1Creighton University School of Medicine.
2Department of Anesthesiology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center; and.
J Neurosurg. 2020 May 22;134(5):1624-1630. doi: 10.3171/2020.2.JNS192354. Print 2021 May 1.
Deep brain stimulation (DBS) is a well-established therapy for treating neurological movement disorders. Some patients who have received DBS therapy have noticed significant weight gain. Further investigation into correlations between patient characteristics and weight gain following DBS device implantation, which the authors here have done, will provide physicians with useful clinical information.
The authors performed a retrospective study of patients with Parkinson's disease (PD) and essential tremor (ET) who had received DBS therapy in the period from 2012 to 2017. Patient weights had been recorded preoperatively and at 3, 6, and 12 months postoperatively. These data were used to compare patient characteristics, including diagnosis, body mass index (BMI), sex, levodopa equivalent dose (LED), and change in Unified Parkinson's Disease Rating Scale (UPDRS) score. For PD patients, a quantile multivariate regression analysis was used to examine whether significant correlations existed between several of these patient characteristics, as well as age and weight gain following implantation.
PD patients had gained a significant amount of weight at 3 months (mean [SE] 2.66 [0.428] kg, p < 0.001), 6 months (3.64 [0.492] kg, p < 0.001), and 12 months (4.18 [0.540] kg, p < 0.001) after DBS placement. Patients who had undergone subthalamic nucleus (STN) DBS device placement gained, on average, more weight than the patients with globus pallidus internus (GPi) placement at both 6 months (mean 2.558 [1.020] kg, p = 0.01) and 12 months (2.358 [1.130] kg, p = 0.04). BMI in the STN cohort was greater than that in the GPi cohort at 6 months (mean difference [SE] 2.60 [1.127] kg/m2, p = 0.02) and at 12 months (2.36 [1.112] kg/m2, p = 0.04). A reduction in LED was negatively correlated with weight change at 6 months (r = -0.33, p < 0.001) and 12 months (r = -0.41, p < 0.001). There was no weight gain correlated with DBS therapy for ET.
PD patients experienced a significant change in weight over time after DBS therapy, whereas ET patients did not. PD patients with an STN target site experienced greater weight gain, on average, than those with a GPi target site. Furthermore, there was a significant increase in BMI at 6 and 12 months in patients with an STN target compared to that in patients with a GPi target. PD patients whose LED was reduced after DBS gained more weight at 6 and 12 months after surgery than the patients whose LED was kept at the same level or increased.
深部脑刺激（DBS）是治疗神经运动障碍的一种成熟疗法。一些接受 DBS 治疗的患者注意到明显的体重增加。进一步研究患者特征与 DBS 设备植入后的体重增加之间的相关性，作者在这里进行了研究，将为医生提供有用的临床信息。
作者对 2012 年至 2017 年间接受 DBS 治疗的帕金森病（PD）和特发性震颤（ET）患者进行了回顾性研究。患者术前和术后 3、6 和 12 个月记录体重。这些数据用于比较患者特征，包括诊断、体重指数（BMI）、性别、左旋多巴等效剂量（LED）和统一帕金森病评定量表（UPDRS）评分的变化。对于 PD 患者，使用分位数多元回归分析来检查这些患者特征中的几个，以及年龄和植入后体重增加之间是否存在显著相关性。
PD 患者在 DBS 植入后 3 个月（平均[SE]2.66[0.428]kg，p<0.001）、6 个月（3.64[0.492]kg，p<0.001）和 12 个月（4.18[0.540]kg，p<0.001）体重显著增加。与接受苍白球内侧核（GPi）DBS 设备植入的患者相比，接受丘脑底核（STN）DBS 设备植入的患者在 6 个月（平均 2.558[1.020]kg，p=0.01）和 12 个月（2.358[1.130]kg，p=0.04）时体重增加更多。在 6 个月（平均差异[SE]2.60[1.127]kg/m2，p=0.02）和 12 个月（2.36[1.112]kg/m2，p=0.04）时，STN 队列的 BMI 大于 GPi 队列。LED 减少与 6 个月（r=-0.33，p<0.001）和 12 个月（r=-0.41，p<0.001）体重变化呈负相关。DBS 治疗 ET 与体重增加无关。
PD 患者在 DBS 治疗后随时间推移体重发生显著变化，而 ET 患者则没有。与接受 GPi 靶点治疗的患者相比，接受 STN 靶点治疗的 PD 患者平均体重增加更多。此外，与接受 GPi 靶点治疗的患者相比，接受 STN 靶点治疗的患者在 6 个月和 12 个月时 BMI 显著增加。与 LED 保持不变或增加的患者相比，DBS 治疗后 LED 降低的 PD 患者在术后 6 个月和 12 个月时体重增加更多。
