Departments of1Neurology and.
2Department of Neurology, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Chungcheongbuk-do, Korea.
J Neurosurg. 2019 Jan 11;131(6):1797-1804. doi: 10.3171/2018.8.JNS18350. Print 2019 Dec 1.
OBJECTIVE: Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD. METHODS: Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation). RESULTS: During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition. CONCLUSIONS: Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
目的：丘脑底核深部脑刺激（STN DBS）对帕金森病（PD）患者的冻结步态（FOG）有效；然而，其长期效果仍存在争议。本研究旨在探讨 STN DBS 对 PD 患者 FOG 的长期影响。
方法：从前瞻性登记处获得 52 例接受双侧 STN DBS 的 PD 患者的数据。作者对基线时和 1、2 和 5 或 7 年随访时的 5 米步行任务录像进行了 FOG 发生率和严重程度的盲法分析。他们还比较了统一帕金森病评定量表（UPDRS）第三部分、UPDRS 第二部分（UPDRS-II）第 14 项和 FOG 问卷（FOG-Q）的轴评分。术后，在 4 种情况下（停药/停刺激、停药/刺激、服药/停刺激和服药/刺激）评估基于视频的 FOG 分析和轴评分，在 2 种情况下（停药/刺激和服药/刺激）评估 UPDRS-II 第 14 项和 FOG-Q 评分。
结果：在停药状态下，与基线相比，刺激状态在最后一次随访时改善了除基于视频的 FOG 严重程度以外的所有 FOG 结果。与停药状态相比，在停药状态下，基于视频的 FOG 结果和轴评分在最后一次随访时随着刺激状态的改善而改善。在服药状态下，与基线相比，刺激状态并未改善任何 FOG 结果；然而，与停药状态相比，刺激状态在 2 年随访时改善了基于视频的 FOG 结果，在最后一次随访时改善了轴评分。
结论：我们的研究结果表明，STN DBS 在停药状态下对 FOG 有长期影响。然而，STN DBS 在服药状态下对 FOG 没有长期影响，尽管在 2 年随访时仍有短期影响。
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