;131(3):807-812. doi: 10.3171/2018.4.JNS171909. Print 2019 Sep 1.
Deep brain stimulation (DBS) is the procedure of choice for Parkinson's disease (PD). It has been used in PD patients younger than 70 years because of better perceived intra- and postoperative outcomes than in patients 70 years or older. However, previous studies with limited follow-up have demonstrated benefits associated with the treatment of elderly patients. This study aims to evaluate the long-term outcomes in elderly PD patients treated with DBS in comparison with a younger population.
PD patients treated with DBS at the authors' institution from 2008 to 2014 were divided into 2 groups: 1) elderly patients, defined as having an age at surgery ≥ 70 years, and 2) young patients, defined as those < 70 years at surgery. Functional and medical treatment outcomes were evaluated using the Unified Parkinson's Disease Rating Scale part III (UPDRS III), levodopa-equivalent daily dose (LEDD), number of daily doses, and number of anti-PD medications. Study outcomes were compared using univariate analyses, 1-sample paired t-tests, and 2-sample t-tests.
A total of 151 patients were studied, of whom 24.5% were ≥ 70 years. The most common preoperative Hoehn and Yahr stages for both groups were 2 and 3. On average, elderly patients had more comorbidities at the time of surgery than their younger counterparts (1 vs 0, p = 0.0001) as well as a higher average LEDD (891 mg vs 665 mg, p = 0.008). Both groups experienced significant decreases in LEDD following surgery (elderly 331.38 mg, p = 0.0001; and young 108.6 mg, p = 0.0439), with a more significant decrease seen in elderly patients (young 108.6 mg vs elderly 331.38 mg, p = 0.0153). Elderly patients also experienced more significant reductions in daily doses (young 0.65 vs elderly 3.567, p = 0.0344). Both groups experienced significant improvements in motor function determined by reductions in UPDRS III scores (elderly 16.29 vs young 12.85, p < 0.0001); however, reductions in motor score between groups were not significant. Improvement in motor function was present for a mean follow-up of 3.383 years postsurgery for the young group and 3.51 years for the elderly group. The average follow-up was 40.6 months in the young group and 42.2 months in the elderly group.
This study found long-term improvements in motor function and medication requirements in both elderly and young PD patients treated with DBS. These outcomes suggest that DBS can be successfully used in PD patients ≥ 70 years. Further studies will expand on these findings.
深部脑刺激（DBS）是治疗帕金森病（PD）的首选方法。由于术后的内在和外在结果优于 70 岁或以上的患者，因此它已用于 70 岁以下的 PD 患者。然而，以前的研究随访时间有限，表明老年患者的治疗也有获益。本研究旨在评估在接受 DBS 治疗的老年 PD 患者的长期结果，并与年轻人群进行比较。
作者所在机构于 2008 年至 2014 年间接受 DBS 治疗的 PD 患者分为两组：1）老年患者，定义为手术时年龄≥70 岁；2）年轻患者，定义为手术时年龄<70 岁。使用统一帕金森病评定量表第三部分（UPDRS III）、左旋多巴等效日剂量（LEDD）、每日剂量数和抗 PD 药物数评估功能和药物治疗结果。使用单变量分析、1 样本配对 t 检验和 2 样本 t 检验比较研究结果。
共研究了 151 名患者，其中 24.5%的患者≥70 岁。两组最常见的术前 Hoehn 和 Yahr 分期均为 2 期和 3 期。平均而言，老年患者在手术时比年轻患者有更多的合并症（1 对 0，p=0.0001），且平均 LEDD 更高（891mg 对 665mg，p=0.008）。两组患者术后 LEDD 均显著降低（老年患者 331.38mg，p=0.0001；年轻患者 108.6mg，p=0.0439），老年患者降幅更明显（年轻患者 108.6mg 对老年患者 331.38mg，p=0.0153）。老年患者的每日剂量也显著减少（年轻患者 0.65 对老年患者 3.567，p=0.0344）。两组患者的 UPDRS III 评分均显著降低，运动功能均显著改善（老年患者 16.29 对年轻患者 12.85，p<0.0001）；然而，两组间运动评分的降低无统计学意义。年轻组的平均随访时间为术后 3.383 年，老年组为 3.51 年。年轻组的平均随访时间为 40.6 个月，老年组为 42.2 个月。
本研究发现，接受 DBS 治疗的老年和年轻 PD 患者的运动功能和药物需求均有长期改善。这些结果表明，DBS 可成功用于 70 岁或以上的 PD 患者。进一步的研究将扩大这些发现。
