Zhou Haiyan, Wang Linbin, Zhang Chencheng, Qiu Xian, Hu Wei, van der Stelt Odin, Ramirez-Zamora Adolfo, Li Dianyou
Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Neurol. 2019 Jun 26;10:689. doi: 10.3389/fneur.2019.00689. eCollection 2019.
Deep brain stimulation of the Subthalamic nucleus (STN-DBS) is a safe and well-established therapy for the management of refractory motor symptoms in Parkinson's disease (PD). Marked improvement in axial symptoms has been reported in the short term with STN-DBS but questions remain regarding the long-term efficacy of this intervention. We assessed the acute ON and OFF effects of STN-DBS in PD patients who have been treated with STN-DBS for over a decade. We assessed 11 patients with early-onset PD (9 men, 2 women; mean age, 57.1 ± 7.2 y; mean age at illness onset, 38.9 ± 7.5 y) managed with long-term bilateral STN-DBS (mean treatment duration, 13.4 ± 1.3 y). Motor symptoms were assessed by means of the Unified Parkinson's Disease Rating Scale (UPDRS)-III, Timed Up and Go test (TUG), and Hoehn-Yahr scale. Motor assessments in the medication ON and OFF states with stimulation ON and OFF conditions were documented and video recorded. Patients showed a significant improvement in motor symptoms both in the off-medication and on-medication state by a 54% reduction (off-medication/on-stimulation vs. off-medication/off-stimulation) and a 48% reduction (on-medication/on-stimulation vs. on-medication/off-stimulation) in the total UPDRS-III score. Specifically, improvement in axial symptoms (off-medication: 51% reduction; on-medication: 44% reduction), including gait but not posture. Similarly, STN-DBS reduced TUG scores (off-medication: 70% reduction; on-medication: 47% reduction). On stimulation long-term, bilateral STN-DBS can improve appendicular and axial symptoms of patients with early-onset PD in the acute setting.
丘脑底核深部脑刺激术（STN-DBS）是一种用于治疗帕金森病（PD）难治性运动症状的安全且成熟的疗法。有报道称，STN-DBS在短期内可使轴性症状得到显著改善，但这种干预措施的长期疗效仍存在疑问。我们评估了接受STN-DBS治疗超过十年的PD患者中STN-DBS的急性开启和关闭效应。我们评估了11例早发性PD患者（9例男性，2例女性；平均年龄57.1±7.2岁；发病平均年龄38.9±7.5岁），他们接受了长期双侧STN-DBS治疗（平均治疗时长13.4±1.3年）。通过统一帕金森病评定量表（UPDRS）-III、计时起立行走测试（TUG）和霍恩-亚尔分级量表对运动症状进行评估。记录并视频记录了在药物开启和关闭状态下以及刺激开启和关闭条件下的运动评估情况。患者在停药和服药状态下的运动症状均有显著改善，UPDRS-III总分分别降低了54%（停药/刺激开启与停药/刺激关闭相比）和48%（服药/刺激开启与服药/刺激关闭相比）。具体而言，轴性症状有所改善（停药：降低51%；服药：降低44%），包括步态但不包括姿势。同样，STN-DBS降低了TUG评分（停药：降低70%；服药：降低47%）。长期开启刺激时，双侧STN-DBS可在急性期改善早发性PD患者的肢体和轴性症状。
