Bellini Gabriele, Best Laura A, Brechany Una, Mills Russell, Pavese Nicola
Clinical Ageing Research Centre Newcastle University Newcastle Upon Tyne United Kingdom.
Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne United Kingdom.
Mov Disord Clin Pract. 2020 Apr 7;7(4):373-382. doi: 10.1002/mdc3.12938. eCollection 2020 May.
The role of deep brain stimulation (DBS) in the management of motor symptoms in patients with Parkinson's disease is well defined. However, it is becoming increasingly clear that DBS can either improve or worsen a number of non-motor phenomena.
We examined the published literature to better understand the effects on autonomic symptoms following DBS of the subthalamic nucleus and the globus pallidus interna.
We conducted a PubMed search of studies regarding the effects of DBS on the autonomic system published from January 2001. We searched for the following terms and their combinations: Parkinson's disease, deep brain stimulation, subthalamic nucleus, globus pallidus interna, autonomic dysfunction.
Most studies reported in the literature focus on DBS targeting the subthalamic nucleus, with particular emphasis on favorable outcomes regarding gastrointestinal function and bladder control. However, the emergence or worsening of autonomic symptoms in subgroups of patients has also been documented. More controversial is the effect of stimulation on the cardiovascular, pulmonary, and thermo-regulatory systems as well as sexual functioning. Data regarding the influence of DBS on the autonomic system when the target is the globus pallidus interna is less forthcoming, with target selection varying according to centre and clinical indication.
DBS appears to affect the autonomic nervous system, with varying degrees of influence, which may or may not be clinically beneficial for the patient. A better understanding of these effects could help personalize stimulation for individual patients with autonomic disorders and/or avoid autonomic symptoms in susceptible patients.
深部脑刺激（DBS）在帕金森病患者运动症状管理中的作用已得到明确界定。然而，越来越明显的是，DBS可能改善或恶化多种非运动现象。
我们查阅已发表的文献，以更好地了解丘脑底核和内侧苍白球DBS后对自主神经症状的影响。
我们在PubMed上检索了2001年1月以来发表的关于DBS对自主神经系统影响的研究。我们搜索了以下术语及其组合：帕金森病、深部脑刺激、丘脑底核、内侧苍白球、自主神经功能障碍。
文献中报道的大多数研究聚焦于以丘脑底核为靶点的DBS，特别强调在胃肠功能和膀胱控制方面的良好效果。然而，也有文献记录了部分患者亚组中自主神经症状的出现或恶化。关于刺激对心血管、肺和体温调节系统以及性功能的影响则更具争议性。当靶点为内侧苍白球时，关于DBS对自主神经系统影响的数据较少，靶点选择因中心和临床指征而异。
DBS似乎会影响自主神经系统，影响程度各不相同，这对患者可能有临床益处，也可能没有。更好地了解这些影响有助于为患有自主神经障碍的个体患者个性化调整刺激参数，和/或避免易感患者出现自主神经症状。
