Department of Neurosurgery, NS-PARK/F-CRIN, Strasbourg University Hospital, Strasbourg, France.
Department of Neurology, NS-PARK/F-CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg, Strasbourg, France.
Mov Disord. 2021 Mar;36(3):750-757. doi: 10.1002/mds.28320. Epub 2020 Oct 6.
Impact of subthalamic deep brain stimulation (DBS) on impulse control disorders (ICD) in Parkinson's disease (PD) remains controversial.
The objectives of this study were to analyze the natural history of ICD between baseline and 1 year after subthalamic DBS in patients with PD and to identify predictive factors, taking into account the positions of the active contact and stimulation parameters.
We analyzed postoperative modifications of ICD based on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson's Disease cohort. ICD status and Ardouin Scale of Behaviour in PD were assessed at baseline and 1 year following subthalamic DBS. Location of active contacts within the 3 subthalamic nucleus functional territories was investigated.
A total of 217 were patients included. Of the patients, 10.6% had ICD at baseline of which 95.6% improved at 1 year following subthalamic DBS; 3.6% of the patients experienced de novo ICD at 1 year following subthalamic DBS. Dopamine agonist dose reduction (from 309.8 to 109.3 mg) was the main driver of ICD regression (P = 0.05). Higher preoperative dyskinesias were associated with poorer ICD evolution (P = 0.04). Whereas baseline apathy was a risk factor of de novo ICD (P = 0.02), ICD improvement correlated with postoperative apathy (P = 0.004). Stimulation power and position of active contacts-mainly located within the sensorimotor part of the subthalamic nucleus-did not influence ICD.
This 1-year, postoperative follow-up study showed ICD regression and dopaminergic drug reduction with optimal position of the active contacts within the subthalamic nucleus. Whereas patients with PD with preoperative ICD were prone to postoperative apathy, we also showed that those with preoperative apathy had a higher risk to experience postoperative de novo ICD, further highlighting the meaningful influence of postoperative management of dopaminergic medication on outcome and the continuum between apathy and ICD. © 2020 International Parkinson and Movement Disorder Society.
丘脑底核深部脑刺激（DBS）对帕金森病（PD）冲动控制障碍（ICD）的影响仍存在争议。
本研究的目的是分析 PD 患者在丘脑底核 DBS 后基线和 1 年之间 ICD 的自然病史，并确定预测因素，同时考虑活性接触的位置和刺激参数。
我们根据多中心、前瞻性预测因素和帕金森病丘脑底核刺激队列分析了术后 ICD 的改变。在丘脑底核 DBS 后基线和 1 年时，评估 ICD 状态和 PD 的 Ardouin 行为量表。研究了活性接触在 3 个丘脑底核功能区的位置。
共纳入 217 例患者。其中 10.6%的患者基线时有 ICD，95.6%在丘脑底核 DBS 后 1 年时得到改善；3.6%的患者在丘脑底核 DBS 后 1 年时出现新发 ICD。多巴胺能激动剂剂量减少（从 309.8 至 109.3mg）是 ICD 消退的主要驱动因素（P=0.05）。术前更高的运动障碍与 ICD 恶化有关（P=0.04）。而基线时的淡漠是新发 ICD 的危险因素（P=0.02），ICD 改善与术后淡漠有关（P=0.004）。刺激强度和活性接触的位置——主要位于丘脑底核的感觉运动部分——并不影响 ICD。
这项为期 1 年的术后随访研究表明，ICD 消退和多巴胺能药物减少与活性接触在丘脑底核内的最佳位置有关。虽然术前有 ICD 的 PD 患者术后易发生淡漠，但我们还发现，术前有淡漠的患者术后发生新发 ICD 的风险更高，这进一步强调了术后多巴胺能药物管理对结果的重要影响，以及淡漠和 ICD 之间的连续性。
