Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
J Neurol Neurosurg Psychiatry. 2021 Dec;92(12):1313-1318. doi: 10.1136/jnnp-2021-326131. Epub 2021 Sep 11.
The effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson's disease (PD) are understudied.
To investigate clinical predictors of STN-DBS effects on ICB.
In this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into 'QUIP-RS improvement or worsening' and analysed between-group differences.
We included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the 'QUIP-RS worsening' group had more severe baseline impairment in the NMSS attention/memory domain.
Our results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS.
DRKS00006735.
丘脑底核刺激（深部脑刺激，STN-DBS）对帕金森病（PD）冲动和强迫行为（ICB）的影响研究较少。
探讨 STN-DBS 对 ICB 影响的临床预测因素。
在这项前瞻性、开放标签、多中心研究中，我们对 55 名接受双侧 STN-DBS 的 PD 患者进行了评估，患者在术前和术后 6 个月进行了评估。临床量表包括 PD 冲动-强迫障碍评定量表（QUIP-RS）、PD 问卷-8、非运动症状量表（NMSS）、统一 PD 评定量表，以及左旋多巴等效日剂量总量（LEDD-total）和多巴胺激动剂（LEDD-DA）。使用 Wilcoxon 符号秩检验和多重比较校正（Bonferroni 法）分析随访时的变化。我们使用相关性和线性回归来探索 QUIP-RS 变化的预测因素。最后，我们将患者分为“QUIP-RS 改善或恶化”组，并分析组间差异。
我们纳入了 55 名年龄 61.7 岁±8.4 岁、PD 病程 9.8 岁±4.6 岁的患者。QUIP-RS 截止值和精神科评估确定了术前有 ICB 的患者。在有 ICB 的患者中，QUIP-RS 显著改善。然而，我们观察到 QUIP-RS 结果的临床相关变化存在相当大的个体间差异，27.3%的患者恶化，29.1%的患者改善。在事后分析中，较高的基线 QUIP-RS 和较低的基线 LEDD-DA 与 QUIP-RS 的改善程度更大相关。此外，“QUIP-RS 恶化”组在 NMSS 注意力/记忆域的基线损伤更为严重。
我们的结果表明，术前 ICB 严重程度较高和术前 DA 剂量较低的患者 ICB 结局较好，而基线注意力/记忆缺陷更严重的患者结局较差。这些发现强调了在接受 STN-DBS 治疗的患者中进行全面的非运动和运动症状评估的必要性。
DRKS00006735。
