Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
Oper Neurosurg (Hagerstown). 2020 Sep 1;19(3):234-240. doi: 10.1093/ons/opaa049.
Subthalamic nucleus deep brain stimulation (STN DBS) is an effective adjunctive therapy for Parkinson disease. Studies have shown improvement of motor function but often exclude patients older than 75 yr.
To determine the safety and effectiveness of STN DBS in patients 75 yr and older.
A total of 104 patients (52 patients >75 yr old, 52 patients <75 yr old) with STN DBS were paired and retrospectively analyzed. The primary outcome was change in Unified Parkinson Disease Rating Scale (UPDRS) subscale III at 1 yr postoperatively, OFF medication. Secondary outcomes were changes in UPDRS I, II, and IV subscales and levodopa equivalents. Complications and all-cause mortality were assessed at 30 d and 1 yr.
Both cohorts had significant improvements in UPDRS III at 6 mo and 1 yr with no difference between cohorts. Change in UPDRS III was noninferior to the younger cohort. The cohorts had similar worsening in UPDRS I at 1 yr, no change in UPDRS II, similar improvement in UPDRS IV, and similar levodopa equivalent reduction. There were similar numbers of postoperative intracerebral hemorrhages (2/52 in each cohort, more severe in the older cohort) and surgical complications (4/52 in each cohort), and mortality in the older cohort was similar to an additional matched cohort not receiving DBS.
STN DBS provides substantial motor benefit and reduction in levodopa equivalents with a low rate of complications in older patients, which is also noninferior to the benefit in younger patients. STN DBS remains an effective therapy for those over 75 yr.
丘脑底核深部脑刺激（STN DBS）是一种有效的帕金森病辅助治疗方法。研究表明，该方法可改善运动功能，但通常排除年龄大于 75 岁的患者。
确定 STN DBS 对 75 岁及以上患者的安全性和有效性。
共对 104 例（52 例年龄大于 75 岁，52 例年龄小于 75 岁）接受 STN DBS 的患者进行配对并回顾性分析。主要结局是术后 1 年停用药物时的统一帕金森病评定量表（UPDRS）第三分量表的变化。次要结局是 UPDRS 第一、第二和第四分量表以及左旋多巴等效剂量的变化。术后 30 天和 1 年评估并发症和全因死亡率。
两组患者在术后 6 个月和 1 年均有 UPDRS III 显著改善，两组之间无差异。UPDRS III 的变化不劣于年轻组。两组患者在 1 年内 UPDRS I 恶化程度相似，UPDRS II 无变化，UPDRS IV 改善程度相似，左旋多巴等效剂量减少程度相似。两组术后颅内出血（各 2/52 例，老年组更严重）和手术并发症（各 4/52 例）数量相似，老年组死亡率与未接受 DBS 的另一匹配队列相似。
STN DBS 可提供显著的运动益处和减少左旋多巴等效剂量，且并发症发生率较低，对老年患者的益处不劣于年轻患者。STN DBS 仍然是 75 岁以上患者的有效治疗方法。
