Mahlknecht Philipp, Peball Marina, Mair Katherina, Werkmann Mario, Nocker Michael, Wolf Elisabeth, Eisner Wilhelm, Bajaj Sweta, Quirbach Sebastian, Peralta Cecilia, Eschlböck Sabine, Wenning Gregor K, Willeit Peter, Seppi Klaus, Poewe Werner
Department of Neurology Innsbruck Medical University Innsbruck Austria.
Department of Neurosurgery Innsbruck Medical University Innsbruck Austria.
Mov Disord Clin Pract. 2020 Sep 21;7(7):782-787. doi: 10.1002/mdc3.13039. eCollection 2020 Oct.
The long-term impact of deep brain stimulation (DBS) on Parkinson's disease (PD) is difficult to assess and has not yet been rigorously evaluated in comparison to its natural history.
Comparison of key disability milestones (recurrent falls, psychosis, dementia, and institutionalization) and death in patients with PD with versus without DBS.
We collected retrospective information from clinical notes of patients with PD at our center that were implanted with subthalamic DBS >8 years ago (1999-2010) and a control group of PD patients without DBS similar in age at onset, age at baseline, sex distribution, and number of comorbidities at baseline (extracted from a registry study performed in 2004). Cox regression models were used to calculate hazard ratios, adjusted for potential baseline confounding variables (age, sex, disease duration, disease severity, and number of comorbidities).
A total of 74 DBS-treated and 61 control patients with PD were included. For a median observational period of 14 years, patients treated with DBS were at lower risk of experiencing recurrent falls (hazard ratio = 0.57; 95% confidence interval, 0.37-0.90; = 0.015) and psychosis (hazard ratio = 0.26; 95% confidence interval, 0.12-0.59; = 0.001) compared with control patients. There was no significant difference in risk for dementia, institutionalization, or death. Disease progression as assessed by Hoehn and Yahr scores was not slower in DBS-treated patients.
Treatment with chronic subthalamic DBS was associated with lower risk for recurrent falls and psychotic symptoms, effects that may be mediated through improved motor symptom control and reduction in dopaminergic therapies, respectively. There was no evidence for DBS effects on underlying disease progression.
深部脑刺激（DBS）对帕金森病（PD）的长期影响难以评估，与自然病程相比尚未得到严格评估。
比较接受与未接受DBS治疗的PD患者的关键残疾里程碑事件（反复跌倒、精神病、痴呆和入住机构）及死亡情况。
我们从本中心超过8年之前（1999 - 2010年）接受丘脑底核DBS植入的PD患者的临床记录中收集回顾性信息，并从2004年进行的一项登记研究中提取一组年龄、基线年龄、性别分布和基线合并症数量相似的未接受DBS治疗的PD患者作为对照组。采用Cox回归模型计算风险比，并对潜在的基线混杂变量（年龄、性别、病程、疾病严重程度和合并症数量）进行校正。
共纳入74例接受DBS治疗的PD患者和61例对照患者。在14年的中位观察期内，与对照患者相比，接受DBS治疗的患者反复跌倒（风险比 = 0.57；95%置信区间，0.37 - 0.90；P = 0.015）和精神病（风险比 = 0.26；95%置信区间，0.12 - 0.59；P = 0.001）的风险较低。痴呆、入住机构或死亡风险无显著差异。通过Hoehn和Yahr评分评估的疾病进展在接受DBS治疗的患者中并不更慢。
长期丘脑底核DBS治疗与反复跌倒和精神症状风险较低相关，这些影响可能分别通过改善运动症状控制和减少多巴胺能治疗介导。没有证据表明DBS对基础疾病进展有影响。
