Szlufik Stanislaw, Kloda Maria, Friedman Andrzej, Potrzebowska Iwona, Gregier Kacper, Mandat Tomasz, Przybyszewski Andrzej, Dutkiewicz Justyna, Figura Monika, Habela Piotr, Koziorowski Dariusz
Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.
Department of Rehabilitation, II Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
Front Neurol. 2018 Oct 31;9:906. doi: 10.3389/fneur.2018.00906. eCollection 2018.
Subthalamic nucleus deep brain stimulation (STN-DBS) has been an established method in improvement of motor disabilities in Parkinson's disease (PD) patients. It has been also claimed to have an impact on balance and gait disorders in PD patients, but the previous results are conflicting. The aim of this prospective controlled study was to evaluate the impact of STN-DBS on balance disorders in PD patients in comparison with Best-Medical-Therapy (BMT) and Long-term-Post-Operative (POP) group. DBS-group consisted of 20 PD patients (8F, 12M) who underwent bilateral STN DBS. POP-group consisted of 14 post-DBS patients (6F, 8M) in median 30 months-time after surgery. Control group (BMT-group) consisted of 20 patients (11F, 9M) who did not undergo surgical intervention. UPDRS III scale and balance tests (Up And Go Test, Dual Task- Timed Up And Go Test, Tandem Walk Test) and posturography parameters were measured during 3 visits in 9 ± 2months periods (V1, V2, V3) 4 phases of treatment (BMT-ON/OFF, DBS-ON/OFF). We have observed the slowdown of gait and postural instability progression in first 9 post-operative months followed by co-existent enhancement of balance disorders in next 9-months evaluation ( < 0.05) in balance tests (Up and Go, TWT) and in posturography examination parameters ( < 0.05). The effect was not observed neither in BMT-group nor POP-group ( > 0.05): these groups revealed constant progression of static and dynamic instability ( > 0.05). STN-DBS can have modulatory effect on static and dynamic instability in PD patients: it can temporarily improve balance disorders. mainly during first 9 post-operative months, but with possible following deterioration of the symptoms in next post-operative months.
丘脑底核深部脑刺激术（STN-DBS）已成为改善帕金森病（PD）患者运动障碍的既定方法。也有人声称该方法对PD患者的平衡和步态障碍有影响，但先前的结果相互矛盾。这项前瞻性对照研究的目的是评估与最佳药物治疗（BMT）组和长期术后（POP）组相比，STN-DBS对PD患者平衡障碍的影响。DBS组由20例接受双侧STN-DBS的PD患者（8例女性，12例男性）组成。POP组由14例术后患者（6例女性，8例男性）组成，术后中位时间为30个月。对照组（BMT组）由20例未接受手术干预的患者（11例女性，9例男性）组成。在9±2个月的时间内进行3次随访（V1、V2、V3），测量4个治疗阶段（BMT-开/关、DBS-开/关）的UPDRS III量表、平衡测试（起立行走测试、双任务定时起立行走测试、串联行走测试）和姿势描记参数。我们观察到，在术后的前9个月，步态减慢和姿势不稳进展减缓，而在接下来9个月的评估中，平衡测试（起立行走测试、串联行走测试）和姿势描记检查参数中的平衡障碍同时加重（P<0.05）。在BMT组和POP组中均未观察到这种效应（P>0.05）：这些组显示静态和动态不稳持续进展（P>0.05）。STN-DBS对PD患者的静态和动态不稳可能具有调节作用：它可以暂时改善平衡障碍，主要是在术后的前9个月，但在接下来的术后月份中症状可能会恶化。
