Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.
Parkinson's and Movement Disorder Center, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Neurosurgery. 2020 Apr 1;86(4):524-529. doi: 10.1093/neuros/nyz316.
Several patient and disease characteristics are thought to influence DBS outcomes; however, most previous studies have focused on long-term outcomes with only a few addressing immediate postoperative course.
To evaluate predictors of immediate outcomes (postoperative confusion and length of postoperative hospitalization) following deep brain stimulation surgery (DBS) in Parkinson disease (PD) patients.
We conducted a retrospective study of PD patients who underwent DBS at our institution from 2006 to 2011. We computed the proportion of patients with postoperative confusion and those with postoperative hospitalization longer than 2 d. To look for associations, Fisher's exact tests were used for categorical predictors and logistic regression for continuous predictors.
We identified 130 patients [71% male, mean age: 63 ± 9.1, mean PD duration: 10.7 ± 5.1]. There were 7 cases of postoperative confusion and 19 of prolonged postoperative hospitalization. Of the 48 patients with tremors, none had postoperative confusion, whereas 10.1% of patients without tremors had confusion (P = .0425). Also, 10.2% of patients with preoperative falls/balance-dysfunction had postoperative confusion, whereas only 1.6% of patients without falls/balance-dysfunction had postoperative confusion (P = .0575). For every one-unit increase in score on the preoperative on-UPDRS III/MDS-UPDRS III score, the odds of having postoperative confusion increased by 10% (P = .0420). The following factors were noninfluential: age, disease duration, dyskinesia, gait freezing, preoperative levodopa-equivalent dose, number of intraoperative microelectrode passes, and laterality/side of surgery.
Absence of tremors and higher preoperative UPDRS III predicted postoperative confusion after DBS in PD patients. Clinicians' awareness of these predictors can guide their decision making regarding patient selection and surgical planning.
有几个患者和疾病特征被认为会影响 DBS 的结果；然而，大多数先前的研究都集中在长期结果上，只有少数研究涉及术后即刻过程。
评估帕金森病 (PD) 患者接受深部脑刺激术 (DBS) 后即刻结果（术后意识混乱和术后住院时间）的预测因素。
我们对 2006 年至 2011 年在我院接受 DBS 的 PD 患者进行了回顾性研究。我们计算了术后意识混乱和术后住院时间超过 2 天的患者比例。为了寻找关联，我们使用 Fisher 确切检验对分类预测因素进行分析，使用逻辑回归对连续预测因素进行分析。
我们共纳入了 130 名患者（71%为男性，平均年龄：63 ± 9.1 岁，平均 PD 病程：10.7 ± 5.1 年）。术后有 7 例出现意识混乱，19 例出现术后住院时间延长。在 48 例有震颤的患者中，无一例出现术后意识混乱，而无震颤的患者中有 10.1%出现意识混乱（P =.0425）。此外，术前有跌倒/平衡功能障碍的患者中有 10.2%出现术后意识混乱，而无跌倒/平衡功能障碍的患者中只有 1.6%出现术后意识混乱（P =.0575）。术前 UPDRS Ⅲ/MDS-UPDRS Ⅲ评分每增加 1 分，出现术后意识混乱的几率增加 10%（P =.0420）。以下因素无影响：年龄、病程、运动障碍、步态冻结、术前左旋多巴等效剂量、术中微电极通过次数以及手术的侧别/侧位。
无震颤和较高的术前 UPDRS Ⅲ 预测 PD 患者 DBS 术后意识混乱。临床医生对这些预测因素的认识可以指导他们在患者选择和手术计划方面做出决策。
