Rajan Roopa, Krishnan Syam, Kesavapisharady Krishna Kumar, Kishore Asha
Comprehensive Care Center for Movement Disorders Sree Chitra Tirunal Institute for Medical Sciences and Technology Kerala India.
Mov Disord Clin Pract. 2016 Mar 31;3(3):288-291. doi: 10.1002/mdc3.12271. eCollection 2016 May-Jun.
Abrupt cessation of STN-DBS is an under-recognized cause of life-threatening akinetic crisis in Parkinson's disease (PD) and can present as a movement disorder emergency. We report on 2 patients who survived severe and prolonged akinetic crisis after abrupt cessation of STN stimulation for PD (malignant STN-DBS withdrawal syndrome). We discuss the clinical similarities and possible differences in pathophysiology from the akinetic crisis in medically-treated PD. Although early implantable pulse generator (IPG) replacement is the definitive treatment, medical and economic considerations may preclude early surgery and strategies for medical management assume importance. We reflect upon the socioeconomic concerns surrounding DBS in countries lacking health care coverage and the need for user-independent monitors and indicators of low IPG battery status.
丘脑底核深部脑刺激(STN-DBS)突然停止是帕金森病(PD)中一种未被充分认识的危及生命的运动不能危象的原因,可表现为运动障碍急症。我们报告了2例帕金森病患者在丘脑底核刺激突然停止后经历了严重且持久的运动不能危象并存活(恶性STN-DBS撤停综合征)。我们讨论了与药物治疗的帕金森病运动不能危象在临床方面的相似性以及病理生理学上可能存在的差异。尽管早期更换植入式脉冲发生器(IPG)是确定性治疗方法,但医疗和经济因素可能会妨碍早期手术,因此药物管理策略显得尤为重要。我们思考了在缺乏医疗保健覆盖的国家中与DBS相关的社会经济问题,以及对独立于用户的IPG低电量状态监测器和指标的需求。