Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus.
J Neurol Neurosurg Psychiatry. 2019 Dec;90(12):1310-1316. doi: 10.1136/jnnp-2019-320858. Epub 2019 Aug 17.
Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson's disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PD-RBD+) and without (PD-RBD-).
We analysed data from PD patients who were treated with bilateral DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only pre-DBS), and motor and non-motor assessments pre-DBS and post-DBS.
Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson's Disease Rating Scale (UPDRS)-III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (-45%) but remained unchanged in the PD-RBD- group (-14%). The depression score improved significantly in the PD-RBD+ (-34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%).
While pre-DBS, PD patients with and without RBD showed different clinical profiles, post-DBS, the clinical profiles were comparable between the two groups. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of RBD assessment prior to DBS surgery.
尽管帕金森病（PD）中的快速眼动睡眠行为障碍（RBD）与非运动症状增加有关，但它对深部脑刺激（DBS）结果的影响尚不清楚。这是第一项比较伴 RBD（PD-RBD+）和不伴 RBD（PD-RBD-）的 PD 患者 DBS 后结果的研究。
我们分析了在丘脑底核接受双侧 DBS 治疗的 PD 患者的数据。评估包括夜间多导睡眠图（仅在 DBS 前）以及 DBS 前和 DBS 后的运动和非运动评估。
在 50 名 PD 患者（29 名男性，平均年龄 62.5 岁，平均 PD 病程 11.8 年）中，有 24 名（48%）患有 RBD。在 DBS 前，两组在社会人口统计学特征、疾病持续时间和 PD 药物方面相当。多变量分析显示，与运动、非运动和生活质量特征相关的临床特征在伴和不伴 RBD 的 PD 患者之间有显著差异。最具鉴别性的因素是统一帕金森病评定量表（UPDRS）-III、淡漠和抑郁评分。在两组中，DBS 后 UPDRS-III、Epworth 嗜睡量表和 PD 问卷均显著改善。PD-RBD+组的 UPDRS-II 评分显著改善（-45%），而 PD-RBD-组无变化（-14%）。PD-RBD+组的抑郁评分显著改善（-34%），而 PD-RBD-组无变化。PD-RBD+组的淡漠评分无变化，但 PD-RBD-组显著增加（+33%）。
虽然在 DBS 前，伴和不伴 RBD 的 PD 患者表现出不同的临床特征，但在 DBS 后，两组之间的临床特征是可比的。在抑郁症状、淡漠和日常生活活动方面，PD-RBD+患者的 DBS 后结果较好。这些发现强调了在 DBS 手术前评估 RBD 的重要性。
