Thomsen Birgitte L C, Jensen Steen R, Clausen Anders, Karlsborg Merete, Jespersen Bo, Løkkegaard Annemette
Department of Neurology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark.
Faculty of Health and Medical Science University of Copenhagen Copenhagen Denmark.
Mov Disord Clin Pract. 2020 Sep 21;7(7):788-796. doi: 10.1002/mdc3.13040. eCollection 2020 Oct.
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is well established and the most effective treatment for advanced Parkinson's disease (PD). However, little is known of the long-term effects.
The aim of this study was to examine the long-term effects of STN-DBS in PD and evaluate the effect of reprogramming after more than 8 years of treatment.
A total of 82 patients underwent surgery in Copenhagen between 2001 and 2008. Before surgery and at 8 to 15 years follow-up, the patients were rated with the Unified Parkinson's Disease Rating Scale (UPDRS) with and without stimulation and medicine. Furthermore, at long-term follow-up, the patients were offered a systemic reprogramming of the stimulation settings. Data from patients' medical records were collected. The mean (range) age at surgery was 60 (42-78) years, and the duration of disease was 13 (5-25) years. A total of 30 patients completed the long-term follow-up.
The mean reduction of the motor UPDRS by medication before surgery was 52%. The improvement of motor UPDRS with stimulation alone compared with motor UPDRS with neither stimulation nor medication was 61% at 1 year and 39% at 8 to 15 years after surgery (before reprogramming). Compared with before surgery, medication was reduced by 55% after 1 year and 44% after 8 to 15 years. After reprogramming, most patients improved.
STN-DBS remains effective in the long run, with a sustained reduction of medication in the 30 of 82 patients available for long-term follow-up. Reprogramming is effective even in the late stages of PD and after many years of treatment.
丘脑底核深部脑刺激术（STN-DBS）已得到充分确立，是晚期帕金森病（PD）最有效的治疗方法。然而，其长期影响尚不清楚。
本研究旨在探讨STN-DBS对帕金森病的长期影响，并评估治疗8年以上后重新编程的效果。
2001年至2008年期间，共有82例患者在哥本哈根接受了手术。在手术前以及随访8至15年时，采用统一帕金森病评定量表（UPDRS）对患者进行评分，评分分为刺激开启、刺激关闭且未服药以及刺激关闭且服药三种情况。此外，在长期随访时，为患者提供刺激参数的系统性重新编程。收集患者病历数据。手术时的平均（范围）年龄为60（42-78）岁，病程为13（5-25）年。共有30例患者完成了长期随访。
术前药物治疗使运动UPDRS平均降低52%。术后1年时，仅刺激状态下的运动UPDRS较无刺激且未服药状态下的运动UPDRS改善了61%，术后8至15年（重新编程前）改善了39%。与术前相比，术后1年药物用量减少了55%，术后8至15年减少了44%。重新编程后，大多数患者病情改善。
从长远来看，STN-DBS仍然有效，在82例可进行长期随访的患者中有30例药物用量持续减少。即使在帕金森病晚期且经过多年治疗后，重新编程仍然有效。
