帕金森病丘脑底核刺激的长期预后预测因素。

Predictors of Long-Term Outcome of Subthalamic Stimulation in Parkinson Disease.

机构信息

Movement Disorders Unit, University Hospital Center, Grenoble Alpes University, Grenoble, France.

Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

出版信息

Ann Neurol. 2021 Mar;89(3):587-597. doi: 10.1002/ana.25994. Epub 2021 Jan 9.

DOI:10.1002/ana.25994

PMID:33349939

Abstract

OBJECTIVE

This study was undertaken to identify preoperative predictive factors of long-term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS).

METHODS

All consecutive PD patients who underwent bilateral STN-DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short-term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long-term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores compared to the baseline off-medication scores. As a secondary objective, potential predictors of short-term motor outcome after STN-DBS were assessed by performing univariate and multivariate linear regression analyses.

RESULTS

In the long-term analyses (mean follow-up = 8.4 ± 6.26 years, median = 10 years, range = 1-17 years), 138 patients were included. Preoperative higher frontal score and off-medication MDS-UPDRS part III scores predicted a better long-term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1-year follow-up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off-medication MDS-UPDRS part III scores predicted the short-term motor outcome.

INTERPRETATION

Frontal lobe dysfunction, disease severity in the off-medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long-term motor STN-DBS effects. ANN NEUROL 2021;89:587-597.

摘要

目的

本研究旨在确定在接受双侧丘脑底核深部脑刺激（STN-DBS）的大量连续帕金森病（PD）患者中，术前预测长期运动结局的因素。

方法

从 1993 年至 2015 年，在格勒诺布尔大学医院（法国）接受双侧 STN-DBS 的所有连续 PD 患者均在术前、术后 1 年（短期）和长期进行评估。收集了所有可用的人口统计学变量、神经影像学数据和临床特征。通过进行生存分析和单变量/多变量 Cox 回归分析，研究了长期运动结局的术前预测因素。长期刺激后运动获益的丧失定义为与基线停药评分相比，运动障碍协会赞助的帕金森病修订统一评分量表（MDS-UPDRS）第三部分评分的降低小于 25%。作为次要目标，通过进行单变量和多变量线性回归分析，评估了 STN-DBS 后短期运动结局的潜在预测因素。

结果

在长期分析中（平均随访时间=8.4±6.26 年，中位数=10 年，范围=1-17 年），共纳入 138 例患者。术前较高的额评分和停药时 MDS-UPDRS 第三部分评分预测刺激后长期运动反应更好，而神经影像学上存在血管改变则预测运动结局较差。在 357 例有 1 年随访的患者中，术前左旋多巴反应、震颤主导表型、基线额评分和停药时 MDS-UPDRS 第三部分评分预测了短期运动结局。